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Objective: To identify the correlation between systolic time ratio(STR) measured with electrical cardiometry (EC) device ICON (Osypka Medical, Berlin, Germany) and echocardiography in patients undergoing cardiac surgery and to find a noninvasive technique for estimating left ventricular systolic function during the perioperative period. Materials and Methods: Systolic time ratio data were obtained simultaneously from the electrical cardiometry device ICON (Osypka Medical, Berlin, Germany) and transthoracic echocardiography at the following predefined timepoints--before anaesthesia induction (T0 baseline), after induction (T1), at the end of the surgery(T2), and after extubation (T3) in patients undergoing elective cardiac surgery. The agreement between the systolic time ratio measured by electrical cardiometry and transthoracic echocardiography was studied using Bland-Altman plots. Paired t-tests were used to compare systolic time ratio measurements at different time points. Results: Mean STR by EC and Echocardiography at T0 was 0.456 (0.429-0.483) and 0.348 (0.330-.366) at T1 was 0.464 (0.442 -0.486) and 0.372 (0.344-0.401) at T2 was 0.421 (0.402 -0.439) and 0.305 (0.290-0.320) and at T3 was 0.438 (0.419-0.457) and 0.353 (0.336-0.370), P value <0.001. Bland-Altman analysis showed that EC measured STR compared with echocardiography at T0 with a mean bias of 0.108 and (with limits of agreement -0.19,0.14) at T1 it was 0.092 (with limits of agreement -0.21,0.40) at T2 it was 0.11 (with limits of agreement -0.04,0.28) and at T3 it was 0.085 (with limits of agreement -0.101,0.271). Conclusion: In conclusion, no association between systolic time ratio as measured by electrical cardiometry and echocardiography was found in our study. Our results do not conclusively prohibit using electrical cardiometry in the perioperative period to evaluate LV systolic function. Further work must be done to establish the role of STR as a surrogate marker of LV systolic function. [ABSTRACT FROM AUTHOR]

The annual heart transplant rate is gradually increasing worldwide. A proportion of this patient population present for an elective or emergency surgery which may or may not be related to the transplanted heart. A MEDLINE search for heart transplant, anaesthesia, adult, paediatric and surgery was conducted to review anaesthetic management for heart transplant recipients. Anaesthesia and perioperative management are different in these cases. A thorough understanding of the physiology of denervated heart, post-transplant morbidities and pharmacology of immunosuppressants is essential for best perioperative management and improved post-operative outcome. [ABSTRACT FROM AUTHOR]

The curse of knowledge" is a human cognitive bias that may lead to ineffective communication and we should acknowledge that we are affected by it. The communication with patient should be simple and clear. Though anesthesia has become safer following better drugs and technology but still we may face patients with grave comorbidities. Anesthesiologists may not get enough time to communicate with patients, preoperatively, but we should endeavor to collect as much information as possible from a patient using simple rather technical terms. Effective communication may avoid 'curse of knowledge' and result in improved patient safety. Anesthesiologists should make an effort to spend considerable time in pre-anaesthesia check-up clinics or in ward to communicate with patient who is likely to undergo surgical procedure. Similarly, we should have a candid communication with trainees in anaesthesia so that the events are not taken for guaranteed. This would avoid the curse of knowledge and assure better patient care. The same approach of clear communication should be applied to our surgical colleagues. [ABSTRACT FROM AUTHOR]

Patients with coexisting peripheral vascular disease and coronary artery disease constitute a high risk surgical group. Perioperative management of such patients is an anaesthetic challenge. A 57-year-old male presented with critical limb ischaemia and impending gangrene of the right lower limb. Associated coronary artery disease with triple vessel involvement was diagnosed on coronary angiography. This patient underwent an aorto-femoral bypass. The postoperative course was complicated by the development of mesenteric ischaemia requiring emergency laparotomy and bowel resection. [ABSTRACT FROM AUTHOR]

The article discusses a case of patent ductus arteriosus (PDA) ligation involving an 8-month old infant. In the case, the infant suffered severe laryngospasm and acute ventricular dysfunction during post-operative periodinan. Based on the study by PC McNamara and colleagues, PDA ligation is related with impaired left ventricular systolic performance due to altered loading conditions.