No abstract

Elective postoperative ventilation in patients undergoing “on pump” open heart surgery has been a standard practice. Ultra fast-track extubation in the operating room is now an accepted technique for “off pump” coronary artery bypass grafting. We tried to incorporate these experiences in on pump open heart surgery and compare the haemodynamic and respiratory parameters in the immediate postoperative period, in patients on standard postoperative ventilation for 8-12 hours. After ethical committee’s approval and informed consent were obtained, 72 patients, between 28 and 45 years of age, undergoing on pump open heart surgery, were selected for our study. We followed same standard anaesthetic, cardiopulmonary bypass (CPB) and cardioplegic protocol. Thirty-six patients (Group E) were randomly allocated for immediate extubation following operation, after fulfillment of standard extubation criteria. Those who failed to meet these criteria were not extubated and were excluded from the study. The remaining 36 patients (Group V) were electively ventilated and extubated after 8-12 hours. Standard monitoring for on pump open heart surgery, including bispectral index was done. The demographic data, surgical procedures, preoperative parameters, aortic cross clamp and cardiopulmonary bypass times were comparable in both the groups. Extubation was possible in more than 88% of cases (n=32 out of 36 cases) in Group E and none required reintubation for respiratory insufficiency. Respiratory, haemodynamic parameters and postoperative complications were comparable in both the groups in the postoperative period. Therefore, we can safely conclude that immediate extubation in the operating room after on pump open heart surgery is an alternative acceptable method to avoid postoperative ventilation and its related complications in selected patients.

BACKGROUND: In an attempt to improve the recovery and early rehabilitation after thoracotomy, various methods of pain-relief have been tried to prolong the duration and to improve the quality of postoperative analgesia. Paravertebral block using steroids like dexamethasone, administered as an adjuvant along with local anaesthetic agents, could be of particular interest. METHODS: Fifty patients undergoing elective thoracotomy were randomly assigned to one of the following groups containing twenty five patients each. Group D patients received 8 mg (2 ml) of dexamethasone added to 18 ml of 0.25% levobupivacaine as paravertebral block (total volume 20 ml). Group L patients received 18 ml of 0.25% levobupivacaine and 2 ml of isotonic saline (20 ml in total) as paravertebral block. Analgesic effect was evaluated by measuring pain intensity (VAS score) and duration of analgesia. RESULTS: A longer delay was observed between paravertevral block with study medication and first requirement of supplementary analgesic in group D (602.24±78.72 minutes) compared to group L (410.48±56.64 minutes). Total consumption of diclofenac sodium in first 24 hours in postoperative period was significantly less in group D. No significant side effects were noted. CONCLUSION: Dexamethasone, used as adjuncts to levobupivacaine for thoracic paravertebral block in patients undergoing thoracotomy, improve the quality and prolong the duration of post operative analgesia.

We present this rare case of a 24 year old male who was knocked down by a slowly backing truck when the rear wheels climbed on to the right side of the abdomen and on hearing the shouts of people rolled forwards causing a partial run over injury.

Carcinoma of the esophagus can coexist with significant Coronary Artery Disease (CAD) in the elderly. A staged approach to the two problems, carrying out Coronary Artery Bypass Grafting (CABG) first followed by cancer resection at two anesthetic settings is a logical way of tackling the conditions. But it lengthens morbidity and increases economic burden. Simultaneous tackling of these two problems, i.e. operation at the same anesthetic settings can offer a better outcome albeit at the cost of a longer operative time. We present such a patient who underwent simultaneous Off Pump Coronary Artery Bypass Grafting (OPCAB) and esophago-gastric resection successfully through a posterolateral thoracotomy and upper midline laparotomy. (Ind J Thorac Cardiovasc Surg 2009; 25: 142-144)