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January-June 2007 Volume 10 | Issue 1
Page Nos. 13-71
Online since Tuesday, January 8, 2008
Accessed 86,206 times.
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EDITORIAL |
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IT empowered anaesthesiologist |
p. 13 |
Anil Karlekar DOI:10.4103/0971-9784.37919 PMID:17455403 |
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REVIEW ARTICLE |
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Pathophysiology of congenital heart diseases  |
p. 19 |
Devyani Chowdhury DOI:10.4103/0971-9784.37920 PMID:17455404 |
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ORIGINAL ARTICLES |
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Efficacy of combined modified and conventional ultrafiltration during cardiac surgery in children |
p. 27 |
Naresh Kumar Aggarwal, Sambhu Nath Das, Gautam Sharma, Usha Kiran DOI:10.4103/0971-9784.37921 PMID:17455405 Thirty children undergoing cardiac surgery under cardiopulmonary bypass (CPB) were prospectively studied to assess beneficial effects of modified ultrafiltration (MUF) over and above conventional ultrafiltration (CUF). Transoesophaegeal echocardiography determined ejection fraction (EF), fractional area change (FAC) and posterior wall thickness in end-diastole and end-systole were measured and compared in two groups undergoing CUF (group I) and CUF plus MUF (group II). Haemodynamic data, haematocrit, temperature drift, postoperative chest tube drainage in first 48 hours, ventilation and intensive care unit (ICU) stay were also recorded. Within group data were analysed by general linear trend and intergroup comparisons were made with t-test. EF and FAC decreased at 0 min after CPB in both groups, but both recovered at 10 and 30 min after CPB in group II. Increase in EF and FAC in group II was about 12-15 % and 3-5 % from 0 min respectively. There was also significant improvement in posterior wall thickness and haematocrit (P<0.05) in group II. Patients in group II maintained better systolic blood pressure and heamoglobin after CPB. Chest tube drainage in first 48 hours was significantly less in group II (100 ±18 verses 85 ± 20 ml, P<0.05), but ventilation and ICU stay were not different between the two groups. Combined ultrafiltration has beneficial effect an haemodynamics with improvement in EF and FAC. It improves haematocrit and decreases chest pulse drainage. |
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Treating metabolic impairment and myocardial stunning with phosphodiesterase inhibitor type III, milrinone, administered prior to coronary artery occlusion in the presence of calcium channel blockade in pigs |
p. 34 |
Avner Sidi, Jochen D Muehschlegel, David S Kirby, Emilio B Lobato DOI:10.4103/0971-9784.37922 PMID:17455406 This study examined milrinone effects on ischaemic myocardial metabolism and function with calcium blockade. We studied 15 pigs in 3 groups: group C received no drugs; group D received diltiazem 5 mg bolus followed by infusion; group D+M received diltiazem and milrinone (50 µg/Kg). The left anterior descending (LAD) artery was then occluded for 15 minutes. Left ventricular (LV) function data obtained included rate, pressures, output, Emax, and dP/dT. Blood lactate was obtained from the LAD and circumflex vessels at baseline, end of occlusion, early (15 min) and late (1 hour) reperfusion. In group D+M, less depression of LV function occurred during ischaemia and early reperfusion. Lactate extraction in the LAD region was less negative in D+M group than in the group without milrinone during ischaemia and late reperfusion. We conclude the preemptive administration of milrinone prior to ischaemia added to calcium blockade improved myocardial function and ischaemic metabolic effects. |
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Comparison of analgesic efficacy of fentanyl and sufentanil for chest tube removal after cardiac surgery |
p. 42 |
VS Joshi, Sandeep Chauhan, Usha Kiran, AK Bisoi, Poonam Malhotra Kapoor DOI:10.4103/0971-9784.37923 PMID:17455407 Chest tube removal in the postcardiac surgical patients is a painful and distressful event. Fentanyl and sufentanil have not been used for pain control during chest tube removal in the postoperative period. We compared efficacy of fentanyl and sufentanil in controlling pain due to chest tube removal.
One hundred and forty one adult patients undergoing cardiac surgery were recruited in a prospective, randomized, double blind, placebo controlled study. Patients were randomized to receive either 2 µg/Kg fentanyl IV or 0.2 µg/Kg sufentanil IV or 2 ml isotonic normal saline, 10 min before removing chest tubes. Pain intensity was assessed by measuring visual analog scale pain score 10 minutes before removing chest tubes and 5 min and 20 min after removing chest tubes. Level of sedation, heart rate, arterial pressure, oxygen saturation, and respiratory rate were recorded by a blinded observer at the same time intervals.
Mean pain intensity scores 10 minutes before removal of chest tubes in fentanyl, sufentanil and control groups were 23.88±5.2, 25.10±5.39 and 23.64±6.10 respectively. The pain scores 5 minutes after chest tube removal were reduced to 20.11±6.9 (p<0.05) in the fentanyl group and 13.60±6.60 (p<0.05) in the sufentanil group, whereas in control group pain scores increased to 27.97±8.39 (p<0.05). The pain scores in sufentanil group were significantly lower compared with fentanyl or control group. Sedation scores remained low in all groups and patients remained alert and none of the patients showed any adverse effects of opioids. Heart rate, arterial pressure and respiratory rate had least variations in sufentanil group than fentanyl or control group. |
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Comparison of sevoflurane and isoflurane in OPCAB surgery |
p. 46 |
BG Venkatesh, Yatin Mehta, Anand Kumar, Naresh Trehan DOI:10.4103/0971-9784.37924 PMID:17455408 Maintenance of anaesthesia with volatile anaesthetic agents affects the perioperative course of patients undergoing off-pump coronary artery bypass (OPCAB) surgery. This facilitates adequate depth of anaesthesia, reduction in need of analgesic dosage, early extubation and transfer from Intensive Care Unit. We compared two volatile anaesthetic agents sevoflurane and isoflurane in terms of haemodynamic effects, amount of analgesic needed during surgery, quantity of agent needed for maintenance of anaesthesia and postoperative recovery in 40 patients undergoing OPCAB surgery. Anaesthesia was induced with fantanyl, midazolam and thiopentone, and vecuronium was used for muscle relaxation. An Octopus stabiliser was used and coronary anastomosis was performed using internal mammary artery and saphenous vein grafts. Routine monitoring was performed. The depth of anaesthesia was monitored using Bispectral index monitor. The inspired/expired concentration of anaesthetic agents to maintain the desired BIS and the amount of volatile anaesthetic agent needed was also noted. The amount of analgesic used intraoperatively was noted in both the groups. The 'time of awakening' defined as eye opening on verbal commands, and time of extubation were noted. There were no differences in haemodynamic parameters, depth of anaesthesia, and quantity of agent needed, but patients in isoflurane group required more intraoperative analgesics than sevoflurane group. Time of awakening (48 ± 13 vs 114 ± 21 mins; P < 0.001) and subsequent extubation (124 ± 25 vs 177 ± 36 mins, P<0.001) was earlier in sevoflurane group than isoflurane group. There was no evidence of perioperative myocardial infarction in both the groups. We conclude that sevoflurane and isoflurane can both be safely used in OPCAB surgery, but the awakening and extubation times are significantly less with sevoflurane. |
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CASE REPORTS |
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Inhaled prostacyclin for the management of pneumonia in a patient with cyanotic heart disease with superior cavo-pulmonary connection |
p. 51 |
John G Augoustides, Ibrahim Abdullah, Alberto Pochettino, C William Hanson DOI:10.4103/0971-9784.37925 PMID:17455409 |
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Off-pump coronary artery bypass grafting in a polycythaemic patient - case report and review of literature |
p. 54 |
Dheeraj Arora, Rajiv Juneja, Dinesh Pendarkar, Yatin Mehta, Naresh Tehran DOI:10.4103/0971-9784.37926 PMID:17455410 |
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Increased prothrombin time and lactic acidosis: Rofecoxib drug interaction with acenocoumarin and metformin |
p. 58 |
Prabhat Tewari, Soumya Sankar Nath, Gauranga Mazumdar DOI:10.4103/0971-9784.37927 PMID:17455411 |
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INTERESTING CARDIOTHORACIC IMAGE |
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Absent left main coronary artery |
p. 61 |
Sanjay Goel, Achal Dhir DOI:10.4103/0971-9784.37928 PMID:17455412 |
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Choardae tendineae from posteromedial papillary muscle inserting into the anterior mitral leaflet - an unusual presentation |
p. 63 |
Deepak K Tempe, Vishnu Datt, Amit Banerjee, Ashish Gandhi DOI:10.4103/0971-9784.37929 PMID:17455413 |
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LETTER TO THE EDITOR |
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An unusual tracheal intubation in a patient with tracheo-oesophageal fistula |
p. 64 |
SK Mathur, Shahnaz Ahmad, Rampal Singh, P Bhaskar Rao, D Agarwal DOI:10.4103/0971-9784.37930 PMID:17455414 |
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TUTORIAL |
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Anaesthesia for off-pump coronary artery surgery |
p. 65 |
Sanjula Virmani, Deepak K Tempe DOI:10.4103/0971-9784.37931 PMID:17455415 |
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