Deepak Kumar Satsangi

Unexplained desaturation following a Glenn shunt

74 Annals of Cardiac Anaesthesia  Vol. 17:1  Jan-Mar-2014 The mass was abutting the trachea and the right main bronchus causing their displacement and some degree of compression but as evident in coronal view of contrast enhanced computed tomography chest shown in the article, air luminogram was maintained. Considering insignificant external compression and absence of any airway compressive symptoms in both supine position and during sleep, normal routine anesthesia management including induction was carried out in this patient. It is agreed that in the present case with a history of mass for more than 1 year, anesthesia induction, propofol infusion, long duration of surgery (5 hours) in prone position may all have contributed to the airway compromise that followed the tracheal extubation after the surgery. In retrospect, it is clear that presence of airway compression/displacement on imaging and/or the symptoms of airway compromise in presence of posterior mediastinal mass should not be taken lightly. In such cases interdisciplinary team discussion (anesthesiology, surgery, radiology, pathology and otolaryngology), clinical assessment, careful planning and vigilance is required. A lack of symptoms in the pre‐operative evaluation in such patients, does not guarantee an uneventful anesthetic course and all the necessary arrangements including rigid bronchoscope and cardiopulmonary bypass should be made depending upon the severity and involvement to prevent airway catastrophe.

Anomalous Origin of Left Common Carotid Artery from the Ascending Aorta in a Case of Tetralogy of Fallot

An 11-year-old male undergoing evaluation for a definitive repair of a tetrology of Fallot was found on a preoperative CT angiogram to have an anomalous origin of the left common carotid artery from the ascending aorta (Fig. 1). There was only mild indentation of the posterior aspect of the trachea (Fig. 2). He had an uncomplicated repair and since there was no evidence of tracheal compression, no other vascular intervention was required (Fig. 3).

Pulmonary reperfusion injury : A comparison of bubble and membrane oxygenators

Twenty cases of single valve replacement or atrial septal defect repair who underwent elective corrective surgery using either membrane (Capiox E) oxygenator (n=10) or bubble (Bentley 10™) oxygenator (n=10) were studied for the activation of cellular and humoral elements in blood. The bubble oxygenator was found to have more damaging effect of platelet sequestration and pulmonary sequestration of leucocytes. The C3c and’ c4 levels were found to be equally decreased in both groups. Both groups however showed no significant pneumocyte changes and there was no adverse effect on the postoperative clinical outcome in both groups.

Emergency aorto-coronary bypass grafting following complications of coronary angioplasty

Acute myocardial ischaemia during percutaneous transluminal coronary angioplasty (PTCA) and allied procedures often necessitates emergency coronary artery bypass grafting (CABG). Between July 1987 and December 1993, a total of 1221 patients underwent PTCA for occlusive coronary artery disease. Twentytwo (1.8%) of them required emergency CABG for various complications. The most common complications leading to emergency CABG were intimal dissection and acute occlusion. Sixteen (72.7%) of these 22 patients were haemodynamlcally unstable when received in the operation suite. Seven of them were on percutaneousfemorofemoral cadiopulmonary bypass support, three on external cardiac massage and six supported with inotropes. The remaining six patients were haemodynamically stable. There were eight (36.3%) deaths, all in the haemodynamically unstable subset of patients.This study suggests that for better outcome from emergency CABG following complications of angioplasty, patient needs to be referred for surgery early while haemodynamics are still stable. Persistence with nonsurgical caiheter manoeuvres to treat ischaemia following an angioplasty complication results in inordinate delay leading to haemodynamic instability, the latter predicting a poor prognosis following emergency CABG.