Annals of Cardiac Anaesthesia

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A Comprehensive Clinical Acumen Enhanced by Point-of-Care Ultrasonography in Managing Acute Life-Threatening Massive Pulmonary Thromboembolism in a Peripheral Setting: A Case Report
(Wolters Kluwer – Medknow, 2025-03) Chhaperwal, Prabhav; Kumar, Sudhir; Suri, Gurbinder; Garg, Uma; Kapoor, Suraj; Devarakonda, Bhargava
Acute massive pulmonary thromboembolism (PTE) is a potentially life?threatening condition requiring urgent management to decrease mortality. However, in the peripheral setting, managing the emergency can be challenging. We report a case of massive PTE presenting with cardiopulmonary arrest, successfully managed with advanced cardiac life support, early initiation of anticoagulants (heparin), and thrombolytics. This case report explores the successful management of a critically ill patient presenting with massive pulmonary embolism in a peripheral healthcare facility, emphasizing the importance of a well?coordinated approach in such challenging environments. The approach in the case included recognizing the challenge with timely provisional diagnosis, initial stabilization, hemodynamic support, early consideration for anticoagulants, and thrombolysis after supporting provisional diagnosis with point?of?care ultrasonography (POCUS), team effort, and administrative support in Cas Evac to the tertiary care center. Timely administration of heparin and thrombolytics may serve as potential life?saving measures in peripheral settings, along with the availability of an ultrasound machine. Managing acute life?threatening massive PTE in peripheral settings requires a strategic and resourceful approach. Timely administration of heparin and thrombolytics may serve as potential life?saving measures. However, the administration of thrombolytics in PTE needs the support of POCUS to make quick decisions in peripheral settings. Collaboration between peripheral and advanced tertiary care healthcare facilities is crucial to ensure optimal outcomes for patients experiencing this critical condition.
Accuracy of Intraoperative Transesophageal Echocardiographic Doppler Parameters in Assessing the Right Ventricular Diastolic Function After Repair of Tetralogy of Fallot in Pediatric Patients
(Wolters Kluwer – Medknow, 2025-03) Panidapu, Nagarjuna; Babu, Saravana; Dharan, Baiju S.; Sen, Barsha; Koshy, Thomas
Background: This study aimed to assess the accuracy of tricuspid spectral Doppler (E/A) and tissue Doppler parameters (E/E’) to diagnose right ventricular diastolic dysfunction (RVDD) in comparison to American Society of Echocardiography (ASE criteria) in pediatric tetralogy of Fallot (TOF) patients after surgical repair. Methods: This prospective, observational study was done at a tertiary care hospital involving 40 pediatric TOF patients aged less than 2 years who underwent complete intracardiac repair with cardiopulmonary bypass (CPB). Echocardiographic observations were made using a pediatric transesophageal echocardiography probe after surgical repair in the post?CPB period. The ASE?described parameters (late diastolic forward flow in the main pulmonary artery, right atrial dilatation, inferior vena cava dilatation, and hepatic venous flow reversal) were acquired to diagnose the RVDD. The tricuspid Doppler parameters (E/A and E/E’) were measured, and its predictive ability to diagnose RVDD was analyzed and compared with the ASE criteria. Results: Based on the ASE criteria, 13 patients (32.5%) were diagnosed to have RVDD. We found that an E/E’ ratio of ? 6.26 and an E/A ratio of >1.34 can be taken as the cutoff for diagnosing the RVDD. Based on the tricuspid Doppler parameters (E/A > 1.34 and E/E’ >6.26), 17 patients (42.5%) were diagnosed to have RVDD, which was comparable to that of the diagnosis by ASE criteria ( P > 0.05). Conclusion: The results suggested that the use of tricuspid Doppler parameters can be equally accurate and reproducible to the current ASE?described echocardiographic parameters for diagnosing RVDD after surgical repair of TOF.
Assessment of Right Ventricle Function in Patients with Mitral Repair: Case Series
(Wolters Kluwer – Medknow, 2025-03) Amador, Yannis; Garijo, Jacobo Moreno; Mashari, Azad; Gadotti, Giovanni; Hopman, Wilma M.; David, Tirone E; Meineri, Massimiliano
Objectives: We aim to assess right ventricular function in patients undergoing mitral valve repair using trans-esophageal echocardiography, focusing on the predictive value of right ventricular longitudinal strain compared to other echocardiographic measures. Design: Retrospective analysis. Setting: Toronto General Hospital. Participants: Thirty elective patients undergoing mitral valve repair. Interventions: Quantitative assessment of right ventricular function using transesophageal echocardiography images pre- and post-mitral valve repair, including right ventricular longitudinal strain, fractional area change, tricuspid annular plane systolic excursion, and systolic peak velocity (S'). Measurements and Main Results: 3 patterns of RV strain were identified with right ventricular longitudinal strain emerging as the most significant discriminator among right ventricular functional subgroups, with 43% of cases showing worsening, 20% showing no change, and 37% showing improvement. No correlation was found between right ventricular performance parameters and the need for vasopressors post-cardiopulmonary bypass. There was also no association between initial right ventricular longitudinal strain and difficulty in weaning off bypass or increased demand for pressors. Changes in tricuspid annular plane systolic excursion across all cases warrant further investigation with a larger cohort. Conclusions: Right ventricular longitudinal strain is a valuable tool for assessing right ventricular function post-mitral valve repair, offering insights into immediate postoperative outcomes and long-term right ventricular remodeling. Despite limitations like single-surgeon experience and institution-specific choice of pressors, our study provides useful insights into right ventricular function post-mitral repair surgery, paving the way for future research in larger patient populations.
Clinical Benefits of Parasternal Block with Multihole Catheters when Inserted before Sternotomy
(Wolters Kluwer – Medknow, 2025-03) Eljezi, Vedat; Jallas, Crispin; Pereira, Bruno; Chasteloux, Melanie; Dualé, Christian; Camilleri, Lionel
Background: The aim of this study was to assess whether parasternal block with multihole catheters inserted before surgical incision enables to alleviate postoperative analgesia and opioid reduction in cardiac surgery patients with sternotomy. Methods: Twenty?six adult patients scheduled for cardiac surgery with sternotomy aged between 18 and 84 olds were included in this prospective, monocentric, open, single?group trial. Two parasternal multihole catheters were inserted on each side of the sternum before the surgical skin incision for cardiac surgery and 10 mL of ropivacaine 7.5 mg mL–1 was initially administered in each catheter. Local anesthetic administration followed by continued infusion at 3 mL hr–1 of ropivacaine 2 mg mL–1 per catheter for 48 h postoperatively upon patient arrival in the intensive care unit. The efficacy of the parasternal block was assessed according to a composite endpoint including pain score at rest, pain score during movements (dynamic pain), and morphine consumption over 48 hours. Results: The treatment failed in 11 patients and was considered effective in 15 patients. Sixteen patients out of 26 had a sternal pain score ??3/10 on more than 75% of observations, and the treatment was considered successful. In 23/26 patients (88%), the mean pain score at cough was ??3.5/10 and the treatment was considered successful. Morphine consumption over 48 h was significantly lower in the intervention group compared to the control group 7 mg [6; 21] versus 142 mg [116; 176] ( P < 0.001). Conclusions: Parasternal block with multihole catheters inserted before the surgical incision is an effective technique for postoperative analgesia and opioid reduction.
Comparative Evaluation of Regain of Consciousness in Dexmedetomidine–Propofol versus Ketamine–Propofol in the Pediatric Cardiac Catheterization Procedure under Sedation using BIS Monitoring: A Randomized Prospective Study
(Wolters Kluwer – Medknow, 2025-03) Banga, Priya; Negi, Sunder L.; Mandal, Banashree; Barwad, Parag; Saini, Kulbhushan; Gourav, Krishna P.
Background: Congenital heart diseases (CHDs) are not rare and often require an intervention at some point of time. Pediatric cardiac catheterization, a minimally invasive procedure, is performed to diagnose and to correct many cardiac abnormalities. Deep sedation with spontaneously breathing patients is the preferred technique for pediatric catheterization in the pediatric population. Therefore, the author aimed to find the best combination of drugs for pediatric cardiac catheterization procedures using dexmedetomidine–propofol (DP) and ketamine–propofol (KP). Materials and Methods: Cyanotic and acyanotic CHD children, weighing 5–20 kg and undergoing sedation for cardiac catheterization, were randomly assigned into two groups. DP group children received a bolus intravenous (IV) propofol at 1 mg/kg body weight followed by 1 mcg/kg dexmedetomidine over 10 minutes. KP group children received a bolus IV propofol 1 mg/kg followed by ketamine 1 mg/kg over 10 minutes. For maintenance in the DP group, propofol infusion at 1.5 to 2 mg/kg/h and dexmedetomidine at 0.5 mcg/kg/h was started. In the KP group, propofol infusion at 1.5 to 2 mg/kg/h and ketamine at 1 mg/kg/h was started as maintenance. The bispectral index (BIS) was monitored throughout the procedure, and the BIS value was maintained between 60 and 80. Propofol top of 1 mg/kg was administered when the BIS value became more than 80 or when the child moved during the femoral vessel puncture or when the child moved during the procedure. Results: The mean time for regain of consciousness was faster ( P < 0.005) in the KP group (11.02 ± 11.98) compared to the DP group (21.62 ± 18.68). BIS was monitored throughout the procedure; BIS values were lower ( P < 0.001) in the DP group (60.0 ± 11.1) as compared to the KP group (73.7 ± 5.6). The cumulative doses of propofol in the KP group and DP group were comparable. Total fentanyl consumptions in the intraoperative period in the KP group and DP group were comparable ( P > 0.001). There was no difference in drug side effects between the groups. Conclusion: The KP combination had fast and early recovery compared to the DP combination in children who underwent the cardiac catheterization procedure under sedation in children undergoing cardiac catheterization procedures requiring sedation.
Role of Intraoperative Left Ventricular Global Longitudinal Strain in Hemodynamic and Cognitive Outcomes in On-Pump Coronary Artery Bypass Surgery: A Prospective Observational Study
(Wolters Kluwer – Medknow, 2025-03) Lineburger, Eric B.; Arya, Rajesh C.; Junior, Celso G.; Lima, Fernanda S.; Búrigo, Eduardo M.; Fermo, Gabriel Simoni R.
Background: The role of left ventricular global longitudinal strain (LVGLS) in coronary artery bypass grafting (CABG) and outcomes such as low cardiac output syndrome (LCOS) is not well established. The authors investigated the relationship between LVGLS before and after induction of anesthesia, their differences, and their relationship with LCOS and other outcomes. Methodology: A prospective observational study was conducted in a public/private hospital with 50 adult patients scheduled for on?pump CABG with normal left ventricular ejection fraction (LVEF). Acoustic windows necessary to obtain the 2D?LVGLS were acquired with transthoracic echocardiography (TTE) before induction of anesthesia (LVGLSBI) and after with mechanical ventilation (LVGLSAI) using transesophageal echocardiography (TEE). LCOS was defined as the use of epinephrine, dobutamine, and/or milrinone at minimum IV doses of 1 ?g/min?1, 2.5 ?g/kg?1/min?1, and 0.375 ?g/kg?1/min?1, respectively, for a minimum of 24 h after cardiopulmonary bypass. Results: A dedicated workstation (EchoPAC Software v203, GE) was used for offline calculation of LVGLS. LVGLSBI did not have a significant correlation with LCOS (mean difference, 1.66; 95% CI, ?–3.63 to 3.05; P = 0.862), nevertheless, it was an independent risk factor of in?hospital mortality (OR, 0.74; 95% CI, 0.57–0.95; P = 0.02), 3?month mortality (OR, 0.80; 95% CI, 0.64–0.99; P = 0.05), and delirium (OR, 0.65; 95% CI, 0.43–0.97; P = 0.03) in the multivariate analysis. LVGLSAI was also an independent risk factor for 3?month mortality (OR, 0.78; 95% CI, 0.62–0.99; P = 0.04). Conclusions: In CABG surgeries, LVGLS was a predictor of adverse outcomes in both awake and anesthetized patients with normal LVEF.
Effectiveness of Three-dimensional Cardiac Computed Tomography Scan in Congenital Heart Surgery–An Impact on Diagnostic Performance and Surgical Management
(Wolters Kluwer – Medknow, 2025-03) Kumar, Alok; Ganguly, Monalisha; Dhanalakshmi, B; Chakrabarti, Ritwik; Mishra, Arvind; Tiwari, Nikhil
Background: Recent advances in gated cardiac contrast?enhanced computed tomography (CECT) with anesthesia support, enhance the imaging performance in congenital heart disease (CHD). 3D reconstruction of the CECT image is a novel modality that could help manage pediatric cardiac patients. Methods: A retrospective study of children diagnosed with CHD presenting for surgical intervention ( n = 139) was carried out at our cardiac surgical center. Primary diagnosis was established by transthoracic echocardiography. Analysis of all data and reports including echocardiography, cardiac CECT, operative notes, and medical documents were performed to determine the impact of cardiac 3D CECT concerning the following: supporting the primary diagnosis, providing relevant diagnostic information, prompting management changes, cardiac catheterization or interventions. Results: Forty?eight children underwent cardiac CECT scans and 3D reconstruction of the images over one year. The indications of 3D CECT included suspicion of extracardiac shunt, delineation of vascular anatomy, and intracardiac structure extent identification. With cardiac 3D CECT, every patient’s primary diagnostic question was answered with ease. Moreover, the accuracy of the diagnosis gave increased confidence among surgeons in the procedures they performed. 3D Cardiac CECT brought a change in the surgical management in 35.4% of scans, there was percutaneous intervention in 12.55% and surgery was abandoned and changed to medical management in 48%. Conclusions: For children reported with complex CHD, it was evident that cardiac 3D CECT in selected patients was accurate, supported the primary diagnostic questions in almost all cases, and aided in optimization that further had an impact on surgical intervention and management.
Anesthesia for Pentalogy of Cantrell with Surgical Repair of Tetralogy of Fallot Along with Absent Diaphragm: A Case Study
(Wolters Kluwer – Medknow, 2025-06) Maheshwari, Vaibhav; Sahoo, Manoranjan
Pentalogy of Cantrell compiles the union of five anomalies including defects of the midline abdominal wall, lower sternum, anterior diaphragm, diaphragmatic pericardium, and any form of intra?cardiac pathology 1. The intra?cardiac defects associated commonly are ventricular septal defects, followed by atrial septal defects, Tetralogy of Fallot, and pulmonary stenosis 2. It is also a rare syndrome with an estimated incidence of 1:65,000 to 200,000 live births.3 4 Here in we present a case of a 4?year?old male patient, diagnosed with Pentalogy of Cantrel was referred to our institute with chief complaints of breathlessness associated with cyanosis on exertion. He has ectopia cordis along with omphalocele since birth.
Intraoperative Management of Hypoxemia with Anticoagulant-Free Venovenous Extracorporeal Membrane Oxygenation Amid Diagnostic Uncertainty
(Wolters Kluwer – Medknow, 2025-06) Tretter, Eric M.
Clinically relevant fat embolism syndrome (FES) is a potentially fatal intraoperative event, particularly in trauma patients. Rapid diagnosis is challenging in the perioperative setting, but treatment requires swift intervention and multidisciplinary coordination. This case report presents a polytrauma patient undergoing pelvic ring fixation who developed refractory hypoxia secondary to suspected FES. Successful initiation of anticoagulant?free venovenous extracorporeal membrane oxygenation (ECMO) intraoperatively, without definitive diagnosis, resulted in patient survival. Given the paucity of large?scale studies detailing the efficacious use of ECMO for FES in the perioperative setting, this report serves to expand the growing understanding of treatment for this potentially catastrophic event.
Anaesthetist Preparedness for Transhepatic Approach to Ostium Secundum Atrial Septal Defect Device Closure: A Case Report
(Wolters Kluwer – Medknow, 2025-06) Sarkar, Subhadeep; Jana, Sayandeep
Routes for transcatheter closure of ostium secundum atrial septal defect (OS ASD) by device implantation include hepatic vein & jugular vein besides standard transfemoral approach. We report the case of a female child with OS ASD, who presented with an anomalous systemic venous drainage. Only the hepatic vein was draining directly to RA hence the only option left was transhepatic. Multidisciplinary consensus was taken and the procedure proceeded under general anaesthesia. To avoid cathlab misadventures, tracing systemic venous drainage besides pulmonary venous drainage in a case of OS ASD is important. The anaesthetist should be aware of the transhepatic approach and possible complications which may arise. Preparedness for the complications and invasive monitoring ensures success for this challenging procedure.
The ProtekDuo Cannula for Venopulmonary ECMO as Bridge to Lung Transplantation: A Single Center Case Series
(Wolters Kluwer – Medknow, 2025-06) Stukov, Yuriy; Rackauskas, Mindaugas; Maybauer, Marc O.
Venovenous extracorporeal membrane oxygenation is the most commonly used mode of support in pre?lung transplant recipients. In patients who experience right ventricular dysfunction, venopulmonary ECMO is an excellent option to preserve RV function. We retrospectively reviewed patients who were supported with venopulmonary ECMO. Descriptive analysis, patient characteristics, ECMO outcomes, and survival were assessed. The primary outcome was mortality. Mean age was 45.5 ± 15.63, mean ECMO hours 1391.75 ± 1239.01. 4 patients had right ventricular dysfunction. All patients received bilateral orthotopic lung transplant. One?year survival was 100% for all patients. Venopulmonary extracorporeal membrane oxygenation can be safely used to bridge patients with end?stage lung disease to lung transplantation.
Communication Between Vascular Catheter Lumens: Safety Implications
(Wolters Kluwer – Medknow, 2025-06) Pruthi, Gegal; Dey, Ankita; Dhindsa, Dilraj
In this case, we report a rare manufacturing defect in a multi?lumen central venous catheter, where communication between lumens was discovered during a pre?use flush check. This defect raises significant safety concerns, including potential medication interference and inaccurate CVP readings. Vigilant pre?use testing and heightened awareness of such anomalies are crucial to preventing life?threatening complications.
Intraoperative Transesophageal Echocardiography Quantification of Mitral Regurgitation by Regurgitation Volume and Fraction Using 2D and 3D Techniques
(Wolters Kluwer – Medknow, 2025-06) Poduval, Devika; Jose, Reshmi L.; Madathil, Thushara; Nagarjuna, P; Kartha, Niveditha; Varma, Praveen; Neema, Praveen Kumar
Background and Aims: Intraoperative quantification of mitral regurgitation (MR) is sometimes necessary to quantify the severity of incidentally detected MR during cardiac surgeries. We aimed to compare and correlate the regurgitant volume (Rvol) and regurgitant fraction (RF) using 2D proximal isovelocity surface area (PISA) and 3D vena contracta area (VCA) with the 3D volumetric method and the integrated multiparametric approach. Methods and Materials: A prospective observational study was conducted on 37 patients undergoing mitral valve surgery for MR. Intraoperative quantification of the severity of MR was done using 2D PISA and 3D VCA methods and was compared with the 3D volumetric method. All three methods were compared with the integrated multiparametric method to obtain cutoff values for identifying severe MR. Results: The correlation coefficients for Rvol with VCA and PISA with the 3D volumetric method were 0.688 and 0.58, respectively. VCA and PISA overestimated the Rvol (VCA = 77.93 ± 27.82 ml, PISA = 76.13 ± 19.25 ml) compared to the 3D volumetric method (66.12 ± 20.30 ml); the RF by the three methods was comparable. Using the receiver operating characteristic–area under curve (AUC) comparing Rvol by these methods with the integrated multiparametric method, the 3D volumetric method performed the best. Conclusion: The Rvol VCA and PISA overestimated MR severity compared to the 3D volumetric method with moderate to good correlation. Rvol 3D was superior with a higher AUC when compared with the integrated multiparametric approach. The RF by the three methods was comparable, albeit with a higher threshold in quantifying severity compared to the conventional criteria.
Comparison of Combined Pectoralis Plane Block and Intercostal Nerve Block with Local Infiltration Analgesia in Patients Undergoing Cardiac Implantable Electronic Device Implantation – A Randomized Controlled Trial
(Wolters Kluwer – Medknow, 2025-06) Senthilkumar, Muhilan; Parida, Satyen; Rudingwa, Priya; Selvaraj, Raja
Background: Cardiac implantable electronic device (CIED) implantation rates have increased exponentially over the past few decades. Limited options are available for pain?free courses during this procedure. Traditionally, local infiltration with conscious sedation is being used. The pectoral nerves (PECS) block has been evaluated for its analgesic efficacy in breast surgeries. Our study assessed the effectiveness of combined PECS 1 block and intercostal nerve block over local infiltration as an analgesic technique during CIED implantations. Method: In this randomized controlled trial, 70 ASA 2 and 3 patients in the age group of 18–75 years scheduled for CIED implantation were randomized into two groups. Group A received local infiltration with 14 ml of 0.375% ropivacaine, and group B received a combined PECS 1 block (10 ml) and intercostal nerve block (4 ml) under ultrasound guidance. Additional lignocaine 1% as 2 ml aliquots was given as rescue during the procedure. We noted the frequency and timing of aliquots. The pain was assessed at 1, 2, 4, 8 and 24 hours post procedure, and intravenous paracetamol was given if the numeric rating scale (NRS) was more than 3. The total paracetamol required and the mean duration of hospital stay were noted for both groups. Results: There was a statistically significant decrease in NRS scores at the initial five steps of the procedure in group B except at skin closure, P value = 0.044. The time for the first demand for analgesia was significantly prolonged in group B with 39.6 ± 15.9 vs 19.6 ± 15.1 minutes in the local infiltration group, respectively, with P value = 0.001. Mean fentanyl requirement during the procedure was significantly lower in B (30.4 ± 10.4 mcg vs 50.7 ± 17.7 mcg) when compared to group A, P value < 0.001, and so was the paracetamol requirement in the postprocedure period, P value = 0.003. The postprocedure pain scores and the duration of hospital stay were comparable for both. Conclusion: Combined PECS 1 and intercostal nerve block in place of traditional local infiltration significantly reduced NRS score and rescue drug requirement during the procedure. It is a suitable option for these patients.
Innovative Use of Pulmonary Artery (PA) Catheter for Lung Isolation in a Pediatric Patient: A Case Report
(Wolters Kluwer – Medknow, 2025-06) Kumara, Vijaya
Lung isolation is essential for optimal surgical exposure and prevents contamination of normal lung. It is challenging in pediatric patients due to the anatomical and physiological differences. The most common methods of achieving lung isolation include the use of double?lumen endotracheal tubes (DLTs) or bronchial blockers (BBs). However, in pediatric patients, the size of the airways often restricts the use of DLTs, and in some cases, specific BBs may not be available or feasible due to the anatomy. Here, we report a case of right lower lobectomy in a two?and?half?year?old child using a pulmonary artery (PA) catheter to isolate the lung.
Microbiological Surveillance of Air Quality in Cardiac Operation Theatres: Comparison of the Conventional Settle Plate Technique vs Use of an Air Sampling Device
(Wolters Kluwer – Medknow, 2025-06) Kumar, Alok; Patil, Prashant; Ankur, Abhinay; Ameta, Nihar; Aggarwal, Monika
Introduction: Surgical site infections (SSIs) after cardiac surgery poses a serious challenge. The foremost reason for contamination in operating rooms (OR) is airborne. Effective surveillance by air sampling or settle techniques is crucial in maintenance of air quality in cardiac OR. Methodology: The air quality of two different cardiac OR (adult and pediatric) with laminar air flow system and HEPA filters in place was studied with an aim to compare the plate and air sampling technique. Sampling was done both passive and actively using a Surface Air System air sampler. Muller Hinton Agar plates incubated at 36 °C were used, and total viable count assessment was calculated using Koch’s sedimentation method. Results: Colony?forming unit (CFU) counts showed significant differences at various time points in both adult and pediatric OR. The settle plate as compared to the air sampling device correlated but showed lesser CFUs across pre, mid, and postsurgical periods ( P < 0.05). The adult cardiac OR had significantly higher bioload than pediatric OR ( P < 0.05). The results suggested that both the technique was good for air quality monitoring in OR. Conclusion: The study compares the two?sampling technique in adult and pediatric cardiac OR, finding higher levels of bioload in adult ORs possibly due to more personnel and longer surgeries. Although settle plates offer basic contamination assessment, air samplers detect specific events efficiently. Using either air sampler or settle plate technique for microbial surveillance in cardiac ORs is suggested for monitoring and prevention of SSI.
Randomized Comparison of Oblique versus Transverse Orientation for Ultrasound-Guided Internal Jugular Venous Cannulation in Pediatric Heart Surgery Patients
(Wolters Kluwer – Medknow, 2025-06) Heriwardito, Aldy; Manggala, Sidharta K.; Christina, Angela
Background: Ultrasound?guided internal jugular venous access improves the rate of successful cannulation of the internal jugular vein in both adult and pediatric patients. Internal jugular venous cannulation in pediatric patients is anatomically and technically more challenging than in adults. The oblique method is a novel approach for guiding central venous cannulation. There is currently a scarcity of research on central venous cannulation techniques for pediatric patients. Aim: The purpose of this study was to compare the success rates between the oblique and transverse approach of jugular venous cannulation in pediatric cardiac surgery patients. Methods: A prospective randomized clinical trial of pediatric patients who underwent cardiac surgery at Cipto Mangunkusumo Hospital was conducted between February and May 2021. Sixty patients were randomized into two groups: 30 in the oblique group and 30 in the transverse group. Results: There was no difference in the first needle pass success rate between the oblique and transversal approaches (86.7% vs. 73.3%;P = 0.19). There is no difference in the total number of attempts between the two groups (1.3 vs 1.43; P > 0.05). Conclusion: There was no difference between oblique and transverse orientations for internal jugular venous cannulation in pediatric cardiac surgery patients in terms of successful cannulation on the first needle pass and total number of attempts.
Pregnancy with a Left Ventricular Assist Device: A Narrative Review
(Wolters Kluwer – Medknow, 2025-03) Abraham, Matthew S.; Andrews, Lijo M.; Deo, Harsha; Paul, John; Angappan, Santhalakshmi; Samuel, Abraham; Abraham, Abey S.
This narrative review discusses the various challenges associated with the presence of a left ventricular assist device (LVAD) during pregnancy. Given the hemodynamic and coagulation changes associated with pregnancy, the presence of an LVAD adds a layer of complexity with respect to optimal management. This review will discuss the anesthetic considerations when dealing with this subset of patients who may have other comorbidities alongside their advanced heart failure. Additionally, this paper aims to review successful pregnancies with an LVAD placement focusing on the mode of delivery and hemodynamic management risk.
Acute Normovolemic Hemodilution Significantly Reduces RBC Transfusion and Lactic Acidosis Following Cardiac Surgery—A Propensity-Matched Study
(Wolters Kluwer – Medknow, 2025-06) Sebt, Vala; Sharifi, Shahnaz; Meysamie, Alipasha; Saberi, Kianoush
Background: Bleeding represents a major complication in heart surgeries. However, even small amounts of allogeneic blood are associated with reduced long?term survival and short?term complications. Acute normovolemic hemodilution (ANH) serves as a viable alternative, but its effectiveness and safety remain controversial. Objective: We aimed to clarify the effects of mild?volume ANH on blood transfusions and short?term complications following heart surgeries. Methods: This was a quasi?experimental study in a referral center on 2271 patients. We performed an extensive propensity?score matching to mitigate the lack of random assignment and potential selection bias. This resulted in 778 patients with no significant differences in 28 variables, including clinical, paraclinical, and operative features. Results: ANH significantly reduced the rate of RBC transfusion by 16% (50.9% vs. 60.9%; RR: 0.84; P = 0.006) and the number of transfused RBCs by 0.24 units (0.96 ± 1.32 vs. 1.20 ± 1.39; P = 0.013) but did not affect the transfusion of FFP or platelets. Furthermore, ANH significantly lowered the incidence of lactic acidosis by 53% (6.8 vs. 11.3%; RR: 0.47; P < 0.001) but had no notable impact on other short?term outcomes following heart surgery, including mortality, re?intubation, re?exploration, delayed sternal closure, length of ICU stay, or duration of mechanical ventilation. Conclusion: Mild?volume ANH significantly reduced the rate and amount of perioperative RBC transfusions, as well as the incidence of lactic acidosis following heart surgery. ANH did not affect the incidence of other complications during hospitalization. Implication: This suggests that ANH could be a safe and beneficial blood conservation technique. Further randomized clinical trials are needed to evaluate its effects.
Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) in Children with Congenital Heart Diseases in Southwest Nigeria
(Wolters Kluwer – Medknow, 2025-06) Makinde, Ronke A.; Alaje, Abiodun K.; Ajose, Abiodun O.; Adedeji, Tewogbade A.; Onakpoya, Uvie U.
Acute kidney injury (AKI) is a major complication of open heart surgery in children with congenital heart diseases. This increases the risk of morbidity and mortality due to late diagnosis because there are no clear?cut markers for early assessment of sudden decline in renal function. The plasma concentrations of cystatin?C were measured at time intervals and compared with plasma creatinine levels in children with cardiac surgery?associated AKI (CSA?AKI). The aim was to evaluate the usefulness of cystatin?C as a biochemical marker of AKI in children undergoing cardiac surgery for congenital heart diseases. Method: This was a prospective, longitudinal study, of 40 children who had open heart surgery, on account of congenital heart diseases, at our study center, between April 2020 and June 2022. Plasma samples were assayed for cystatin?C using the enzyme?linked immunosorbent assay method, while quantification of creatinine was done using a Roche automated analyzer (Cobas C311). Result: Mean plasma concentrations of cystatin?C at 0, 4, 8, 12, 24 and 48 hours were 0.49±0.11 ng/dL, 0.75 ± 0.19 ng/dL, 0.96 ± 0.23 ng/ dL, 0.79 ± 0.20 ng/dL, 0.66 ± 0.15 ng/dL, and 0.60 ± 0.14 ng/dL, respectively, versus 48.98 ± 11.6 ?mol/L, 59.65 ± 13.06 ?mol/L, 63.00 ± 16.53 ?mol/L, 64.90 ± 17.65 ?mol/L, 68.50 ± 19.99 ?mol/L, and 70.78 ± 21.86 ?mol/L, respectively, of creatinine. Plasma cystatin?C peaked earlier at 8 hours compared to creatinine, which peaked at 48 hours. The ROC curve showed that cystatin?C had an AUC of 0.983. Conclusion: This study showed that cystatin?C has a better sensitivity and specificity than creatinine in predicting CSA?AKI in children who had open heart surgery for congenital heart diseases.

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