Background Delirium after cardiac surgery affects mortality, but the mechanism remains unclear. Previous studies have reported gut microbiota are associated with brain activity. Systemic inflammation and antibiotics can damage the gut microbiota after cardiac surgery. We aimed to investigate changes in the gut microbiota and the association between the gut microbiota and delirium after cardiac surgery. Methods Twenty-one patients who underwent cardiac surgery were enrolled. Microbiota counts and fecal organic acid concentrations were measured in fecal samples harvested before surgery, just after surgery, and before discharge. To quantify the microbiota, we extracted total RNA fractions and examined gut microbiota composition using 16S and 23S rRNA-targeted quantitative-reverse Transcription-PCR. Postoperative delirium, insomnia, and pseudopsia were assessed for 1 week. Postoperative total bacterial counts changed significantly from 10.2 ± 0.2 log10 cells/g of feces to 9.8 ± 0.5 in the first postoperative samples (p = 0.003) and 10.0 ± 0.4 in the samples before discharge (p = 0.039). Fecal pH was 6.9 ± 0.6 before surgery and 7.4 ± 0.7 in the first postoperative samples (p = 0.001). Postoperative Staphylococcus and Pseudomonas counts were significantly higher in patients with postoperative pseudopsia than in patients without pseudopsia (3.2 ± 1.3 vs. 5.4 ± 0.9; p = 0.012 and 1.7 ± 0.8 vs. 4.6 ± 2.7; p = 0.001). Conclusions Total bacterial counts were significantly lower after surgery and until discharge. Fecal pH was significantly higher than preoperative levels. Staphylococcus and Pseudomonas counts were significantly higher in patients with postoperative pseudopsia.
Background: Noninvasive cardiac output (CO) measured using ClearSight™ eliminates the need for intra-arterial catheter insertion. The purpose of this study was to examine the accuracy of non-invasive CO measurement in patients with severe aortic valve stenosis (AS). Methods: Twenty-eight patients undergoing elective transcatheter aortic valve implantation were prospectively enrolled in this study. The CO was simultaneously measured twice before and twice after valve deployment (total of four times) per patient, and the CO was compared between the ClearSight (COClearSight) system and the pulmonary artery catheter (PAC) thermodilution (COTD) method as a reference. The Bland-Altman analysis was used to compare the percentage errors between the methods. Results: A total of 112 paired data points were obtained. The percentage error between the COClearSight and COTD was 43.1%. The paired datasets were divided into the following groups according to the systemic vascular resistance index (SVRI): low (< 1,200 dyne s/cm5/m2) and normal (1,200–2,500 dyne s/cm5/m2). The percentage errors were 44.9% and 49.4%, respectively. The discrepancy of CO between COClearSight and COTD was not significantly correlated with SVRI (r = −0.06, P < 0.001). The polar plot analysis showed the trending ability of the COClearSight after artificial valve deployment was 51.1% which below the acceptable cut-off (92%). Conclusions: The accuracy and the trending ability of the ClearSight CO measurements were not acceptable in patients with severe AS. Therefore, the ClearSight system is not interchangeable with the PAC thermodilution for determining CO in this population.
Purpose: The accuracy of ClearSightTM blood pressure measurements in patients with postaortic valve replacement may be inaccurate compared to intra-arterial pressure, the clinical risk of measurement discrepancy remains uncertain. This study aimed to determine the factors associated with errors in measurement. Methods: From October 2020 to November 2021, we collected 881 pairs of intra-arterial/ClearSight blood pressure measurements from 30 adults who underwent transcatheter aortic valve replacement. The agreement of ClearSight blood pressure with intra-arterial pressure was compared, and the clinical risk was evaluated by classifying measurement errors into zones A (no risk) to E (dangerous risk) using error grid analysis. Results: The bias and precision of ClearSight measurement were −4.88 ± 15.46 (mmHg) for systolic, 4.73 ± 8.95 (mmHg) for the mean and 9.53 ± 9.01 (mmHg) for the diastolic blood pressure. The proportions of measurement pairs in zones A were 88.0% for systolic BP and 71.2% for mean BP, respectively. Logistic regression analysis revealed that the risk of measurement error being outside zone A was heart rate [odds ratio, 1.24; 95% confidence interval, 1.15 to 1.35; p<0.001] for systolic and mean blood pressure, and aortic valve area index < 1.0 (cm2. m−2) [odds ratio, 1.62; 95% confidence interval, 1.21 to 2.16; p=0.02] for mean blood pressure.Conclusion: These findings could help to identify patients of unsuitable for ClearSight blood pressure measurement. Our results demonstrate that the small aortic valve area index and low cardiac index are risk factors for measurement error.
Postoperative sore throat and hoarseness (POSTH) is one of the complications of tracheal intubation during general anesthesia, which reduce patient satisfaction. El-Boghdadly et al. clarified the postoperative risk factors and the preventive method of POST in adults and children in a systematic review. Ref) This study was conducted in accordance with a protocol that aggressively excludes factors responsible for POSTH. Generally, the endotracheal tube (ETT) is connected to the respiratory circuit with keeping natural curvature during general anesthesia. However, when the position of ETT is restricted in order to secure a clean field, we have to curve ETT artificially. In this study, we examined whether the two supporting methods of ETT affected the frequency and severity of postoperative sore throat (POST) and hoarseness (POH).
Background: There is no fully recommended methodology for surgery for Barlow's disease. Various methods have been proposed. The aim of this study was to investigate the effectiveness of transesophageal echocardiography (TEE) measurements for selecting the optimal annuloplasty ring size and determining the length of artificial chordae in patients with Barlow's disease who underwent robot-assisted mitral valvuloplasty (R-MVP). Methods: Ten patients were included. Before R-MVP, the anesthesiologist used TEE to predict the optimal annuloplasty ring size and artificial chordae lengths that would reduce mitral regurgitation. The anesthesiolosist's predict ring size was not presented to the surgeon intraoperatively. Results: In 70% (7/10) of cases, the surgeon performed mitral valve repair in full match with the anesthesiologist's repair plan. Mitral regurgitation was controlled in 85% (6/7) of cases. In three cases, the predict annuloplasty ring size and artificial chordae length were not match between anesthesiologist and surgeon. After the operation, 90% (9/10) of patients had no residual mitral regurgitation. Conclusions: Anesthesiologist's TEE measurements were useful for selecting the optimal annuloplasty ring size and artificial chordae length during R-MVP. TEE can play an important role in robot-assisted, minimally invasive cardiac surgery for mitral regurgitation with extensive and complex prolapse, such as in Barlow's disease.
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