Usha Kiran

Role of magnesium in the prevention of postoperative arrhythmias in neonates and infants undergoing arterial switch operation

The objectives of the study were to measure magnesium levels in neonates and infants undergoing arterial switch operation and to ascertain the role of magnesium supplementation in the prevention of postoperative arrhythmias. Group I (n=25): magnesium was administered in the dose of 30xa0mg/kg over 10xa0minutes in normal saline (5xa0ml) immediately after cessation of cardiopulmonary bypass (CPB). Group II (n=25): normal saline (5xa0ml) was administered over 10xa0minutes immediately after cessation of CPB. Samples of arterial blood were collected at four time points: 1) after induction of anaesthesia; 2) 10xa0minutes after initiation of CPB; 3) at rewarming during CPB; and 4) 4xa0hours after shifting the patient to the intensive care unit. Samples were measured for ionized magnesium (iMg), blood gases, haematocrit level, electrolytes, ionized calcium and glucose. Continuous ECG rhythm analysis and documentation of arrhythmias was performed for 24xa0hours after surgery. The mean preoperative iMg levels were below the normal level in both the groups. A significant increase in iMg levels (P=0.00) was seen in both groups during rewarming. There is no statistically significant difference in the incidence of arrhythmias between the magnesium supplemented group (4%) and the control group (20%) in the postoperative period, a tendency towards reduction in arrhythmias was only observed in the magnesium supplemented group.

Simulation in cardiac catheterization laboratory: Need of the hour to improve the clinical skills

Simulation is an effective teaching tool to decrease the learning curve for novices without compromising patient safety. Simulation helps interventionalist in mentally translating a two dimentional, black and white image into a usable three dimentional model. It also bridges the gap in training diverse team members on new procedures and products. All simulators have collision detection, i.e., virtual contact forces generated from collision which updates haptic output with new calculations.

Comparison of three dose regimens of aprotinin in infants undergoing the arterial switch operation

To determine the most effective dose regimen of aprotinin for infants undergoing arterial switch operation for transposition of the great arteries in reducing blood loss and postoperative packed red blood cell (PRBC) requirements. A total of 24 infants scheduled for arterial switch operation for transposition of the great arteries were included in the study. The infants were randomly assigned to one of the three groups. Group I (n = 8) patients received aprotinin in a dose of 20,000 kallikrein inhibiting units (KIU)/kg after induction of anesthesia, 20,000 KIU/kg was added to the pump prime, and 20,000 KIU/kg/hour infusion for three hours after weaning from bypass; group II (n = 8) patients received aprotinin 30,000 KIU/kg after induction of anesthesia, 30,000 KIU/kg was added to the pump prime and 30,000 KIU/Kg/hour infusion for three hours after weaning from bypass; group III patients (n = 8) received aprotinin 40,000 KIU/kg after induction of anesthesia, 40,000 KIU/kg was added to the pump prime and 40,000 KIU/kg/hour infusion for three hours after weaning from bypass. Postoperatively, the cumulative hourly blood loss and PRBC requirements were noted up to 24 hours from the time of admission in the intensive care unit (ICU). Use of blood and blood products were noted. Coagulation parameters such as hematocrit, activated clotting time (ACT), fibrinogen, prothrombin time (PT), international normalized ratio (INR), platelet count, and fibrin degradation products (FDP) were investigated before cardiopulmonary bypass (CPB), after protamine administration, and at four hours postoperatively in the ICU. The number of infants reexplored for increased mediastinal drainage was recorded. Renal functions were monitored by measuring urine output (hourly) and serum urea (mg%) and serum creatinine (mg%) at 24 hours. The sternal closure time was comparable in all the three groups. Cumulative blood loss (ml/kg/24 hours) was greatest in group I (17.30 +/- 7.7), least in group III (8.14 +/- 3.17), whereas in group II, it was 16.45 +/- 6.33 (P = 0.019 group I versus group III; (P = 0.036 group II versus group III). Postoperative PRBC requirements were significantly less in high dose group III (P = 0.008, group I versus III; p = 0.116, group II versus group III) . Tests for coagulation performed at four hours postoperatively, viz. ACT, PT, INR, FDP, and platelets were comparable in the three groups. Urine output on CPB was comparable in all the groups. Serum urea and creatinine showed no significant difference between the three groups twenty four hours postoperatively. Aprotinin dosage regimen of 40,000 KIU/kg at induction, in CPB prime and postoperatively for three hours was most effective in reducing postoperative blood loss and PRBC transfusion requirements. Aprotinin does not have any adverse effect on renal function.

Anesthetic management of patent ductus arteriosus--not always an easy option.

Annals of Cardiac Anaesthesia uf06c Vol. 13:3 uf06c Sep-Dec-2010 and organizationally complex environment of the operation theatre. Retained foreign bodies were most likely to occur during an emergency operation, after an unexpected change in the operative procedure and in obese patients. Routine exploration of the abdomen or any cavity that has been opened before closure, use of only sponges with radioopaque markers, two counts after fascial closure and by the new personnel on permanent relief of either the scrub person or the circulating nurse and routine intraoperative X-rays are also a useful adjunct to the swab counts.

Anger: An enemy of heart, raj yoga meditation is heart friendly

© 2017 Annals of Cardiac Anaesthesia | Published by Wolters Kluwer Medknow Angry outburst has been long related with increased the incidence of heart attack.[1] Anger, a negative emotion is a burst of energy, which is considered an “Enemy of Heart.” Anger is not only burst of energy but also it is a burst of hormones, which increases the heart rate and blood pressure, ultimately increasing the load on heart and oxygen demand. On the other hand, Yoga meditation is heart friendly.

Diagnostic dilemma: Low oxygen saturation during cardiac surgery

We report a case of rheumatic heart disease with severe mitral stenosis having cyanosis and low oxygen saturation on pulse oximetry. The findings of clinical examination and low values on pulse oximetry were inconsistent with the findings of normal partial pressure of oxygen and oxygen saturation on arterial blood gas analysis, leading to diagnostic dilemma. In such clinical scenario, the anesthesiologist should be aware and vigilant about the differential diagnosis of low oxygen saturation on pulse oximetry.

The blalock and taussig shunt revisited

The systemic to pulmonary artery shunts are done as palliative procedures for cyanotic congenital heart diseases ranging from simple tetralogy of Fallots (TOFs)/pulmonary atresia (PA) to complex univentricular hearts. They allow growth of pulmonary arteries and maintain regulated blood flow to the lungs till a proper age and body weight suitable for definitive corrective repair is reached. We have reviewed the BT shunt with its anaesthtic considerations and management of associated complications.

Global end-diastolic volume an emerging preload marker vis-a-vis other markers - Have we reached our goal?

A reliable estimation of cardiac preload is helpful in the management of severe circulatory dysfunction. The estimation of cardiac preload has evolved from nuclear angiography, pulmonary artery catheterization to echocardiography, and transpulmonary thermodilution (TPTD). Global end-diastolic volume (GEDV) is the combined end-diastolic volumes of all the four cardiac chambers. GEDV has been demonstrated to be a reliable preload marker in comparison with traditionally used pulmonary artery catheter-derived pressure preload parameters. Recently, a new TPTD system called EV1000™ has been developed and introduced into the expanding field of advanced hemodynamic monitoring. GEDV has emerged as a better preload marker than its previous conventional counterparts. The advantage of it being measured by minimum invasive methods such as PiCCO™ and newly developed EV1000™ system makes it a promising bedside advanced hemodynamic parameter.

Is it really ruptured sinus of valsalva? The crucial role of comprehensive transesophageal echocardiography in clinical decision-making

ventricular (LV) hypertrophy. The chest X‑ray except for cardiomegaly with LV apex was inconclusive. Upon TTE, patient was diagnosed with RSOVA draining into the left ventricle. Cardiac catheterization and angiography further showed‑normal coronaries, right coronary cusp (RCC) aneurysm with rupture into left ventricle causing severe regurgitation [Figure 1], normal left ventricle function, absence of any ventricular septal defect (VSD), no gradient across left ventricle and aorta and Qp/Qs = 1. Patient was scheduled for RSOVA repair with aortic valve repair/replacement.Following anesthetic induction, intraoperative multiplane, color Doppler, two‑dimensional and three‑dimensional (3D) ‑ TEE examination was performed (iE33