Research (Cardiac Anesthesia)

Original Articles

1
+
Predictive efficacy of procalcitonin, platelets, and white blood cells for sepsis in pediatric patients undergoing cardiac surgeries who are admitted to intensive care units: Single-center experience
Jigar Surti, Imelda Jain, Komal Shah, Amit Mishra, Yogini Kandre, Pankaj Garg, Jatin Shah, Ashok Shah, Payal Tripathi
Full Text

Background: 

Sepsis is one of the major contributor of morbidity and mortality in pediatric cardiac surgeries.

Aim: 

The aim of this study was to compare the predictive efficacy of total leukocyte counts (TC), platelet count (PC), and procalcitonin (PCT) for sepsis in patients undergoing cardiac surgeries who are admitted to the Intensive Care Unit.

Materials and Methods: 

This prospective, single-center study included 300 neonates, infants, and pediatric patients who had undergone various open heart surgeries at our center from September 2014 to November 2015.

Results: 

Overall, the incidence of sepsis was 14% in pediatric patients undergoing cardiac surgeries. TC of postoperative 48 h were significantly lower (11889.19 ± 5092.86 vs. 14583.22 ± 6562.96; P = 0.004) in septic patients. The low levels of platelets on postoperative 24 h and 72 h were observed in patients with sepsis as compared to patients without sepsis, whereas the levels of PCT at various time intervals (preoperative, postoperative - 24 h, 48 h, and 72 h) had shown no association with sepsis in the study population. Low PC (24 h) was the strongest predictor of sepsis showing an odds ratio of 1.9 (95% confidence interval [CI]: 1.42–3.51; P = 0.001) and area under curve of 0.688 with 95% CI of 0.54–0.83 (P = 0.018).

Conclusion: 

We may conclude that in Indian pediatric population platelet levels are highly associated with sepsis as compared to any other hematological parameter. The immediate postoperative level of platelet is the strongest predictor of sepsis and could be effectively used in the clinical settings.

2
+
Effects of glargine insulin on glycemic control in patients with diabetes mellitus type II Undergoing off pump coronary artery bypass graft.
Hemang Gandhi, Alpesh Sarvaia, Amber Malhotra, Himanshu Acharya, Komal Shah
Full Text

Abstract

Background: The prevalence of diabetes mellitus in patients requiring coronary artery bypass grafting (CABG) is noticeably high (20%–30%). These patients have inferior perioperative outcome, reduced long‑term survival, and high risk of recurrent episodes of angina. To improve perioperative outcome surgical unit defined satisfactory glycemic control is desired during this period. Hence, the aim of our study is to compare the efficacy of glargine insulin combination with continuous human insulin infusion for perioperative glycemic control in patients with diabetes undergoing CABG.

Materials and Methods: Fifty Patients, who were posted for off‑pump CABG with diabetes mellitus type II, were randomized in two group, Group I normal saline + human insulin infusion during the perioperative period, Group II (glargine group): Glargine + human insulin infusion during perioperative period.

Results: During surgery and in the postoperative period, random blood sugar and human insulin requirement are significantly higher in control group than glargine group. Other infection, step‑up antibiotics, intensive care unit (ICU) stay, and hospital stay were significantly higher in control groups in postoperative period.

Conclusion: Our study results suggest that glargine effectively manages blood glucose level with significantly greater control over postoperative morbidity.

1
+
Risk Factors for Delayed Extubation after Ventricular Septal Defect Closure: a Prospective Observational Study
Divyakant Parmar, Ketav Lakhia , Pankaj Garg, Ritesh Shah, Jigar Surti , Jigar Panchal, Himani Pandya, The Brazilian Journal of Cardiovascular Surgery 2017; Volume 32(4):276-82
Full Text

Abstract

Objective: The objective of our study was to determine the feasibility of early extubation and to identify the risk factors for delayed extubation in pediatric patients operated for ventricular septal defect closure.

Methods: A prospective, observational study was carried out at our Institute. This study involved consecutive 135 patients undergoing ventricular septal defect closure. Patients were extubated if feasible within six hours after surgery. Based on duration of extubation, patients were divided two groups: Group1= extubation time ≤ 6 hours, Group 2= extubation time >6 hours. Results: A total of 99 patients were in Group 1 and 36 patients in Group 2. Duration of ventilation was 4.4±0.9 hours in Group 1 and 25.9±24.9 hours in Group 2 (P<0.001). Univariate analysis showed that young age, low weight, low partial pressure of oxygen, trisomy 21, multiple ventricular septal defect, high vasoactive inotropic score, transient heart block and low cardiac output syndrome were associated with delayed extubation. However, regression analysis revealed that only trisomy 21 (OR: 0.248; 95%CI: 0.176-0.701; P=0.001), low cardiac output syndrome (OR: 0.291; 95%CI: 0.267-0.979; P=0.001), multiple ventricular septal defect (OR: 0.243; 95%CI: 0.147-0.606; P=0.002) and vasoactive inotropic score (OR: 0.174 95%CI: 0.002-0.062; P=0.039) are strongest predictors for delayed extubation.

Conclusion: Trisomy 21, low cardiac output syndrome, multiple ventricular septal defect and high vasoactive inotropic score are significant risk factors for delay in extubation. Age, weight, pulmonary artery hypertension, size of ventricular septal defect, aortic cross-clamp and cardiopulmonary bypass time did not affect early extubation.

Keywords: Heart Septal Defects, Ventricular. Cardiac Output, Low. Vasoactive Inotropic Score.

2
+
Role of dexmedetomidine in myocardial protection during beating coronary artery bypass grafting.
Alpesh Sarvaia, Jigisha Pujara, Varsha Sarvaiya, Himani Pandya, Visharad Trivedi, Sunil Kumar Ninama, Himanshu Acharya, International Journal of Medical Research and Review 2017;Volume 5(2):176-187
Full Text

Abstract
Background: On-pump CABG is associated with a high risk of myocardial injuries and other complications that result into myocardial ischemia and arrhythmias. OPCAB surgery may reduce, although not entirely eliminate, these myocardial injuries. This prospective study was designed to determine whether the intraoperative use of Dexmedetomidine could reduce the incidence of myocardial injuries after off pump CABG. Methods: A total of 100 patients who underwent off-pump coronary artery bypass surgery were included and randomly divided into Dexmedetomidine-treated and Control groups (groups B and A, respectively) 50 patients in each groups. Following the first vascular anastomosis grafting, the patients in group B received a loading dose of 0.5 μg/kg/10min of Dexmedetomidine via central venous catheter followed by a continuous infusion of 0.5 μg/kg/hr of Dexmedetomidine. The infusion was discontinued at the end of surgery. In group A, 0.9% physiological saline was infused using identical methods to group B. Results: The primary outcomes measured included serum levels of cardiac biomarkers like CPKMB & Trop I. Secondary outcomes included hemodynamic stability, ischemia or arrhythmia events & post-operative ICU stay. Dexmedetomidine use significantly reduced postoperative CPK-MB (26.38 ± 7.11 v/s 30.48 ± 9.84, P=0.019) & Trop I (0.678 ± 0.742 v/s 1.011 ± 0.67, P=0.021) at 24 & 48 hours respectively. Intraoperative dexmedetomidine therapy also reduced the risk of overall complications. Conclusion: Intra operative administration of low-dose dexmedetomidine reduces myocardial damage during off-pump coronary artery bypass grafting surgery as indicated by significantly decreased level of cardiac biochemical markers, CK-MB and cTnI post-operatively.

Keywords: Myocardial, Ischemia, Arrhythmias.

3
+
Monitoring Microcirculatory Blood Flow during Cardiopulmonary Bypass in Paediatric Cardiac Surgery Patients as a Predictor for Anaerobic Metabolism
Ramesh Patel, Atul Solanki, Hasmukh Patel, Jignesh Patel, Himani Pandya, Jainam Sharma, Journal of Clinical And Diagnostic Research. 2017; Volume11(4): UC22-UC25
Full Text

ABSTRACT

Introduction: Improving tissue oxygenation is one of most important tasks in management of low cardiac output. Central venous oxygen saturation (ScvO2) and lactate are established criteria for monitoring the adequacy of tissue oxygenation. The venous-to-arterial carbon dioxide difference [P(v-a)CO2] is inversely associated with cardiac output.

Aim: To study the use of P(v-a)CO2/C(a-v)O2 ratio as a marker of low cardiac output during Cardiopulmonary Bypass (CPB) in paediatric cardiac surgical patients.

Materials and Methods: The present study was a prospective observational study conducted over a period of nine months from 1st August 2015 to 30th April 2016. A total of 110 children were enrolled, who underwent CPB during cardiac surgery. The CPB time, Mean Arterial Pressure (MAP), flow rate, cross clamp time, were recorded for all the patients as well as Arterial Blood Gas (ABG) and Venous Blood Gas (VBG) were checked at four different points of time: 1) Before CPB, 2) 10 minutes after initiation of CPB, 3) 30 minutes on CPB and 4) off CPB.

Results: The results indicated that Receiver Operating Characteristic curve (ROC curve) at 30 minute of CPB time P(v-a)CO2/C(a-v)O2 was more specific and sensitive than lactate to detect anaerobic metabolism. Decrease platelet count was significant on second postoperative day.

Conclusion: The present study suggests the use of P(v-a)CO2/C(a-v)O2 ratio as a marker to detect low flow on CPB. Our study was single centric and with a small size, studies involving large population and multiple centers are required to support the recent findings.

4
+
Topical and low-dose intravenous tranexamic acid in cyanotic cardiac surgery
Jigar Patel, Mrugesh Prajapati, Hardik Patel, Hemang Gandhi, Shilpa Deodhar, Himani Pandya , Asian Annals of Cardiovascular And Thoracic Annals. 2017; Volume 25(2):118-122.
Full Text

Abstract
Background: Coagulopathy is a major problem in surgery for cyanotic congenital heart disease. Tranexamic acid has been used both topically and systemically and plays a vital role in pediatric cardiac surgery by reducing blood loss and blood product requirement. We aimed to determine the anti-fibrinolytic effectiveness of low-dose systemic or topical tranexamic acid or a combination of both.

Methods: Seventy-five patients were divided in 3 groups of 25. Group A patients were given tranexamic acid 20 mg kg1 intravenously after sternotomy and 20 mg kg1 after heparin reversal. Group B patients were given tranexamic acid 50 mg kg1 in 20 mL of saline intrapericardially before sternal closure, with the drain clamped for 20 min. Group C patients were given tranexamic acid 20 mg kg1 intravenously after sternotomy and 50 mg kg1 intrapericardially before sternal closure. A number of clinical variables were recorded in the first 3 postoperative days. Ventilator time, intensive care unit stay, and outcome were also recorded.

Results: Chest tube drainage and blood product requirements were lowest in group C. Blood urea and serum creatinine levels were higher in groups A and C (p<0.05). Intensive care unit stay and ventilator time were similar in all 3 groups. No patient died and none had a seizure or other neurological event or thromboembolic complication postoperatively.

Conclusion: The combination of low-dose intravenous and topical tranexamic acid reduces postoperative blood loss and blood product requirement without incurring neurological, renal or thromboembolic complications.We recommend the routine use of topical and low-dose systemic tranexamic acid in cyanotic pediatric cardiac surgery.

5
+
Elective Nasal Continuous Positive Airway Pressure To Support Respiration After Prolonged Ventilation In Infants After Congenital Cardiac Surgery
Hemang Gandhi, Amit Mishra, Rajesh Thosani, Himanshu Acharya, Ritesh Shah, Jigar Surti, Alpesh Sarvaiya, Annals of Pediatric Cardiology 2017;Volume10:26-30
Full Text

Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery.


Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured.


Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation.

Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation.

Keywords: Congenital cardiac surgery, infants, nasal continuous positive airway pressure, oxygen mask

6
+
During Extracorporeal Circulation (ECC): Metabolic Characteristics Management Reduce Post Operative Sepsis, Liver Dysfunction and Renal Dysfunction in Paediatric Patients
Solanki Atul, Patel Ramesh, Acharya Himanshu, Patel Jignesh, Sharma Jainam
Full Text

Abstract

Aim: Aim of this study is to investigate the impact of perfusion flow, haematocrit level, lactate level and DO2 (oxygen delivery) during extracorporeal circulation for paediatric patients post operative sepsis, liver and renal dysfunctions. 

Introduction: Organ dysfunction afterextracorporeal circulation (ECC) has been associated with oxygen delivery DO2. For conventional extracorporeal circuit required crystalloid priming solution of 350450 ml, resulting in hemodilution.The metabolic needs of paediatric patients during ECC is organ specific because of tissues oxygen consumption VO2. If the ratio of VO2/DO2 is increase during ECC in paediatric patients which give unreliable value of VO2/DO2.This unreliable values give an anaerobic metabolism and lactic acidosis. Due to hemodilution and low delivery of oxygen, postoperative morbidity and mortality will increase. 

Material and Methods: In this prospective study we enrolled total of 180 consecutive paediatric and small children. Who underwent for cardiac surgery with extracorporeal circulation system. Patients were divided into two groups, based on patients haematocrit level  8.5% and >8.5% haematocrit level, oxygen delivery (DO2) and extracorporeal circulation pump flow were recorded. For all paediatric operation with extracorporeal circulate system patients preoperative and postoperativetotal blood count, platelet count, blood urea, serum creatinine, electrolytes, SGPT, SGOT and total bilirubin(tb), serological viral test HepatitisB (HBsAg) and HIV test were performed. Result: In this prospective study we have investigated the lowest haematocrit, lowest oxygen delivery DO2, and low perfusion flow rates may increase postoperative sepsis, liver dysfunction, renal dysfunction and overall ventilation hours / ICCU stay. Conclusion: The present study explored the specific haematocrit level, oxygen delivery DO2 level, perfusion flow and lactate level during ECC in paediatric patients postoperative sepsis, liver dysfunction, renal dysfunction and overall ventilation hours / ICCU stay. The low haematocrit level and low perfusion flow during ECC in paediatric patients is a possible risk for post operative renal dysfunction. Adequate oxygen delivery and perfusionflow reduced risk of renal dysfunction and liver dysfunction.

1
+
CLONIDINE AND KETAMINE FOR STABLE HEMODYNAMICS IN OFF PUMP CORONARY ARTERY BYPASS.
Jigar Patel, Rajesh Thosani, Jignesh Kothari,Pankaj Garg and Himani Pandya. (Asian Cardiovascular & Thoracic Annals 0(0) 1–9)
Full Text

Background: The current era of fast-track extubation and faster recovery after cardiac surgery requires agents that provide perioperative sedation, suppress sympathetic response, reduce opioid requirement, and maintain hemodynamic stability. Methods: In a prospective randomized double-blind study, 75 off-pump coronary artery bypass patients were divided into 3 groups of 25 each: group A had clonidine 1 mgkg–1, group B had clonidine 1 mgkg–1 and ketamine 1 mgkg–1, and group C had a saline placebo. Perioperative changes in heart rate, systolic and diastolic blood pressure, sedation score, pain score, and requirement of analgesics, beta blockers, fentanyl, propofol, and inotropes were recorded, as well time to extubation, intensive care unit stay, and 30-day mortality. Results: The combination of clonidine and ketamine led to stable hemodynamics and reduced beta-blocker dosage. The sedation score was highest in groups A and B up to 24 h postoperatively. The pain score was lowest in group B in the first 24 h, and the total dose of analgesics was highest in group C. Clonidine and ketamine or clonidine alone reduced extubation time, but intensive care unit stay was unchanged Conclusions: Combined low-dose clonidine and ketamine produced perioperative sedation and effective suppression of sympathetic response with stable hemodynamics. Intraoperative beta-blocker use was reduced without increasing inotrope requirement. This combination prolonged the analgesic effect of opioids, reducing postoperative pain score and analgesic requirement. Low-dose clonidine alone produced sedation but did not completely block sympathetic response. Intensive care unit stay and patient outcome were not affected by clonidine or ketamine.

2
+
CAUDAL NEOSTIGMINE WITH BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN PAEDIATRIC PATIENT: COMPARISON WITH BUPIVACAINE ALONE.
Dr.Mrugesh Prajapati, Dr. Trupti D Shah, Dr. Indu Chadha,Dr. B.J Shah Indian Journal of Basic and Applied Medical Research; June 2016: Vol.-5, Issue- 3, P. 239 – 247
Full Text

Abstract

Background: The use of caudal block in children was extensively reviewed by Kay in 1974.Its advantages are postoperative pain relief,decrease  need  for  narcotic  and  non-narcotic analgecics,early  feeding  ,early  ambulation,less  risk  of  chest  infection,more rapid return of child's bright and alert state and early discharge from hospital.

Material Method: We studied 75 children, ASA physical status 1 or 2, aged 2-10 yrs., undergoing elective surgery below the level of  umbilicus.  Patients  were  allocated  randomly  to  one  of  the  three  groups  (n=25).Group  B  received  caudal  Inj.of  0.25% bupivacaine  1ml/kg,  Group  BN1  received  0.25% bupivacaine  1ml/kg  with  Neostigmine  1mcg/kg,  Group  BN2  received  0.25% bupivacaine  1ml/kg  with  neostigmine  2mcg/kg.  Total volume  was  kept  same  in  all  the  groups.  HR,  BP,  RR were  monitored continuously intraoperatively and 2 hrs. after surgery in recovery room. Post-operative pain was assessed at 30 min, 2, 4,8,12 and 24  hrs  after  recovery  from  anaesthesia  using  modified  objective  pain  score.    A  postoperative  score ≥  4  was  managed  with  a paracetamol  suppository  (15mg/kg),  The  time  at  which  postoperative  rescue  analgesia,  if  any,was  first received  and  number  of paracetamol doses per 24 postoperative hrs. were noted.

Result:  Time  to  first  rescue  analgesic  administration  was  longer  in  group  BN1  and  BN2  than  group  B  (P < 0.05).  Incidence  of side effects .such as nausea / vomiting was not significantly different in all three groups.

Conclusion:  We  concluded  that  addition  of  neostigmine  to  caudal  bupivacaine  is  associated  with  prolonged  duration  of postoperative analgesia without increasing incidences of side effect than caudal bupivacaine alone.

3
+
COMPARISON OF ALBUMIN, HYDROXYETHYL STARCH AND RINGER LACTATE SOLUTION AS PRIMING FLUID FOR CARDIOPULMONARY BYPASS IN PEDIATRIC CARDIAC SURGERY.
Jigar Patel, Mrugesh PrajapatI, Atul Solanki, Himani Pandya Journal of Clinical and Diagnostic Research. 2016 Jun, Vol-10(6): UC01-UC04
Full Text

Introduction: In paediatric cardiac surgery, there is still not any information with regard to the best choice of priming fluids for Cardiopulmonary Bypass (CPB). Albumin, Hydroxyethyl Starch (HES) & ringer lactate equally used but each has its advantages & disadvantages. Albumin & HES had better fluid balance which affect outcome in paediatric cardiac surgery significantly. Aim: To compare priming solution containing albumin, hydroxyethyl starch and ringer lactate during elective openheart surgery in paediatrics aged up to 3 years. Materials and Methods: All patients were managed by standardized institution protocol and were randomly distributed into three groups based on the priming solution which is used in the CPB Circuit and having 35 patients in each group. Group A: Receive albumin 10 ml/kg in priming solution, Group B: Receive Hydroxyethyl starch (HES130/0.4) 6% 20ml/kg in priming solution, Group C: Receive ringer lactate priming solution. Primary outcome variable included perioperative haemoglobin, total protein, colloid osmotic pressure, platelets, fluid balance, urine output, post-operative blood loss, blood products usage, renal & liver function, extubation time, ICU stay & outcome. Results: Patients receiving albumin had higher perioperative platelet count, total protein level & colloid osmotic pressure, lesser post-operative blood loss & blood products requirement. Patients receiving HES had lower level of platelets postoperatively than ringer lactate group but not associated with increase blood loss. HES did not affect renal function & haemostasis in this dose. Patients receiving ringer lactate had positive fluid balance intraoperatively. All three groups have similar effect on renal & liver function, urine output, time to extubation, ICU stay & ...

4
+
SAFE AND EASY METHOD WITH LITTLE MODIFICATION IN TECHNIQUE IS USEFUL FOR SUCCESSFUL INTERNAL JUGULAR VEIN CANNULATION ON SAME SIDE EVEN AFTER INTRA-ARTERIAL PUNCTURE WITHOUT USING ULTRASOUND GUIDANCE IN ADULT CARDIAC PATIENTS.
Rajesh Thosani, Jigar Patel, Hemang Gandhi, Chirag Doshi, Jignesh Kothari Annals of Cardiac Anaesthesia | Apr-Jun-2016 | Vol 19 | Issue 2
Full Text

Background: The modification in technique is useful for successful right-sided internal jugular vein (IJV) cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult patients. Materials and Methods: This study was carried out in total 160 adult patient from American Society of Anesthesiologists Grade II to III patients male (n = 95) and female (n = 65) who underwent cardiac surgery where cannulation was done on right sided by triple lumen catheter (7 French) using Seldinger technique. Results: Majority of patients were cannulated successfully by Seldinger technique with single or double attempt except for five patients in which arterial puncture occurred. All five patients were cannulated successfully on the same side with this modified technique without any significant major complications. They were managed by application of blocker at the end of arterial needle puncture without removing it. In our routine practice, we were used to removing this needle and applying compression for few minutes to prevent hematoma formation after an arterial puncture. In this study, cannula was used as a marker or guideline for the relocation of IJV on the same side and recannulation was performed by changing the direction of needle on same side lateral to the previous one and without going towards the same direction to prevent the arterial puncture again. Conclusion: Most simple and useful modified technique for institutes where the complications are most common with trainee doctors and in hospitals where there is no advanced facility like ultrasound-guided cannulation available. By this modification, it will be time saving, very comfortable, and user-friendly technique with high success rate.

5
+
STORAGE RED BLOOD CELL (RBC) TRANSFUSION (PRIME) FOR EXTRACORPOREAL CIRCULATION CIRCUIT IN PEDIATRIC CARDIAC SURGERY: POSTOPERATIVE IMPACT ON BIOCHEMICAL CHANGES.
Atul Solanki, Ramesh Patel, Jigar Patel, Himanshu Acharya, Jignesh Patel, Dhaval Shukla International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 08
Full Text

Background: In neonates, approximately 20% of red blood cell (RBC) and most of the plasma products are used for surgical procedures. The major reason for transfusion in cardiac surgery is because the extracorporeal circulation circuit (ECC) needs to be primed with blood. Biochemical changes take place when RBCs are kept for a phase of time and are together termed the storage lesion. Objective: To clarify the incidence and nature of postoperative liver function, sepsis, and renal function associated with storage RBC prime for cardiopulmonary bypass circuit in new born, infants, and small children. Materials and Methods: A total of 50 consecutive patients who underwent ECC between January 2014 and September 2015 and required blood prime were included in this study. Patients who required RBC were divided into two groups based on patients age and storage RBC age. Arterial blood sample and storage RBCs bag samples were collected in vivo for the assessment for postoperative biochemical parameters determinations. Result: Postoperative white blood cell for more than 7-day storage RBCs prime in more than 365 days age patients is 16982.5 ± 4808.45. Postoperative serum glutamic pyruvic transaminase (SGPT) for more than 7-day storage RBCs prime in more than 365 days age patients mean (± SD) was 23.5 ± 7.56. Postoperative serum glutamic oxaloacetic transaminase (SGOT) for more than 7-day storage RBCs prime in more than 365 days age patients was 139.88 ± 70.32. Postoperative serum bilirubin for more than 7-day storage RBCs prime in more than 365 days age patients was 2.13 ± 0.99. Postoperative urea for more than 7-day storage RBCs prime in more than 365 days age patients was 25.88 ± 6.73. Postoperative serum creatinine for more than 7-day storage RBCs prime in more than 365 days age patients was 0 ± 0. ...

6
+
A COMPARATIVE STUDY OF PEDIATRIC CARDIAC CATHETERIZATION PROCEDURE UNDER GENERAL ANESTHESIA WITH OR WITHOUT FEMORAL NERVE BLOCK.
Jigisha Pujara, Bhavesh Thakkar, Parineeta Jaiswal, Tarun Madan J. Evid. Based Med. Healthc., pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 3/Issue 13/Feb. 15, 2016
Full Text

OBJECTIVEAnesthetic management for interventional cardiac procedures/cardiac catheterization in pediatric patients is challenging. Cardiacanomalies vary from simple to complex congenital cardiac anomalies, shunts may be present at multiple levels and patients may be profoundly cyanotic, may be with ventricular dysfunction. They usually require sedation and analgesia to maintain steady stable state. In adults, such type of procedures can be well managed with local anesthesia. METHODS: Fifty patients were included in the study. They were randomly divided into two groups- Group A (n=25) patients received femoral N. block along with IV sedation and analgesia while group B (n=25) patients received only IV sedation and analgesia. Both groups were compared for hemodynamics, pain score and requirement of IV anesthetic agents and any complications if come up. RESULTS: Group A patients required IV ketamine 3.24mg/kg (±0.31SD) as compared to 5.58mg/kg (±1.6SD) in group B, which suggests significantly reduced requirement of IV anesthetic agents in group where femoral nerve block has been given. Hemodynamic parameters remained stable and comparable (no statistically significant variation) Pain score was less in group A patients than group B. CONCLUSION: It has been observed that Group A patients required less dosages of IV anesthetic agents, with stable hemodynamics and lesspain score and sedation score as compared to group B patients.

7
+
USE OF URINARY PO2 FOR EARLY DETECTION OF RENAL DYSFUNCTION IN CARDIAC SURGICAL PATIENTS.
Ramesh Patel, Harshil Joshi, Hasmukh Patel, Jignesh Kothari, Himani Pandya, Atul Solanki International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 05
Full Text

Background: Medullary hypoxia is a critical initiating event in the development of Multiple forms of acute kidney injury (AKI), and the urinary PO2 provides an index of medullary oxygenation. This biomarker has the Potential to aid in the management of patients at risk of AKI and, so, to possibly prevent development of AKI. Objective: To evaluate the effect of cardiopulmonary bypass (CPB) on urine oxygen tension (PO2) and determine whether perioperative PO2  can predict postoperative renal dysfunction in patients undergoing cardiac surgery. Materials and Methods: This prospective, observational study has enrolled a total of 63 patients who were undergoing on-pump cardiac surgery. On the basis of the AKI guideline, the patients were distributed into two groups. Group A patients did not develop AKI (n = 45), and the remaining patients developed AKI: group B (n = 12). Preoperative renal data and intraoperative and postoperative data were collected. Result: Urine PO2 data were recorded for 63 patients from blood gas analyzer. Prebypass and postbypass urine PO2 was similar up to 24-h postoperative in all patients. Even in patients who develop AKI, we did not find any difference in urine PO2  prebypass and postbypass. Conclusion: These results suggest the possibility of PO2  detecting an early stage of renal dysfunction in cardiac surgery although further studies will be required to substantiate it.

1
+
A PILOT STUDY OF COMPARISON BETWEEN CONTINUOUS PARAVERTEBRAL BUPIVACAINE INFUSIONS V/S INTRAVENOUS PARACETAMOL INFUSIONS FOR PAIN RELIEF IN PATIENTS UNDERGOING MINI INVASIVE CORONARY ARTERY BYPASS GRAFTING
Hemang Gandhi, Rajesh Thosani, Harshil Joshi, Himanshu Acharya, Chirag Doshi, Nirav Parikh J of Evidence Based Med & Healthcare / Vol. 2/Issue 42/Oct. 19, 2015
Full Text

BACKGROUND: Optimum pain relief following mini invasive CABG is essential for patient comfort and to reduce the incidence of postoperative pulmonary complications. METHODS: A randomized clinical trial was conducted on 30 patients scheduled for mini CABG. The patients were randomly divided into two groups. After surgery in group A- paravertebral infusion of local anaesthetics (PVB), bolus dose of 5 ml of 0.25% bupivacaine was injected through the paravertebral catheter in supine position; followed by an infusion of 0.125% bupivacaine at the rate of 0.1 ml/kg/hr, which was continued in the postoperative period. In group B- intravenous paracetamol (IVP), after shifting patient to ICU paracetamol infusion of 10mg/ml is started a 15 ml/hr if patient weight is more than 50kg. If patient weight is less than 50 kg infusion started at 0.3ml/kg/hr. Adequacy of analgesia was assessed at rest and during coughing over 48 hours. Analgesic efficacy was assessed using a visual analogue score. RESULTS: Pain scores were significantly higher in Group A during the assessment period. (p less than 0.01) as compared to the group B. Forced expiratory volume in one second (FEV1), arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2) showed better results in group A as compared with group B. ventilation time and ICU stay were also less in patients who received paravertebral analgesia. CONCLUSION: We conclude that in the early postoperative period, the use of 0.125% bupivacaine infusion through the paravertebral catheter in patients undergoing mini CABG improves pain relief and decrease pulmonary complication.

2
+
DOES MEAN PERFUSION PRESSURE DURING CARDIOPULMONARY BYPASS AFFECT RENAL FUNCTION?
Ramesh Patel, Atul Solanki, Hasmukh Patel, Himani Pandya, Jignesh Patel, Sanjay Patel J of Evidence Based Med & Hlthcare, Vol. 2/Issue 41/Oct. 12, 2015
Full Text

BACKGROUND: After cardiac surgery acute kidney injury (AKI) is a common and serious condition carrying significant costs and is independently associated with increased morbidity and mortality. During cardiopulmonary bypass (CPB) surgery, modifiable factors may contribute to post-operative AKI. Their prevention might be a potential target for nephroprotection and any other morbidity after cardiac surgery. METHODS AND MATERIAL: The objective of the present study was to identify and determine whether intraoperative hypotension or any other cofactor are independent risk factors for postoperative AKI defined by the RIFLE (renal Risk, Injury, Failure, Loss of renal function and End-stage renal disease). On basis of this patients were divided into two groups according to rise in serum creatinine more than 0.3 mg/dl till 72 hrs postoperatively. Group B patients have developed AKI (n=34) and the remaining patients were in Group A. RESULT: In our study we have found that mean arterial pressure during CPB were less in group B patients compare to group A patients which was statistically significant (p less than 0.001). And in this group ICU stay and mortality rate were also high compare to group A patient who had not developed AKI. CONCLUSION: Lower MAP during CPB is associated with development of postoperative renal derangement, leads to increase ICU stay and mortality. Larger studies are required to further support the evidence.

3
+
MAGNESIUM SUPPLEMENTATION DURING CARDIOPULMONARY BYPASS TO PREVENT JUNCTIONAL ECTOPIC TACHYCARDIA AFTER PEDIATRIC TOF SURGERY – A RANDOMIZED CONTROLLED STUDY.
Mrugesh Prajapati, Jigar Patel, Himani Pandya and Hasmukh Patel International Journal of Biomedical and Advance Research 2015; 6(08): 584-588.
Full Text

Objective: The occurrence of postoperative junctional ectopic tachycardia (JET) is more frequent in certaintypes of congenital heart surgery. Magnesium decreases the incidence of junctional ectopic tachycardia after surgery. Therefore we prospectively examined the effect of magnesium treatment on the incidence of postoperative JET in pediatric patients undergoing surgical repair of congenital heart defects. Methods and results: We performed a randomized, double-blind, controlled study in 90 pediatric patients. Magnesium sulphate (MgSO4) or placebo was administered during the rewarming phase of cardiopulmonary bypass: group 1, placebo group (30 patients); group 2, 25 mg/kg of MgSO4 (30 patients); and group 3, 50mg/kg of MgSO4 (30 patients). The overall incidence of JET was 11.1%. Group 1 patients had higher proportion of JET 6 (20%), than group 2 and group 3 (10 %, 3.3%). Conclusions: Supplementation with MgSO4 during cardiopulmonary bypass seems to reduce the incidence of hypomagnesaemia and junctional ectopic tachycardia at admission to the cardiac intensive care unit. This effect seems to be dose related. 

4
+
HYPERLACTATEMIA AFTER CARDIAC SURGERY AS A PROGNOSTIC RISK FACTOR.
Dr. Ritesh Shah, Dr. Hasmukh Patel, Himani Pandya International Journal of Science and Research (IJSR) Volume 4 Issue 8, August 2015
Full Text

Background: Elevated blood lactate level after cardiac surgery is an indicator of systemic hypoperfusion and tissue hypoxia. Our aim of the study was to evaluate the relationship between postoperative blood lactate levels and outcome in patients undergoing open heart surgery and to verify the clinical impact of hyperlactatemia (HL) and low lactemia (LL) after coronary artery bypass grafting in terms of postoperative morbidity and mortality rate. Methods: Postoperative blood lactate level was measured in 96 patients. Low and high lactate level was defined as level less than or equal to 4 mmol/L in 69 (Group A) and more than 4 mmol/L in 27 patients (Group B) respectively. Preoperative, perioperative and postoperative details were retrieved from patient records. Results: Demographic characteristics, postoperative data were similar in both groups. Increased cross-clamp and cardiopulmonary bypass times in patients who underwent on pump were associated with a significant rise in postoperative lactate levels. Increased length of ICU stay (Group A 78.49 ± 41.96 vs. Group B 91.81 ± 59.44), mechanical ventilation time (Group A 9.47 ± 6.17 vs. Group B 15.07 ± 14.15) and higher mortality rates (Group A no=01 vs. Group B no=4) were also found in high lactate group. Conclusion: Longer duration of CPB and cross clamp time are associated with a significant increase in lactate levels during perioperative period and that increased lactate levels are directly associated with the increased duration of mechanical ventilation, postoperative ICU stay and mortality

5
+
FACTORS INFLUENCING PROLONGED STAY IN THE INTENSIVE CARE UNIT AFTER CARDIAC SURGERY
Ritesh Shah, Ramesh Patel, Ramanand Sharma, Himani Pandya, Komal Shah NATIONAL JOURNAL OF MEDICAL RESEARCH│Volume 5│Issue 2│Apr – Jun 2015
Full Text

Background: There are different risk factors that affect the intensive care unit (ICU) stay after cardiac surgery. The aim of this study was to evaluate possible risk factors influencing prolonged ICU stay. Methodology: We conducted 443 adult patients undergoing different cardiac surgery to determinate causes of prolonged ICU stay. These patients were divided into two groups according to ICU stay ≤ 4 days and >4 days. We evaluated preoperative, intraoperative and postoperative risk factors for prolong ICU stay. Results: Among the 443 patients studied, 277 (62.52%) had stayed ≤ 4 days and 166 (37.42%) had stayed >4 days in ICU. Frequency of prolonged ICU stay was 42.7% in patients undergoing coronary artery bypass graft (CABG), 37.3% in patients with valve surgery, 9% in patients with CABG plus valve surgery and 10.8% others surgery. Patients with > 4 days of ICU stay received more blood transfusion and higherinotropes duration. They also had longer time duration of surgery, cardiopulmonary bypass, and long ventilation hours and other preoperative and postoperative risk factors. (P < 0.05 for all comparisons). Conclusions: The relationships between the pre-, intra- and postoperative risk factors and prolonged ICU stay after coronary artery bypass grafting with cardiopulmonary bypass, suggest that serum creatinine, urea and liver dysfunction were risk factors for prolong ICU stay, Whereas among surgical variables cardio pulmonary bypass time, cross clamp time and time duration of surgery are the main associates of higher ICU duration.

6
+
COMPARISON OF INCIDENCE OF ACUTE KIDNEY INJURY IN ON PUMP V/S OFF PUMP CORONARY ARTERY REVASCULARISATION SURGERY.
Ritesh Shah, Harshil Joshi, Jignesh Kothari, Ramesh Patel, Himani Pandya, Himanshu Acharya American Journal of Advanced Medical & Surgical Research, 2015;1(1):35-40
Full Text

Off pump coronary artery bypass grafting (OPCAB) is worldwide acceptable as the preformed choice for myocardial revascularization. However, no definite data exist as to whether it is better than conventional coronary artery bypass grafting (CABG). We aimed to compare the incidence of acute kidney injury (AKI) and early outcomes between the conventional CABG and OPCAB. Between November 2014 to April 2015, 40 patients underwent ONCAB (group A) and another 40 patients had been subjected to OPCAB (group B). Analysis of preoperative, perioperative and postoperative courses related to AKI and clinical outcomes were performed. The perioperative data showed longer inotrope duration in ONCAB (46.85 ± 32.90hrs. vs. 26.42 ± 21.47 hrs, P  less than 0.05) as compared to OPCAB group, respectively. The incidence of pts. who need prolonged mechanical ventilation (more than 7 h), was also higher in ONCAB as compared to OPCAB group. Rise in serum creatinine as per our definition AKI practice guideline is comparable and non-significant in both the group (group A 6 no of patients vs group B 7 no of patients p =1.000). The choice of operative technique OPCAB versus ONCAB is not associated with reduced renal morbidity. But still OPCAB is more favorable with low ICU and hospital stay.

7
+
SODIUM BICARBONATE INFUSION: TO PREVENT CARDIAC SURGERYASSOCIATED ACUTE KIDNEY INJURY.
Ramesh Patel, Ritesh Shah, Jignesh Kothari, Harshil Joshi, Rajesh Thosani, Himani Pandya,Atul Solanki Journal of Evolution ofMedical and Dental Sciences 2015; Vol. 4, Issue 17, February 26; Page: 2910-2918
Full Text

Objective : The incidence of cardiac surgery–associated acute kidney injury is 50% of patients and is associated with increased mortality and morbidity. This study aimed to determine if perioperative urinary and plasma alkalization with sodium bicarbonate infusion reduces the incidence of cardiac surgery–associated acute kidney injury. Setting and Design : This study is double blind randomized control trial conducted at U N Mehta Institute of Cardiology and Research Center, India. Methods and Results : A total of 140 patients scheduled to undergo elective cardiac surgery, who were at increased risk of development of cardiac surgery–associated acute kidney injury using recognized risk factors. Patients were randomly allocated to receive either sodium bicarbonate (n = 70) or sodium chloride (n = 70) infusion, commencing at the start of anesthesia, in a dose of 4 mmol/kg over 24 hour. The primary outcome measure was the number of patients with development of CSA-AKI, defined as an increase in creatinine greater than 25% from baseline to peak value within the first three postoperative days. Significant differences among the groups in both plasma and urinary pH were achieved 6 hours after commencement of the infusion, and these changes persisted for more than 24 hours. A total of 7 out of 70(10%) patients in the sodium bicarbonate group and 16 out of 70(22.85%) patients in the sodium chloride group developed acute kidney injury within the first three postoperative days with p value of 0.06 which is statistically not significant. There were also no significant differences in ventilation hours, ICU or hospital length of stay, or mortality. Conclusions: Perioperative alkalization of blood and urine using an infusion of sodium bicarbonate did not result in a decrease in the incidence of acute kidney injury in patients ...

1
+
COMPARATIVE STUDY OF ORAL MIDAZOLAM, ORAL KETAMINE AND THEIR COMBINATION AS PREMEDICATION IN PEDIATRIC CARDIAC SURGERY.
Shah R.B., Patel R.R., Patel J.J., Mishra A.A., Thosani R.M. Indian Journal of Applied Basic Medical Science 16 B(23) July, 2014
Full Text

Background : Midazolam and ketamine are useful premedication orally to decrease anxiety in children. We compared the effects of high dose midazolam with ketamine and with low dose combination of midazolam and ketamine both. Methods : 75 children between 6 months to 10 years with congenital heart disease were posted for surgeries were randomly selected for 3 groups. Group A received midazolam 0.75mg/kg p.o., Group B received ketamine 8mg/kg p.o., and Group C received midazolam 0.5mg/kg and ketamine 4mg/kg p.o. Heart rate, blood pressure, respiratory rate, oxygen saturation, anxiety score and sedation score were noted at 10, 20, 30 minutes after premedication and at time of parental separation and face mask application. Standard general anaesthesia technique was employed. Results: There were linear decreasing trends in sedation score and anxiety score were noted compare to presedation score. However, group C shows superior effect at the time of parental separation and face mask application. Hemodynamic changes were similar in all groups. Conclusions: Combination of oral midazolam and ketamine at low dosage is excellent premedication for sedation and anxiolysis at the time of parental separation and face mask application and are highly acceptable to children and their parents with minimum side effects.

2
+
EFFECT OF PREOPERATIVE ORAL SILDENAFIL ON SEVERE PULMONARY ARTERY HYPERTENSION IN PATIENTS UNDERGOING MITRAL VALVE REPLACEMENT.
Hemang Gandhi, Bipin Shah, Ramesh Patel, Rajesh Toshani, Jigisha Pujara, Jignesh Kothari, Naman Shastri Indian Journal of Pharmacology | June 2014 | Vol 46 | Issue 3 281 – 285
Full Text

Aim : Long standing mitral valve disease is usually associated with severe pulmonary hypertension. Perioperative pulmonary hypertension is a risk factor for right ventricular (RV) failure and a cause for morbidity and mortality in patients undergoing mitral valve replacement. Phosphodiesterase 5 inhibitor‑sildenafil citrate is widely used to treat primary pulmonary hypertension. There is a lack of evidence of effects of oral sildenafilon secondary pulmonary hypertension due to mitral valve disease. The study aims to assess the effectiveness of preoperative oral sildenafil on severe pulmonary hypertension and incidence of RV failure in patients undergoing mitral valve replacement surgery. Materials and Methods : A total of 40 patients scheduled for mitral valve replacement with severe pulmonary hypertension (RV systolic pressure (RVSP) ≥60 mmHg) on preoperative transthoracic echo were randomly treated with oral sildenafil 25 mg (N = 20) or placebo (N = 20) eight hourly for 24 h before surgery. Hemodynamic variables were measured 20 min after insertion of pulmonary artery catheter (PAC) under anesthesia (T1), 20 min at weaning from cardiopulmonary bypass (CPB) (T2) and after 1,2, and 6 h (T3, T4, T5, respectively) during the postoperative period. Results: Systolic and mean pulmonary artery pressure (MPAP) and pulmonary vascular resistance index (PVRI) were significantly lower (P < 0.0001) in sildenafil group at all times. Ventilation time and postoperative recovery room stay were significantly lower (P < 0.001) in sildenafil group. Conclusions: Sildenafil produces significant pulmonary vasodilatory effect as compared with placebo in mitral valve replacement patients with severe pulmonary hypertension. It also reduces ventilation time ...

3
+
CORRELATION OF END TIDAL CARBON DIOXIDE WITH ARTERIAL CARBON DIOXIDE DURING CARDIOPULMONARY BYPASS.
Dr. Kothari J. V. ,Dr. Patel R. D.,Dr. Chaurasiya A,Dr. Solanki A ,Dr. Thosani R. M Indian Journal of Applied Basic Medical Science 16a(22):645-647;2014
Full Text

Introduction : Optimal blood gas management is subjected to pH- and alpha- state during hypothermia; Alpha state managed by maintaining constant total carbon dioxide stores during cardiopulmonary bypass (CPB) changes thermodynamic dissociation with change in temperature. pHremains constant during temperature changes. A correlation between end tidal carbon dioxide and arterial PCO2 known to be a non- invasive and safe procedure in patients undergoing Coronary artery bypass graft. Patients and Methods : Forty patients were maintained with normothermia and hypothermia during cardiac surgery in the current study. All patients were operated with midline sternotomy, aortic bicavalcannulation or aortic-right atrium cannulation for cardiopulmonary bypass. Arterial Blood Gas measurements (ABG) along with ETCO2 and PaCO2 monitoring were performed. Results: The patient group had undergone a variety of surgical procedures (viz. Coronary artery bypass grafting, Replacement of mitral- or aortic- valve or double valve). They were maintained on CPB with aorta cross clamp. There was no significant difference in ETCO2 and PaCO2 pressures both at normothermia as well as moderate hypothermia during CPB. Conclusions: Monitoring ETCO2 reflects accurate measurements of PaCO2. Repeated sampling for ABG therefore can be avoided as a cheap, non-invasive method to ascertain the health of the patients.

4
+
ROLE OF TRANEXAMIC ACID FOR REDUCING BLOOD LOSS IN TETRALOGY OF FALLOT.
Dr. Patel R. D., Dr. Shah R. B, Dr. Kothari J. V., Dr. Mishra A. A.,Dr. Solanki A. J.,Dr. Thosani R. M. Indian Journal of Applied Basic Medical Science 16a(22):658-668;2014
Full Text

Background : Antifibrinolytic agents are used to reduce post-operative blood loss during cardiac surgeries. Paucity of literature on tranexamic acid in patients undergoing tetralogy of fallot repair encouraged us for this study at a tertiary cardiac care center. Administration of antifibrinolytic agent tranexamic acid decreases bleeding and transfusions during postoperative period. Methods : Sixty pediatric patients undergoing surgical repair for tetralogy of fallot were divided into two groups. The control (Group-A) did not receive the drug while the study group (Group-B) received IV tranexamic acid at pre-incision, during priming and heparin reversal at 10 mg/kg. Blood loss, need for supplementation of blood and blood products, coagulation parameters and re-exploration rate were compared between the groups. Results: Both groups had comparable demographic parameters (age, weight, and body surface area and tetralogy of fallot characteristics). Tranexamic acid treated patients experienced lesser blood loss (p<0.0003), need for PCV (p<0.0001) or Fresh Frozen Plasma (FFP; p<0.0001). Improved coagulation parameters [increased Fibrinogen content (p<0.01) and platelets (p<0.01); decreased activated clotting time (p<0.01) and fibrin degradation product (p<0.01) were also seen in drug treated patients. Conclusions: Tranexamic acid was effective in reducing post-operative blood loss with improved coagulation parameters. We therefore advocate its routine use for tetralogy of fallot repair surgeries in pediatric patients.

1
+
A MODIFIED ANAESTHESIA PROTOCOL FOR PATIENTS UNDERGOING MINIMAL INVASIVE CARDIAC SURGERY BY RIGHT THORACOTOMY- A. SINGLE CENTER EXPERIENCE.
Thosani R.M., Shah B.K., Gandhi H.G., Sharath Kumar K., Rawal J. R. Indian Journal of Applied – Basic Medical Sciences (2013), Volume 15A (20) JAN-13
Full Text

Objectives : Median sternotomy is a well accepted incision for most cardiac surgical procedures. However due to some obvious advantages, now right thoracotomy incision is preferred for some cardiac surgical procedures. The patient position for right thoracotomy necissitates some modifications in anesthesia protocols. In this study we evaluated the feasibility of this approach in selected procedures. Methods : Between February 2009 and October 2012, 41 patients underwent Cardiac surgery via right thoracotomy. The patients selected for this approach were in ASA Grade-II to III without diabetes or hypertension. The surgeries conducted were Atrial septal defect closure (28 cases), valve replacements (12 cases) and one case of thoracic mass excision. A standardized protocol of anaesthesia induction and maintainence was administered with injection propofol, fentanyl and vecuronium bromide dosed according to the patient’s body weight. Tracheal intubation was carried out with Left sided DLT (double lumen tube) followed by single lumen tube after the surgery for post operative ventilation. A cardiac surgery was performed through right thoracotomy in fourth inter costal space with incision of 4 to 6 cm in size. There was no mortality or significant morbidity in any of these patients and there was decreased bleeding and shortened duration of ICU stay. Results: Feasibility of undergoing complex cardic surgery by lateral thoractomy is shown by our experience and we also observed less bleeding and early post operative recovery and ambulation. The approach was highly accepted for cosmetic reasons also. Conclusions: Anaesthesia technique for cardiac surgery by midline sternotomy technique is standardised in most institutes. However, the modifications required for the minimally invasive heart surgery ...

2
+
A COMPARISON OF THE EFFECTIVENESS OF DEXMEDETOMIDINE INFUSION AND MIDAZOLAM FOR SEDATING CARDIAC PATIENTS UNDERGOING AWAKE FIBREOPTIC NASAL INTUBATION.
Shah B.K., Thosani R.M., Trivedi V.C., Shah C.D., Prajapati M.M., K.Sharathkumar, Rawal J.R. Indian Journal of Applied – Basic Medical Sciences (2013), Volume 15A (20) JAN-13
Full Text

Background and Objectives: Fiberoptic intubation is indicated method for difficult airway management. Optimal intubating condition with sedation and patient comfort are important factor for fiberoptic nasal intubation. Titration between sedation and respiratory depression with usual drugs are difficult. It should provide patient comfort and cooperation, spontaneous respiration without airway obstruction, depression of airway reflexes, haemodynamic stability and amnesia.Dexmedetomidine (a2- adrenoceptor agonist) is a new drug with sedative, analgesic and amnesic properties with minimal respiratory depression and can be easily titrated by infusion. We evaluated the efficacy of this drug and compared it with midazolam in patients with normal airways undergoing cardiac surgery. Methods: 47 patients with normal airways who were to undergo awake Fiberoptic intubation were enrolled in this study. The patients were randomly assigned two groups: the first group (n=25) received Dexmedetomidine (1 mcg/kg infusion over 5 minutes) and the control group (n=22) received Midazolam (0.05 mg/kg intravenously). The pulse rate, blood pressure, Oxygen saturations and respiratory rate were monitored after 5 min, during and after intubation. The intubation success was 100% in both groups. Post procedure patient satisfaction and comfort was assessed by a Comfort scale. Results: In this study of patients undergoing Cardiac surgery with normal airways we found that patients treated with Dexmedetomidine had better hemodynamic safety with regard to blood pressure and heart rate and the depth of respiration and the oxygen saturations were also stable throughout the procedure. Post procedure satisfaction was better with Dexmedetomidine (14 vs 22, P<0.0001). There were no significant adverse events in both groups. ...