CONTEXT:Patients receive preoperative information about possible postoperative complications, but little is known about how they perceive this information or how they understand the consequences when complications occur. AIM:This study explored how patients who experienced postoperative complications perceived preoperative information and how they understood the potential impact of those complications on their well-being. MATERIALS AND METHODS:A qualitative study was conducted with patients who had undergone elective coronary artery bypass grafting or valve surgery and experienced a postoperative complication (Clavien-Dindo ≥≥3B). A qualitative researcher conducted semi-structured telephone interviews. Thematic analysis was used to identify recurring themes. RESULTS:Eight patients were interviewed. The most common complication was postoperative hemorrhage requiring rethoracotomy (n = 7). Six themes were identified: (1) Negative perceptions of risk communication, (2) Need for personalized aftercare, (3) Inadequate validation of emotional experiences, (4) Unawareness of perioperative information, (5) Diversity in patients' functioning and impact of complications, and (6) Discontinuity of care. Patients need a comprehensive explanation of complications that occurred, partly because they did not fully understand the consequences. Patients and family members needed emotional support during the perioperative period. Patients preferred follow-up care by the same physician within the same hospital. CONCLUSION:Patients who experienced complications after cardiac surgery expressed a desire for more detailed discussions of complications and their consequences, increased emotional support, and continuity of care. Potential improvements in perioperative care in this specific patient group could include debriefing of complications, providing psychological support, and offering video or phone consultations.
ABSTRACT Morquio syndrome is a lysosomal storage disease that can lead to glycosaminoglycan deposition in the tissues. Skeletal deformities, cardiovascular complications, and airway abnormalities are well-recognized in this condition, specifically owing to thickened mucosa and epiglottis, making fiberoptic-guided intubation less successful. Our patient had severe aortic regurgitation and was posted for aortic valve replacement. Anesthetic challenges encountered during the management of the case, and a different approach to airway management are highlighted in this report. With increased survival of patients affected with Morquio syndrome, cardiac anesthesiologists might see an increasing number of similar patients requiring corrective cardiac surgery.
CONTEXT:Inflammatory and oxidative stress responses are markedly amplified following cardiopulmonary bypass (CPB), contributing to myocardial injury, vascular dysregulation, and potential multiorgan dysfunction. AIMS:This study aimed to define how inflammatory, oxidative, and cellular stress responses quantified by tumor necrosis factor-alpha (TNF-α), hydroxyl (OH-) radical scavenging capacity, and heat shock protein-70 (HSP-70) relate to early postoperative myocardial contractility, arterial tone, and vasoactive-inotropic requirements after CPB. SETTINGS AND DESIGN:A prospective cohort study was conducted in patients undergoing coronary artery bypass grafting (CABG) with preserved preoperative ejection fraction (EF). METHODS AND MATERIALS:Postoperative biomarker levels and perioperative changes in TNF-α, OH- scavenging capacity, and HSP-70 with early myocardial contractility maximum rate of rise of left ventricular pressure (dP/dtmax), arterial elastance, and vasoactive-inotropic score were assessed. STATISTICAL ANALYSIS USED:Correlation analyses were performed using Pearson's or Spearman's correlation coefficients as appropriate. RESULTS:A total of 52 patients were included in the study. Higher postoperative HSP-70 levels were associated with reduced early myocardial contractility (r = -0.315; P = 0.025) and increased vasoactive-inotropic requirements (ρ =0.341; P = 0.014). No significant associations were observed among postoperative biomarker variables, and changes in TNF-α or OH- scavenging capacity were not related to early postoperative hemodynamic outcomes (all P > 0.05). CONCLUSIONS:Early post-CPB myocardial dysfunction appears more closely associated with cellular stress (HSP-70) than with inflammatory or oxidative responses. Elevated HSP-70 levels in the early postoperative CABG may act as damage-associated molecular patterns associated with transient myocardial depression and higher vasoactive-inotropic requirements, whereas early inflammatory and oxidative changes showed no direct hemodynamic correlation.
Background:Cardiopulmonary bypass (CPB) during cardiac surgery poses physiological challenges such as altered drug pharmacokinetics. Sevoflurane, a commonly used volatile agent, provides favorable myocardial protection; however, precise dosing during CPB remains difficult. Entropy monitoring, which assesses cerebral and electromyographic activity, offers real-time guidance on anesthetic depth. This study aimed to investigate entropy-guided sevoflurane administration relation with end-oxygenator sevoflurane concentrations, in patients undergoing elective on-pump cardiac surgery.Materials and Methods:A prospective, randomized controlled trial was conducted in a single tertiary care center affiliated with a teaching hospital, enrolling 74 adult patients scheduled for elective on-pump cardiac surgeries. Participants were randomized into two groups: fixed sevoflurane concentration (1.5% v/v) and entropy-guided sevoflurane titration. Depth of anesthesia was monitored with state entropy (SE) and response entropy (RE), end-oxygenator sevoflurane concentrations, and clinical parameters.Results:Compared to the fixed-dose group, the entropy-guided group exhibited lower SE and RE values intraoperatively, indicating tighter control of anesthetic depth. Higher sevoflurane dial settings were used initially in the entropy group, resulting in higher end-oxygenator concentrations. Although mean arterial pressure and arterial blood gas parameters remained within acceptable ranges in both groups, VIS was higher in the entropy-guided group, suggesting an increased requirement for vasoactive and inotropic support. There was no statistically significant variation in postoperative mechanical ventilation duration or intensive care unit stay between the two groups.Conclusion:Overall, entropy monitoring facilitated a precise titration of sevoflurane without adversely affecting immediate postoperative outcomes.
ABSTRACT Right atrial appendage aneurysm (RAAA) is a rare cardiac anomaly, predominantly considered congenital, resulting from dysplasia or localized absence of atrial myocardium leading to thinning and aneurysmal dilation. However, this case highlights the possibility of an acquired mechanism, particularly in the context of chronic infectious and inflammatory conditions such as tuberculosis (TB), which may have contributed to aneurysm formation in this patient. The patient’s presentation with the left-sided chest pain and weight loss in the setting of active pulmonary TB raises clinical suspicion of an infectious etiology contributing to atrial wall weakening. Histopathological examination of the excised aneurysmal wall and thrombus was instrumental in confirming the diagnosis and etiopathogenesis. Surgical excision of the aneurysm and thrombus remains the cornerstone of management in symptomatic or complicated RAAA, particularly with chamber compression or thromboembolism risk. In this patient, postoperative recovery was uneventful, and continuation of anti-tubercular therapy was crucial to eradicate residual infection and prevent recurrence. Serial follow-up demonstrated no residual aneurysm or thrombus, stable right atrial and ventricular dimensions, and preserved cardiac function. The patient remained symptom-free without arrhythmias or embolic events, underscoring the importance of vigilant postoperative surveillance. This case not only broadens the differential for RAAA etiology to include infectious causes like TB, but also highlights the integral role of histopathological diagnosis and sustained postoperative monitoring for optimal patient outcomes.
ABSTRACT Individuals requiring transplantation represent the sickest cohort of patients with end-stage lung failure. Commonly, they have multiple comorbidities that carry significant risk for post-transplant recovery. Clinical circumstances, such as widespread clots and vascular thrombosis, require novel approaches in attempt to provide extracorporeal life support. We present a patient, who developed respiratory failure during recovery from bilateral lung transplantation, complicated by internal jugular vein thrombosis and an inferior vena cava filter in situ . She was cannulated with a ProtekDuo via the right external jugular vein due to lack of other patent vessels, representing a first in man method description.
ABSTRACT We present a challenging case of a high-grade spindle cell sarcoma originating in the right lung with intracardiac extension to the left atrium and left ventricle via the pulmonary veins, complicated by aorto-iliac thromboembolism. An 18-year-old male presented with sudden-onset bilateral lower limb weakness, low-grade fever, cough, and breathlessness. Computed tomography imaging revealed a large mediastinal mass with intracardiac extension and an infrarenal aortic thrombus. A multidisciplinary team performed a successful single-stage procedure involving excision of the intracardiac tumor via median sternotomy under cardiopulmonary bypass, right pneumonectomy under total circulatory arrest, and bilateral transfemoral embolectomy. Histopathology confirmed a high-grade spindle cell sarcoma with negative surgical margins. This case highlights the importance of a collaborative team approach, vigilant intraoperative monitoring, and the strategic use of circulatory arrest in managing complex thoracic tumors with intravascular extension.
ABSTRACT Coronary stent infective endocarditis (IE) is a rare but serious complication of percutaneous coronary intervention. Extension to adjacent valvular structures, particularly causing cusp perforation of the aortic valve, is exceedingly uncommon. Intraoperative transesophageal echocardiography (TEE) may reveal complications not detected preoperatively, thereby changing surgical plans. We report a patient who underwent coronary angioplasty followed by persistent fever and suspicion of stent infection. Angiography detected stent related left anterior descending artery aneurysm and preoperative plan for stent explantation and revascularization was made. However, on the operating table, intraoperative TEE demonstrated perforation of the right coronary cusp of the aortic valve with severe aortic regurgitation. Surgical strategy was modified to include stent explantation, coronary artery bypass graft (CABG), and aortic valve replacement. The stent specimen showed evidence of infection. The patient’s postoperative course was favorable under targeted antibiotic therapy. This case illustrates how intraoperative TEE can uncover unanticipated valvular destruction in stent-related IE and meaningfully alter surgical decision-making. Early recognition, imaging vigilance, and flexibility in surgical planning are essential in management of such rare but high-risk complications.
ABSTRACT This case report describes the successful perioperative anesthetic management of a 60-year-old woman with Mayo Level IV clear cell renal cell carcinoma and sickle cell trait who underwent radical nephrectomy, inferior vena cava thrombectomy, and right atrial thrombus excision under cardiopulmonary bypass. The anesthetic challenges included a large intracardiac mass with a high probability of producing mechanical obstruction across the right ventricular inflow and embolization, risk of massive hemorrhage, and perioperative concerns related to sickle cell trait. Intraoperative transesophageal echocardiography helped in thrombus surveillance, vascular access, cannulation guidance, and tumor clearance verification. Surrogate markers identified a subclinical hemolytic event.
ABSTRACT This case report tells the story of a 36-year-old overweight male with suspected myocarditis, who goes into cardiac arrest, and is subsequently transported to a heart center for extracorporeal membrane oxygenation. Mechanical support was established and running until distal limb perfusion was attempted. It is suspected that an aspired guidewire of a central venous catheter placed with the Seldinger technique was aspired and eventually obstructed the impeller of the centrifugal pump.
ABSTRACT This case report discusses the anesthetic management of a 47-year-old female with recurrent adenocystic carcinoma of the trachea and dilated cardiomyopathy (DCMP) undergoing tracheal tumor debulking and stenting. The patient experienced hemodynamic collapse due to failed expiration during ventilation using a Ventrain device, necessitating a return to spontaneous bag-mask ventilation and an urgent tracheostomy to maintain the airway.
