Extracorporeal membrane oxygenation (ECMO) is a modality utilized for partially or completely supporting the cardiac and/or pulmonary function. There are multiple vascular access techniques depending upon the necessity and the mode of ECMO used. ECMO has evolved over the years as an integral part of the cardiac care discipline. Historically, this lifesaving modality began as an extension of cardiopulmonary bypass and was associated with adverse outcomes. Currently, ECMO has evolved as an accepted and viable solution to patients with severe cardiac/respiratory/cardiorespiratory failure that is refractory to conservative management. The outcomes of patients on ECMO are dependent on multiple factors originating from demographic and pathophysiological status of patients as well as the control of homeostasis during ECMO within the acceptable range. Various studies have been published by many practitioners over past decades since the dawn of ECMO era. A brief review of such experience is summated, and a conclusion is derived about the clinical course of the patients on ECMO, while adding the author’s experience about the same in a tertiary care large-volume center.
Background and Aims: Ultrasound guided adductor canal block (ACB) is a modality for providing analgesia after arthroscopic anterior cruciate ligament repair surgery. Intra-articular infiltration of analgesics in the knee joint acts on the free nerve endings at the operative site and provides analgesia. We aim to compare the analgesic efficacy and opioid consumption between these two modalities. Material and Methods: Sixty patients were randomized to receive either ACB under ultrasound guidance (group A) or intra-articular infiltration (group B). Post-operatively time of rescue analgesia and opioid consumption were noted. Quality of analgesia was assessed every 2 hours until 6 hours, then every 6 hours until 24 hour post-operative period between the two groups. Data was analysed statistically and P value < 0.05 was considered significant. Results: Time of rescue analgesia was comparable in both the groups (p value 0.4317). NRS scores in ACB group and intra-articular infiltration group were comparable till first 6 hours (p value 0.4519) but increased in intra-articular infiltration group at 12 th hour (p value <0.0001) and 18 th hour (p value <0.0117) as compared to group receiving ACB. The opioid consumption was more in intra-articular infiltration group than ACB group although not statistically significant (p value 0.6319). Conclusion: ACB is a better modality for postoperative analgesia after arthroscopic anterior cruciate ligament repair surgery as analgesia of intra-articular infiltration wears off in 12-24 hour period which is crucial for early ambulation and from rehabilitation point of view.
The new coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure to multisystem organ dysfunction and death. Healthcare workers, particularly anesthesiologists, are at increased risk since their airway management expertise is required in situations where suspected or confirmed cases of COVID-19 require surgical procedures and in critical care settings. Such patients undergoing surgery have a higher perioperative morbidity and mortality. Additionally, aerosol-generating procedures place the operating room staff at high risk of contracting the COVID-19 infection. Here, we present a review of COVID-19 management, particularly in the perioperative setting. In addition, this article highlights specific concerns with the use of transesophageal echocardiography and the precautions to be taken during cardiopulmonary resuscitation. This review article is based on this institutional protocol supported by literature from recent publications and guidelines from major health organizations on COVID-19.
ORIGINAL RESEARCHwhere studies have reported that almost 40-50% have T2-DM. It is expected that patients undergoing OPCAB may suffer from acidosis intraoperatively as a consequence of decrease in cardiac output owing to displacement/verticalization of the heart. Uncontrolled diabetes mellitus may cause numerous physiochemical changes in the blood glucose, volume status, acid-base balance, and plasma electrolytes. Excess blood sugar
IntroductIonCardiovascular disease (CVD) is a leading cause of all deaths and disability worldwide. As per the report of Global Burden of Disease in 2017, CVD caused an estimated 17.8 million deaths worldwide, corresponding to 330 million years of life lost and another 35.6 million years lived with disability. 1,2 CABG is a surgical option available for patients with significant CAD who are not suitable candidates for percutaneous interventions. CPB with cardiac arrest (on pump) provides a surgical field free of motion and blood, allowing safe anastomosis construction. Yet, the use of CPB is associated with complications peculiar to extracorporeal circulation that may be a major determinant of perioperative morbidity, hospital stay, and costs. CABG surgery on the beating heart without extracorporeal circulation (off-pump) has been successfully introduced in clinical practice. Off-pump coronary artery bypass (OPCAB) may avoid serious complications associated with CPB such as stroke, renal dysfunction, and systemic inflammatory response syndrome.Diabetes is an important cardiovascular risk factor for CAD. The prevalence of T2-DM in patients undergoing CABG surgery is nearly 30-40%. 3 This proportion is greater in India
Trilogy of Fallot; a triad of pulmonary stenosis, right ventricular hypertrophy and atrial septal defect is an uncommon acyanotic congenital heart disease. We present a severe case of trilogy of Fallot diagnosed for the first time in pregnancy. The patient was otherwise in a compensated state and had become symptomatic due to physiological changes in pregnancy. The anaesthetic goals therefore included maintaining the existing physiology and preventing decompensation thereby avoiding Eisenmengerisation. The anaesthetic management of the severe and complex heart disease keeping patient safety at the core is discussed. Keywords: Caesarean section, congenital heart disease, trilogy of Fallot.
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