A new association of multiple congenital anomalies/mental retardation syndrome with bradycardia-tachycardia syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Congenital bradycardia-tachycardia syndrome is a rare disorder. Its association with multiple congenital anomalies/mental retardation (MCA/MR) syndrome is exceptional.</p> <p>Case presentation</p> <p>We report a case of a new association of MCA/MR with bradycardia-tachycardia syndrome in an 18-year-old Indian man. This syndrome is characterized by mental retardation with delayed development of milestones, progressive scoliosis, cryptorchidism, asymmetrical limbs involving both the upper and lower limbs, sleep apnea syndrome, bradycardia-tachycardia syndrome and Dandy-Walker syndrome. Our patient was admitted for septoplasty with adenoidectomy. Patients with MCA/MR with bradycardia-tachycardia syndrome pose a unique challenge to the anesthesiologist. Establishing a good rapport with these patients is imperative. In addition to that, the anesthesiologist should anticipate the difficulty in intubation and rhythm abnormalities during the peri-operative period. Bradycardia or sinus arrest is a well-known complication during the induction and maintenance of anesthesia. Lignocaine should be used with caution in patients with bradycardia-tachycardia syndrome. Monitoring of ventilation parameters (end-tidal CO₂, SPO₂, airway pressure) is essential as these patients are prone to develop pulmonary artery hypertension secondary to sleep apnea syndrome.</p> <p>Conclusion</p> <p>Based on our clinical experience in detailed pre-operative evaluation and planning, we would emphasize peri-operative anticipation and monitoring for dysrhythmias in patients with MCA/MR and bradycardia-tachycardia syndrome undergoing any surgical procedure.</p

Do we need a pulmonary artery catheter in cardiac anesthesia? - An Indian perspective

There has been considerable controversy regarding the use of pulmonary artery catheter (PAC) in clinical practice. Some studies have indicated poor outcome in patients who were monitored with PAC. However, these studies, which have condemned the use of PAC, were conducted on patients in intensive care units, where the clinical scenarios with regard to patients&#x2032; status are somewhat different as compared to those of a cardiac operating room. This study was designed to identify the indications of PAC use in cardiac operating rooms. A questionnaire was mailed to anasthesiologists in cardiac centers and the response was analyzed.The practicing cardiac anesthesiologists recommended the use of PAC for following indications in cardiac surgery: coronary artery bypass grafting (CABG) with poor left ventricular (LV) function, LV aneurysmectomy, recent myocardial infarction (MI), pulmonary hypertension, diastolic dysfunction, acute ventricular septal rupture and insertion of left ventricular assist device (LVAD).The analysis of responses from practicing anesthesiologists clearly indicates that use of a PAC cannot be recommended as a matter of routine, but a definite role is suggested in selected groups of patients undergoing cardiac surgery

Continuous Cardiac Output Measurement during Off-Pump Coronary Artery Bypass Grafting: Radial Arterial Pulse Wave versus Femoral Arterial Pulse Wave

Background and Objectives Measurement of cardiac output (CO) during off-pump coronary artery bypass grafting (OP-CABG) is useful to assess the impact of displacement of heart during surgery. FloTrac uses the pulse-contour analysis algorithm to derive stroke volume (SV) and CO. This study was aimed to determine whether the site of monitoring of arterial pressure influences the CO measurement using Flotrac/Vigileo. Methods The authors recorded 75 sets of observations in 15 patients who underwent elective OP-CABG. Each patient had the radial and femoral artery cannulated and connected to FloTrac/Vigileo. The hemodynamic parameters were monitored at specified points of time intraoperatively. Results The CO, cardiac index, SV, stroke volume index, and stroke volume variation measured from radial artery did not differ from those of femoral artery at all points of measurement. Conclusion Either of the sites of monitoring of arterial pressure (namely radial and femoral artery) is acceptable for monitoring CO during OP-CABG

Neutrophil Gelatinase-associated Lipocalin as a Biomarker for Predicting Acute Kidney Injury during Off-pump Coronary Artery Bypass Grafting

Background: Acute kidney injury (AKI) following cardiac surgery is a major complication resulting in increased morbidity, mortality, and economic burden. In this study, we assessed the usefulness of estimating serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker in predicting AKI in patients with stable chronic kidney disease (CKD) and undergoing off-pump coronary artery bypass grafting (OP-CABG). Patients and Methods: We prospectively studied sixty nondialysis-dependent CKD patients with estimated glomerular filtration rate <60 ml/min/1.73 m2 who required elective OP-CABG. Patients were randomized into two groups, Group D received dopamine infusion at 2 μg/kg/min following anesthesia induction till the end of the surgery and Group P did not receive any intervention. Serum creatinine, NGAL, brain natriuretic peptide, and troponin-I were estimated at specified intervals before, during, and after surgery. The results of the study patients were also compared to a simultaneous matched cohort control of thirty patients (Group A) without renal dysfunction who underwent OP-CABG. Results: No patient required renal replacement therapy, and no mortality was observed during perioperative and hospitalization period. Six patients from control group (n = 30), ten patients from placebo group (n = 30), and 12 patients from dopamine group (n = 30) developed stage 1 AKI. However, we did not observe any stage 2 and stage 3 AKI among all the groups. There was a significant increase in serum NGAL levels at the end of surgery and 24 h postoperatively in placebo and dopamine groups as compared to the control. Conclusion: The measurement of NGAL appears to predict the occurrence of AKI after OP-CAB surgery. However, large multicentric studies may be required to confirm the findings of this study