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Background: Chronic postsurgical pain (CPSP) worsens patients' mortality, morbidity, and quality of life. Cardiopulmonary bypass is mandatory for cardiac surgery, but it induces intense inflammation. The presence of inflammation is a crucial part of pain sensitization. An extreme inflammatory response due to cardiopulmonary bypass might cause a high prevalence of CPSP after cardiac surgery. We hypothesized that the prevalence and severity of CPSP are higher in patients after on-pump coronary artery bypass graft (CABG) surgery than in those after off-pump CABG surgery. Methods: This prospective, observational study was performed on a cohort from a randomized trial (on-pump CABG: 81 patients, off-pump CABG: 86 patients). A questionnaire about the severity of surgical wound pain that evaluated pain with the numerical rating scale (NRS) was filled out by the patients. NRS responses for current pain, peak pain in the last 4 weeks, and average pain in the last 4 weeks were evaluated. The main outcomes were the severity of CPSP as evaluated using the NRS and the prevalence of CPSP. CPSP was defined as pain with an NRS score > 0. Differences in severity between groups were analyzed using multivariate ordinal logistic regression models adjusted for age and sex, and differences in prevalence between groups were analyzed using multivariate logistic regression models adjusted for age and sex. Results: The questionnaire return rate was 77.0%. During a median follow-up of 17 years, 26 patients complained of CPSP (on-pump CABG: 20 patients, off-pump CABG: 6 patients). Ordinal logistic regression showed that the NRS response for current pain (odds ratio [OR] 2.34; 95% CI 1.12–4.92; P = 0.024) and the NRS response for peak pain in the last 4 weeks (OR 2.71; 95% CI 1.35–5.42; P = 0.005) were significantly higher in patients who underwent on-pump CABG surgery than in those who underwent off-pump CABG. Logistic regression showed that on-pump CABG surgery was an independent predictor of CPSP (OR 2.59; 95% CI 1.06–6.31; P = 0.036). Conclusions: The prevalence and severity of CPSP are higher in patients with on-pump CABG surgery than in those with off-pump CABG surgery. [ABSTRACT FROM AUTHOR]

Measuring regional cerebral blood flow (rCBF) after revascularization for moyamoya disease, as a type of ischemic cerebrovascular disease, is crucial. This study aims to validate our novel technology that combines near-infrared spectroscopy (NIRS) with a frequency filter to extract the arterial component. We measured rCBF before and after revascularization for moyamoya disease and at the end of the surgery using NIRO-200NX (Hamamatsu Photonics, Japan) and indocyanine green (ICG). rCBF was calculated using Fick's principle, change in arterial ICG concentrations, and maximum arterial ICG concentration. rCBF measured with NIRS (rCBF_N) was compared with pre- and postoperative rCBF measured with SPECT (rCBF_S). Thirty-four procedures were analyzed. rCBF_N increased from baseline to end of the surgery (mean difference (MD), 2.99 ml/min/100 g; 95% confidence interval (CI), 0.40–5.57 ml/min/100 g on the diseased side; MD, 4.94 ml/min/100 g; 95% CI, 2.35–7.52 ml/min/100 g on the non-diseased side). Similar trends were observed for rCBF_S (MD, 3.98 ml/min/100 g; 95% CI, 2.30–5.67 ml/min/100 g on the diseased side; MD, 2.77 ml/min/100 g; 95% CI, 1.09–4.45 ml/min/100 g on the non-diseased side). Intraclass correlations 3 (ICC3s) between rCBF_N and rCBF_S were weak on the diseased side (ICC3, 0.25; 95% CI, -0.03–0.5; p = 0.07) and the non-diseased side (ICC3, 0.24; 95% CI, -0.05–0.5; p = 0.08). rCBF measurements based on this novel method were weakly correlated with rCBF measurements with SPECT. [ABSTRACT FROM AUTHOR]

Background: Chronic postsurgical pain (CPSP) is defined as chronic pain that develops or increases in intensity after a surgical procedure and persists beyond the healing process, defined as at least 3 months postoperatively. However, the rationale behind this time period is weak. Methods: This prospective observational study included a total of 238 consecutive patients who underwent mitral valve repair via thoracotomy. A questionnaire consisting of a numerical rating scale (NRS) to assess the severity of postsurgical pain was mailed to each participant more than 3 months after the operation. The outcomes of interest were current pain, peak pain in the last 4 weeks, and average pain in the last 4 weeks, each assessed using the NRS. The nonlinear associations between the elapsed time after surgery and the intensity of CPSP were evaluated. All statistical analyses were performed with a two-sided significance level of 5%. Results: Two-hundred and ten patients (88.2%) answered the questionnaire. There was a significant nonlinear association between the elapsed time after surgery and each NRS response (all, P < 0.05). The lowest adjusted log odds of current pain, peak pain in the past 4 weeks, and average pain in the past 4 weeks were − 1.49, − 1.13, and − 1.26 at 33, 33, and 33 months postoperatively, respectively. Conclusions: There was a significant U-shaped association between the elapsed time after surgery and intensity of CPSP. The adjusted log odds of each NRS response was lowest at 33 months after cardiac surgery via thoracotomy. [ABSTRACT FROM AUTHOR]

Background: In minimally invasive cardiac surgery (MICS) and extracorporeal membrane oxygenation (ECMO), a guidewire is inserted from the femoral vein (FV) into the right atrium. However, rarely, the guidewire or catheter strays into the hepatic vein (HV) because of the inferior vena cava (IVC)-HV angle. We report two cases in which a guidewire and venous cannula from the FV strayed into the HV, likely owing to a Eustachian valve. Case presentation: Both patients were women who underwent transesophageal echocardiography-guided FV cannulation. In case 1, a guidewire from the FV strayed into the HV owing to a Eustachian valve. In case 2, ECMO was established postoperatively. Transthoracic echocardiography confirmed the venous cannula had strayed into the HV. Computed tomography indicated IVC-HC angles of 129° (case 1) and 102° (case 2). Conclusion: A Eustachian valve can impede devices inserted from the FV and even allow them to stray into the HV. [ABSTRACT FROM AUTHOR]

Background: Anesthesiologists monitor electroencephalography (EEG) intraoperatively to maintain adequate depth of anesthesia. However, the EEG signal is affected by noise and interference. The SedLine® is a brain function monitor with which the Patient State Index (PSI) is calculated. In this study, we report abnormally high PSI values associated with epicardial pacing during open heart surgery. Case presentation: A 50-year-old man was scheduled for total arch replacement. Atrial demand pacing was started before weaning from cardiopulmonary bypass. The PSI increased from 30 to 80 soon after the start of pacing, and the EEG waveform showed spikes synchronized with the pacing. As the pacing output was lowered, the spikes on the EEG attenuated and disappeared, and the PSI decreased to < 40. When the pacing output was increased again, the spikes recurred, and the PSI increased again. Conclusions: Pacemaker spikes may cause contamination of the EEG, resulting in abnormally high PSI values. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery in frail patients has been reported to be associated with increased mortality and morbidity but may improve functional status of frail patients. Few studies have investigated the impact of cardiac surgery on the trajectory of postoperative frailty. We hypothesized that cardiac surgery in frail patients would improve frailty postoperatively. Method: This study included 71 patients over 65 years old who were scheduled for cardiac surgery via sternotomy or thoracotomy. Frailty was prospectively evaluated using the Kihon Checklist (KCL) at 1 and 3 months postoperatively. Patients were divided into three groups based on the preoperative KCL score: nonfrail, prefrail, and frail. The interaction between the degree of preoperative frailty and the trajectory of postoperative KCL scores was assessed. Results: The KCL score changed significantly over time (P < 0.001), and the KCL score trajectory differed significantly according to the degree of preoperative frailty (P for interaction = 0.003). In the frail group, the KCL score was significantly lower 3 months postoperatively than preoperatively (median 8, interquartile range [5, 9] versus median 9, interquartile range (9, 13), P = 0.029). Conclusion: The trajectory of postoperative KCL scores differed significantly depending on the degree of preoperative frailty. At 3 months after cardiac surgery, the KCL score of frail patients was significantly improved, while that in nonfrail patients was significantly deteriorated. [ABSTRACT FROM AUTHOR]

Background: Previous studies showed that the mitral inter-commissural (IC) distance differed by a few millimeters between the systolic and diastolic cardiac cycles. However, sizing of the mitral annuloplasty ring with a ring sizer, which should be performed in the systole, is performed in diastole during hyperkalemic cardioplegic arrest. The aim of this study was to investigate whether three-dimensional transesophageal echocardiography (3D-TEE) measurements of the mitral valve in end-systole are effective to determine the size of the annuloplasty ring. Methods: This study retrospectively reviewed 92 patients who underwent mitral annuloplasty for degenerative. The IC distance and anterior leaflet height of the A2 segment of the mitral valve were measured by 3D-TEE at the end-systole. The annuloplasty ring size was measured by the surgeons using specific ring sizers. We compared the IC distance measured by 3D-TEE with the implanted annuloplasty size. We also investigated differences in IC distance, A2 height, and ratio of A2 height to IC distance in patients with and without recurrent mild to moderate MR for 36 months. Results: There was a significant correlation between the IC distance by 3D-TEE and the implanted ring size (R2 = 0.7023, p < 0.001). Eight cases had mild or greater recurrent MR. There was a significant difference in the ratio of A2 height to IC distance between patients with and without recurrent MR (p = 0.006). A2 height was greater in patients with recurrent MR, but this difference was not significant (p = 0.059). Conclusions: Our results demonstrated a larger ratio of A2 height to IC distance in patients with recurrent MR. 3D-TEE could be useful for the ring sizing. [ABSTRACT FROM AUTHOR]

Background: There is no fully recommended methodology for surgery for Barlow's disease. Various methods have been proposed. The aim of this study was to investigate the effectiveness of transesophageal echocardiography (TEE) measurements for selecting the optimal annuloplasty ring size and determining the length of artificial chordae in patients with Barlow's disease who underwent robot-assisted mitral valvuloplasty (R-MVP). Methods: Ten patients were included. Before R-MVP, the anesthesiologist used TEE to predict the optimal annuloplasty ring size and artificial chordae lengths that would reduce mitral regurgitation. The anesthesiolosist's predict ring size was not presented to the surgeon intraoperatively. Results: In 70% (7/10) of cases, the surgeon performed mitral valve repair in full match with the anesthesiologist's repair plan. Mitral regurgitation was controlled in 85% (6/7) of cases. In three cases, the predict annuloplasty ring size and artificial chordae length were not match between anesthesiologist and surgeon. After the operation, 90% (9/10) of patients had no residual mitral regurgitation. Conclusions: Anesthesiologist's TEE measurements were useful for selecting the optimal annuloplasty ring size and artificial chordae length during R-MVP. TEE can play an important role in robot-assisted, minimally invasive cardiac surgery for mitral regurgitation with extensive and complex prolapse, such as in Barlow's disease. [ABSTRACT FROM AUTHOR]

Background: The number of elderly patients undergoing elective as well as emergent cardiac surgery is increasing. Octogenarian and older patients undergoing surgery for acute type A aortic dissection (AAD) have a significantly higher risk of postoperative mortality than younger patients. Hemostasis is difficult in octogenarians with AAD. However, few studies have investigated perioperative blood transfusion volumes and hemostatic conditions in patients undergoing AAD surgery. We retrospectively investigated whether these factors differed between octogenarians and younger patients with AAD. Methods: The records of 207 patients who underwent emergency surgery for AAD were reviewed between 2008 and 2014. We compared the total volumes of transfused blood components (red blood cell concentrate, fresh frozen plasma, platelets concentrate, and cryoprecipitate), perioperative blood coagulation test results (prothrombin time-international normalized ratio, activated partial thrombin time, and activated coagulation time), and intensive care unit and hospital stay durations between octogenarians (n = 33) and patients < 80 years old (n = 170). Results: A significantly greater volume of red blood cell concentrates was transfused in octogenarians than in patients < 80 years old. Isolated prolonged activated partial thromboplastin time was observed in octogenarian patients. Duration of hospital stays was significantly longer in octogenarians than in patients < 80 years old. Conclusions: Octogenarians required more red blood cells during surgery for AAD and exhibited isolated APTT prolongation. [ABSTRACT FROM AUTHOR]

Background: Impella® is an antegrade left ventricular assist device with a pump catheter in the left ventricle. We report three cases in which we experienced some pitfalls with circulatory management during Impella placement due to new-onset aortic insufficiency (AI) associated with device placement or the limited maximum flow rate. Case presentation: Three patients developed new-onset AI due to Impella placement. In a patient, the total assisted flow rate was relatively low because of his large body size. In the other patients, in whom the Impella device was used in combination with percutaneous cardiopulmonary support or venoarterial extracorporeal membrane oxygenation (ECMELLA), total flow was maintained at a sufficient level. Conclusions: New-onset of AI after Impella placement and its limited flow rate are considered to be pitfalls in circulatory management. Management with ECMELLA is considered to be effective during the acute phase when patients have decreased cardiac function. [ABSTRACT FROM AUTHOR]

To compare the accuracy and trending ability of the cardiac index (CI) measured by FloTrac/Vigileo™ (CIFT) or derived by the Fick equation (CIFick) using E-CAiOVX (enables continuous monitoring of oxygen consumption) with that measured by thermodilution (CITD) in patients with off-pump coronary artery bypass surgery. Twenty-two patients undergoing elective off-pump coronary artery bypass surgery were included. CIFT and CIFick were determined simultaneously at six time-points during off-pump coronary artery bypass surgery. At each time-point, phenylephrine (50 µg) was administered to increase systematic vascular resistance, with CI measured before and after administration (CITD used as reference method). Agreement of each method was evaluated by Bland-Altman analysis, while trending ability was evaluated by four-quadrant plot analysis and polar plot analysis. By Bland-Altman analysis, CIFT and CIFick showed percentage errors of 49.5% and 78.6%, respectively, compared with CITD. Subgroup analysis showed a percentage error between COFT and COTD of 28.9% in patients with a CI ≥ 2.4 L/min/m2, and 78.1% in patients with a CI ≥ 2.4 L/min/m2. The concordance rate of four-quadrant plot analysis was 93.3% for CIFT and 66.7% for CIFick in datasets where CITD ≥ 2.4 L/min/m2 before and after phenylephrine administration were included. CIFT and CIFick had wide limits of agreement with CITD, and were below acceptable limits for tracking phenylephrine-induced CI changes. However, subgroup analysis showed improved accuracy and trending ability of CIFT when only points where CITD ≥ 2.4 L/min/m2 were included, while there was no improvement in CIFick accuracy or trending ability. [ABSTRACT FROM AUTHOR]

Purpose: The ClearSight™ device monitors continuous pressure and cardiac output via pulse contour analysis. ClearSight™, however, may not be reliable in patients with reduced peripheral perfusion caused by high peripheral resistance. This study aimed to elucidate the accuracy and trending ability of ClearSight™ in patients undergoing abdominal aortic aneurysm (AAA) surgery by comparing the ClearSightTM-derived cardiac index (CICS) with that measured using three-dimensional echocardiography (CI3D). Methods: The study included 20 patients who underwent elective AAA surgery. CICS and CI3D were measured simultaneously at eight time points during the surgery. Trending ability was investigated after aortic clamping and unclamping. We used CI3D as the reference method. Results: Bland–Altman analysis showed a wide limit of agreement between CICS and CI3D (percentage error 41.3%). Subgroup analysis showed a lower percentage error (33.2%) in patients with CI ≥ 2.5 L/min/m2. The cubic splines related to the CI3D and CI discrepancy were negatively sloped, indicating that CI3D had significant influence on the CI discrepancy (p < 0.001). Four-quadrant plot analysis showed that the tracking ability of ClearSight™ after aortic clamping and declamping were clinically unacceptable (81.3% and 78.6%, respectively). Also, the polar plot analysis showed that the concordance rate of ClearSight™ after aortic clamping and declamping were clinically unacceptable (58.3% and 66.7%, respectively). Conclusions: ClearSight™ was not sufficiently accurate in patients undergoing AAA surgery. The tracking ability of ClearSight™ after aortic clamping was below the acceptable limit. [ABSTRACT FROM AUTHOR]

Purpose: Fulminant myocarditis is uncommon, but life-threatening, and some patients need mechanical circulatory support. This study was performed to evaluate how different types of mechanical circulatory support—biventricular assist device (BiVAD) or left ventricular assist device (LVAD) placement—affect intraoperative hemodynamic status. Methods: From January 2013 to September 2016, the patients who underwent BiVAD or LVAD placement for fulminant myocarditis were analyzed. The mean arterial pressure (MAP), mean pulmonary arterial pressure, central venous pressure (CVP), vasoactive score, and inotropic score were recorded at five time points: after the induction of anesthesia; at weaning, 30 min after weaning, and 60 min after weaning from cardiopulmonary bypass (CPB); and at the end of surgery. The vasoactive and inotropic scores were calculated as follows: vasoactive score = norepinephrine (µg/kg/min) × 100 + milrinone (µg/kg/min) × 10 + olprinone (µg/kg/min) × 25: inotropic score = dopamine (µg/kg/min) × 1 + dobutamine (µg/kg/min) × 1 + epinephrine (µg/kg/min) × 100. Results: We enrolled 16 patients of fulminant myocarditis. Ten of them underwent BiVAD placement, and the other underwent LVAD placement. After weaning from CPB, the BiVAD group had a significantly lower MAP but no difference in CVP. The vasoactive score was significantly higher in the BiVAD group at weaning of CPB (p = 0.015), 30 min after weaning (p = 0.004), 60 min after weaning (p = 0.005), and at the end of surgery (p < 0.016). Conclusion: Patients with BiVAD placement required more vasoactive support to maintain optimal hemodynamic status compared with those with LVAD placement. This result indicates that BiVAD placement was more associated with vasoplegic syndrome. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the relationship between FFP (fresh frozen plasma)/pRBC (packed red blood cell) transfusion ratio and outcomes in patients undergoing cardiovascular surgery.Methods: This is a single center retrospective cohort study performed in a cardiovascular center. Patients undergoing cardiovascular surgery between January 2012 and October 2016 with or without massive transfusion (n = 1453). Patients’ outcomes were compared based on FFP/pRBC transfusion ratio (FFP/pRBC > 1 or FFP/pRBC ≤ 1).Results: In hospital mortality and rate of stroke and myocardial infarction was significantly higher in patients with less than 1 of FFP/pRBC transfusion ratio only in patients with massive transfusion (3.0 vs 8.8%, p = 0.001; 0.7 vs 6.4%, p < 0.001; 1.0 vs 3.2%, p = 0.047, respectively).Conclusions: Higher FFP/RBC ratio was associated with reduced risk of death, stroke and myocardial infarction only in patients with cardiovascular surgery receiving massive transfusion. Clinicians should be aware that judicious FFP replacement plays a critical role in the successful management of massive transfusion in cardiac surgery. [ABSTRACT FROM AUTHOR]

Purpose: The fourth-generation FloTrac/Vigileo™ improved its algorithm to follow changes in systemic vascular resistance index (SVRI). This revision may improve the accuracy and trending ability of CI even in patients who undergo abdominal aortic aneurysm (AAA) surgery which cause drastic change of SVRI by aortic clamping. The purpose of this study is to elucidate the accuracy and trending ability of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery by comparing the FloTrac/Vigileo™-derived CI (CIFT) with that measured by three-dimensional echocardiography (CI3D).Methods: Twenty-six patients undergoing elective AAA surgery were included in this study. CIFT and CI3D were determined simultaneously in eight points including before and after aortic clamp. We used CI3D as the reference method.Results: In the Bland-Altman analysis, CIFT had a wide limit of agreement with CI3D showing a percentage error of 46.7%. Subgroup analysis showed that the percentage error between CO3D and COFT was 56.3% in patients with cardiac index < 2.5 L/min/m2 and 28.4% in patients with cardiac index ≥ 2.5 L/min/m2. SVRI was significantly higher in patients with cardiac index < 2.5 L/min/m2 (1703 ± 330 vs. 2757 ± 798; p < 0.001). The tracking ability of fourth generation of FloTrac/Vigileo™ after aortic clamp was not clinically acceptable (26.9%).Conclusions: The degree of accuracy of the fourth-generation FloTrac/Vigileo™ in patients with AAA surgery was not acceptable. The tracking ability of the fourth-generation FloTrac/Vigileo™ after aortic clamp was below the acceptable limit. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) after cardiac surgery is associated with increased morbidity and mortality. Although morbidity of AKI after off-pump coronary artery bypass grafting (OPCAB) has been investigated, little is known about risk factors for AKI after OPCAB. To identify risk factors for AKI, we examined the association between perioperative variables and AKI after OPCAB. Findings: We reviewed the medical records of consecutive adult patients who underwent isolated OPCAB between January 2010 and February 2013 in a single institute, retrospectively. The primary outcome was the incidence of AKI evaluated using Acute Kidney Injury Network classifications during the first 48 h postoperatively. We investigated preoperative and intraoperative variables, including hemodynamic parameters, as potential risk factors for AKI. The relationship between candidates of AKI and incidence of AKI was examined by multivariate logistic regression analysis. A total of 298 patients were enrolled in this study. Acute kidney injury occurred in 47 patients (15.7%). Multivariate logistic regression analysis showed that intraoperative furosemide administration (odds ratio [OR], 5.163; 95% confidence interval, 2.171 to 12.185; P < 0.001] and diabetes mellitus (OR, 1.954; 95% confidence interval, 1.004 to 3.880; P = 0.049) were significantly associated with AKI. Conclusions: Intraoperative furosemide administration and diabetes mellitus were significantly associated with AKI in patients who had received OPCAB. [ABSTRACT FROM AUTHOR]

Background: Near-infrared spectroscopy (NIRS)-based cerebral oximetry is a noninvasive technology used to estimate regional cerebral oxygen saturation (rSO). Extracranial blood flow is known to substantially affect rSO values measured by most clinically available devices. Several studies have also reported that the Trendelenburg position and upright position have a larger effect on rSO measurements than the supine position. Therefore, we investigated the effect of these two positions (the Trendelenburg position versus the upright position) and extracranial contamination on rSO measurements obtained using two commercially available devices and one prototype device. Methods: Twelve healthy volunteers were enrolled in the study. They each had three cerebral oximetry devices applied to their forehead (FORE-SIGHT ELITE™, CAS Medical Systems Inc., Branford, CT, USA; INVOS 5100c™, Medtronic, Minneapolis, MN, USA; and NIRO-TRS, Hamamatsu Photonics, Hamamatsu, Japan). A circumferential pneumatic head cuff was positioned proximal to the NIRS cerebral oximetry sensors. We measured rSO, heart rate (HR), and blood pressure (BP) in six conditions (supine, Trendelenburg and upright positions, with and without scalp ischemia induced by head cuff inflation) every 5 min with each oximetry device. Total hemoglobin (tHb), which is associated with cerebral blood volume (CBV) as measured by positron emission tomography, was measured using the NIRO-TRS device to determine extracranial blood volume in each position. Results: Measurements of rSO with all the devices were affected by extracranial contamination. The percentage of extracranial contamination was highest with INVOS 5100c™ in the upright position (INVOS, 21.3%; FORE-SIGHT, 14.3%; NIRO-TRS, 3.6%). Measurements of rSO obtained in the upright position were significantly lower than those obtained in the supine position, using INVOS-5100c™ and FORE-SIGHT ELITE™ (71 vs. 74% and 67 vs. 72%, respectively), but not using NIRO-TRS (62 vs. 64%). A significant decrease in tHb was observed after head cuff inflation in the supine and Trendelenburg positions (supine, 0.132-0.123 μmol/l; Trendelenburg, 0.133-0.125 μmol/l). Conclusions: Except when using NIRO-TRS, measurements of rSO in the forehead are significantly lower when measured in the upright position than in the supine position. All devices in this study were affected by extracranial contamination. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Moyamoya disease is a chronic cerebrovascular occlusive disease, occurring predominantly in young populations, that causes cerebral ischemia and hemorrhage. Patients with moyamoya disease are at high risk of neurological complications during cardiac surgery because of perioperative hemodynamic changes. However, there is no established evidence on temperature management during cardiopulmonary bypass. Previous reports described normothermia or mild to moderate hypothermia during cardiopulmonary bypass in patients with moyamoya disease; however, surgical conditions, such as not having enough space to clamp the aorta or a clean surgical field, sometimes force us to use deep hypothermic circuratory arrest. We report a successful case of a pediatric patient with moyamoya disease who underwent deep hypothermic circulatory arrest (18 °C) for hemiarch replacement without neurological complications. Deep hypothermia may be an alternative technique for achieving cerebral protection in the context of moyamoya disease. [ABSTRACT FROM AUTHOR]

Purpose: Thoracic endovascular aortic repair (TEVAR) an emerging less invasive alternative to surgery, is now being increasingly employed, but spinal cord ischemia (SCI) is still a threat with this procedure. Delayed paraplegia has been frequently observed after TEVAR, suggesting there may be different courses of SCI between TEVAR and the conventional open surgical repair (OSR) of thoracic and thoracoabdominal aneurysms. Therefore, we conducted a study to investigate the risk factors for and the course of SCI after TEVAR and OSR. Methods: We studied a series of 414 OSR and 94 TEVAR patients prospectively. Postoperative motor function, sensory disturbance, and bladder disturbance were assessed daily to evaluate the course of SCI. Previously reported risk factors for SCI were investigated. Results: Spinal cord ischemia occurred in 6 patients (6.4 %) in the TEVAR group, and in 18 patients (4.3 %) in the OSR group, resulting in no significant difference ( p = 0.401). A greater percentage of patients ( n = 4, 66.7 %) with SCI in the TEVAR group had a delayed onset, compared with 16.7 % ( n = 3) in the OSR group ( p = 0.038). The rate of recovery of walking function after SCI and the incidence of sensory disturbance and bladder dysfunction was similar in the two groups. Multivariate analysis demonstrated that, in the TEVAR group, the stent length of aortic coverage was a significant risk factor for SCI. Conclusion: The incidence of SCI was similar in the OSR and TEVAR groups, but delayed SCI occurred more frequently in the TEVAR group. Except for the delayed onset of SCI, SCI showed a similar course of recovery in the two groups. [ABSTRACT FROM AUTHOR]

Background: Paraplegia is a serious complication of descending and thoracoabdominal aortic aneurysms (dTAAs and TAAAs) surgery. Motor evoked potentials (MEPs) enable monitoring the functional integrity of motor pathways during dTAA and TAAA surgery. Although MEPs are sensitive to temperature changes, there are few human data on changes of MEPs during mild and deep hypothermia. Therefore, we investigated changes of MEPs in deep hypothermic circulatory arrest (DHCA) in dTAA and TAAA surgery. Methods: Fifteen consecutive patients undergoing dTAA and TAAA surgery using DHCA were enrolled. MEPs were elicited and recorded during each degree Celsius change in nasopharyngeal temperature during both the cooling and rewarming phases. Hand and leg skin temperature were also recorded simultaneously. Results: In the cooling phase MEP amplitude decreased lineally in both the hand and leg. The MEP disappeared at ~16°C in both the hand and leg in 10 of 15 patients, but was still elicited in 5 patients. In the rewarming phase MEP in the hand recovered before the temperature reached 20°C for eight patients and 25°C for the other seven patients. In contrast, MEP in the leg recovered below 20°C for two patients and 30°C for three patients. For the other eight patients MEP waves did not recover during the rewarming phase. Conclusion: In the cooling phase of DHCA, MEP disappeared at ~16°C in some patients but was still elicited in others. MEP recovered below 25°C in the hand. Recovery of MEP in the leg was, however, extremely variable. [ABSTRACT FROM AUTHOR]

Off-pump coronary artery bypass grafting surgery (OPCAB) frequently results in significant jugular bulb desaturation. Although jugular bulb desaturation during OPCAB may be associated with postoperative cerebral injury, routine jugular bulb oximetry appears to be invasive and expensive. We hypothesized that intraoperative hemodynamic compromise during OPCAB due to cardiac displacement is associated with jugular bulb desaturation which correlates with specific hemodynamic and physiological changes. Hemodynamic and physiological data were measured at the following points: (1) before anastomosis of the coronary artery (baseline); (2) during anastomosis of the left anterior descending artery; (3) during anastomosis of the circumflex branch or posterior descending artery; and (4) after chest closure. Arterial, mixed venous, and jugular venous bulb blood gas analyses were performed serially. Jugular bulb desaturation (≤50%) frequently occurred during surgical displacement of the heart. Mixed venous oxygen saturation ( $$ Sv_{O_2 } $$), partial pressure of carbon dioxide ( $$ Pa_{CO_2 } $$), and central venous pressure (CVP) showed a significant relationship with jugular bulb oxygen saturation ( r = 0.45) by multivariate linear regression analysis. Multivariate logistic regression analysis also demonstrated that $$ Sv_{O_2 } $$ ≤ 70%, $$ Pa_{CO_2 } $$ ≤ 40 mmHg, and CVP ≥ 8 mmHg were likely predictors of the occurrence of jugular bulb desaturation. Changes in $$ Sv_{O_2 } $$ and $$ Pa_{CO_2 } $$ were associated with jugular bulb oxygen saturation, and $$ Sv_{O_2 } $$ ≤ 70%, $$ Pa_{CO_2 } $$ ≤ 40 mmHg, and CVP ≥ 8 mmHg had a significant odds ratio for jugular bulb desaturation. We suggest that achieving normal values of $$ Sv_{O_2 } $$, $$ Pa_{CO_2 } $$, and CVP may be important to prevent cerebral desaturation during OPCAB. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We report an emergent case of cardiac tamponade due to rupture of the left ventricle. Preload and intracardiac volume were decreased by percutaneous cardiopulmonary support (PCPS), which led to the collapse of the cardiac chamber. The collapsed cardiac chamber made it difficult to diagnose cardiac abnormalities by preoperative transthoracic echocardiography (TTE). On loading fluid infusion and transfusion as volume load to improve the hemodynamic status, transesophageal echocardiography (TEE) revealed several leakages in the left ventricular myocardium. Continuous careful observation on TEE led us to a confident diagnosis of left ventricular rupture. The diagnosis by TEE also led to the employment of the appropriate procedure. TEE is useful for detecting an abnormality due to the location of the cardiac chamber and echocardiographic probe. We also note that continuous careful observation led to the employment of the appropriate procedure. [ABSTRACT FROM AUTHOR]

The article discusses how previous studies have clarified the difficulties in performing accurate near-infrared spectroscopy (NIRS) measurements that has been used clinically as a noninvasive and continuous monitor in cerebral oxygen saturation. The contamination of NIRS measurement by extracranial blood flow is explored. The possible future of NIRS measurement is examined.