Patient with Recent Coronary Artery Stent Requiring Major Non Cardiac Surgery

Anaesthesiologists are increasingly confronted with patients who had a recent coronary artery stent implanta-tion and are on dual anti-platelet medication. Non cardiac surgery and most invasive procedures increase the risk of stent thrombosis especially when procedure is performed early after stent implantation. Anaesthesiologist faces the dilemma of stopping the antiplatelet therapy before surgery to avoid bleeding versus perioperative stent thrombosis. Individualized approach should be adopted with following precautions. i) In a surgical patient with a history of percu-taneous coronary intervention (PCI) and coronary stent, determine the date of the procedure, the kind of the stent inserted and the possibility of complications during the procedure. ii) Consider all patents with a recent stent implan-tation (e.g. less than three months for bare metal stents and less than one year for brachytherapy or drug eluting stents as high risk and consult an interventional cardiologist. iii) Any decision to postpone surgery, continue, modify or discontinue antiplatelet regimes must involve the cardiologist, anaesthesiologist, surgeon, haematologist and the intensivist to balance the risk and benefit of each decision

Immature Platelet Fraction and COVID-19: Maturing prognostic links!

Prompted by the combination of an ever-evolving comprehension of the platelet activation as a pivotal perpetuator of an ongoing systemic inflammatory process and an encouraging literature on the prognostic role of immature platelet fraction (IPF) in septic and prothrombotic settings, we present an elaborated account of the possible prognostic links between IPF and Coronavirus disease 2019 (COVID-19)

Acute Rupture of Sinus of Valsalva into Right Atrium: An Echocardiographic Halftone

A ruptured sinus of Valsalva is a rare and emergent cardiac abnormality, which can be acute and rapidly expanding to cause hemodynamic deterioration. Rupturing into right-sided heart chambers causes severe left-to-right shunt and sudden volume overload. Echocardiography especially transesophageal echocardiography (TEE) is the gold standard facility for early perioperative diagnosis and also to guide surgical technique. Medical stabilization followed by prompt surgical intervention is the treatment of choice. We hereby report a case of sinus of Valsalva rupturing into right atrium leading to severe left-to-right shunt and the role of TEE in its perioperative management

Gastrothorax or tension pneumothorax: A diagnostic dilemma

Gastrothorax, a rare complication following thoracoabdominal aortic aneurysm repair, is reported. The clinical features of a gastrothorax and tension pneumothorax are similar and thus, a gastrothorax can masquerade as a tension pneumothorax. The diagnosis is made by a high level of clinical suspicion, chest X-ray shows a distended stomach with air fluid levels and a computerised tomography is useful in assessing the diaphragm and establishing the positions of the various intra-abdominal organs. Also, the risk of an intercostal drainage tube placement and the role of nasogastric tube in avoiding the development of a tension gastrothorax is highlighted

Bleeding in the lung complicates a routine intracardiac repair: What went wrong!!!

Cyanotic congenital heart disease presents an increased tendency to bleed in view of subtle coagulation defects. Airway bleeding can be particularly difficult to manage while maintaining an adequate ventilation. An isolated lung bleed with the exclusion of possible traumatic, medical and surgical causes of bleeding, should alert the attending anesthesiologist to the possibility of the collateral-related bleeding. Preoperative coil embolization remains an important initial management step in a case of tetralogy of Fallot (TOF) with major aortopulmonary collaterals. Nevertheless, the coiling of the collaterals in certain specific case scenarios is not feasible, rendering the management of a lung bleed, all the more challenging. We, hereby discuss a case of a 7-year-old girl with a massive endotracheal bleed at the time of weaning from cardiopulmonary bypass after corrective surgery for TOF. The subsequent approach and management are discussed. The optimal management of tetralogy with collaterals mandates an effective communication among the cardiologist, radiologist, anesthesiologist, and the surgeon

Gastrothorax or tension pneumothorax: A diagnostic dilemma

Gastrothorax, a rare complication following thoracoabdominal aortic aneurysm repair, is reported. The clinical features of a gastrothorax and tension pneumothorax are similar and thus, a gastrothorax can masquerade as a tension pneumothorax. The diagnosis is made by a high level of clinical suspicion, chest X-ray shows a distended stomach with air fluid levels and a computerised tomography is useful in assessing the diaphragm and establishing the positions of the various intra-abdominal organs. Also, the risk of an intercostal drainage tube placement and the role of nasogastric tube in avoiding the development of a tension gastrothorax is highlighted