Anand Sachithanandan

Simple method for monitoring hand perfusion following radial artery harvest for coronary artery bypass grafting

The ever increasing use of the radial artery (RA) as a coronary bypass conduit raises concerns regarding potential local complications following RA harvest in particular hand ischaemia. Transcutaneous pulse oximetry provides a simple non-invasive objective assessment of collateral ulnar blood flow thus providing adequate continuous monitoring of hand perfusion in the early post-operative phase following RA procurement.

Successful anticoagulation with fresh frozen plasma for cardiopulmonary bypass in a patient with heparin resistance: a cautionary tale

Heparin resistance (HR) is an increasingly common occurrence due to a greater awareness of the benefits of antithrombosis prophylaxis in hospitalised patients with low molecular weight and unfractionated heparin. Furthermore as more high-risk patients with prior heparin exposure undergo cardiac surgery we can expect to encounter more such cases. Adequate anticoagulation is essential for the safe conduct of any operation requiring cardiopulmonary bypass and is usually achieved with systemic heparinisation. We report a case of successful anticoagulation with the intraoperative administration of fresh frozen plasma in a high-risk coronary patient with HR and highlight the perils of unwitting overheparinisation in such cases. This case highlights the importance of clinical awareness of this phenomenon and the available alternative anticoagulants.

eComment. Computed tomography surveillance of lung cancer survivors: The jury is still out

Srikantharajah et al.s review of five single centre studies concludes that the existing evidence for a survival benefit from routine computed tomography (CT) surveillance of non-small cell lung (NSCLC) cancer survivors following an anatomical resection is equivocal and conflicting. Hence they plead for a randomized control trial [1]. In fact this patient subgroup have been largely excluded from prospective analysis by most trial designs.

An absent carotid pulse may indicate critical aortic stenosis

In severe valvular aortic stenosis, obstruction to ventricular contraction results in prolonged ventricular systole and diminished peak flow velocity. This may translate into weak or impalpable peripheral arterial pulses. We report a case of severe aortic stenosis associated with an impalpable carotid pulse (in the absence of local carotid artery disease) that became easily detectable following aortic valve replacement. In the presence of an aortic stenosis murmur, a weak or impalpable carotid pulse is indicative of critical aortic stenosis and warrants urgent investigation.