Madhu Andrew Philip

Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome

Objectives of the Study: To identify the factors causing high lactate levels in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) and to assess the association between high blood lactate levels and postoperative morbidity and mortality. Methods: A retrospective observational study including 370 patients who underwent cardiac surgeries under cardiopulmonary bypass. The patients were divided into 2 groups based on serum lactate levels; those with serum lactate levels greater than or equal to 4 mmol/L considered as hyperlactatemia and those with serum lactate levels less than 4 mmol/L. Blood lactate samples were collected intraoperatively and postoperatively in the ICU. Preoperative and intraoperative risk factors for hyperlactatemia were identified using the highest intraoperative value of lactate. The postoperative morbidity and mortality associated with hyperlactatemia was studied using the overall (intraoperative and postoperative values) peak lactate levels. Preoperative clinical data, perioperative events and postoperative morbidity and mortality were recorded. Results: Intraoperative peak blood lactate levels of 4.0 mmol/L or more were present in 158 patients (42.7%). Females had higher peak intra operative lactate levels (P = 0.011). There was significant correlation between CPB time (Pearson correlation coefficient r = 0.024; P = 0.003) and aortic cross clamp time (r = 0.02, P = 0.007) with peak intraoperative blood lactate levels. Patients with hyperlactatemia had significantly higher rate of postoperative morbidity like atrial fibrillation (19.9% vs. 5.3%; P = 0.004), prolonged requirement of inotropes (34% vs. 11.8%; P = 0.001), longer stay in the ICU (P = 0.013) and hospital (P = 0.001). Conclusions: Hyperlactatemia had significant association with post-operative morbidity. Detection of hyperlactatemia in the perioperative period should be considered as an indicator of inadequate tissue oxygen delivery and must be aggressively corrected.

Isolated lower lip edema: A rare complication of prone positioning

How to cite this article: Goswami D, Borle A. Preplacement check of complete central venous pressure catheter assembly: Should it be made routine? J Anaesthesiol Clin Pharmacol 2017;33:273-4. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. Conflict of interest There are no conflicts of interest.

A rare aneurysm of the sinus of Valsalva—from the left sinus

Sinus of Valsalva aneurysm (SVA) is a rare anomaly which may be congenital or acquired. We present a rare case of an unruptured calcified SVA arising from the left coronary sinus and extending into the left ventricle. Transesophageal echocardiogram revealed moderate aortic regurgitation. The aneurysm was repaired using a synthetic fabric patch preserving the native valve. Only one case of unruptured left SVA prolapsing into the left ventricle has been reported so far in the English literature. Such lesions are rare since the high pressure of the left ventricle prevents the prolapsing of the aneurysm into it.

Entrapped left atrial pressure monitoring catheter in a prosthetic mitral valve.

it was flushed with saline, the transducer was re‐zeroed, and connections of the monitoring cables were checked. However, the LAP remained persistently high. We then re‐evaluated by TEE and noted there was severe prosthetic mitral regurgitation with the LA catheter passing through the prosthetic valve preventing its closure. The surgeon was informed, the LA catheter was withdrawn from its initial insertion, and readjusted. Instantly, the valve movement and LAP normalized, and the mitral regurgitation disappeared.