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Background: This prospective, randomized, double-blind trial was done to compare intranasal dexmedetomidine and intranasal midazolam as premedication for sedation and ease of child-parent separation in pediatric patients of tetralogy of Fallot (TOF) undergoing corrective cardiac surgery. Materials and Methods : Forty children with TOF, between 1 and 10 years, undergoing corrective cardiac surgery were included in the study and, after randomization, were given intranasal midazolam (0.2 mg/kg) or intranasal dexmedetomidine (1 µg/kg), 30 min before shifting to the operation room (OR). Patients were assessed for sedation and child-parent separation, along with hemodynamic parameters, respiratory rate, and oxygen saturation (SpO2) 30 min after drug administration, at the time of shifting inside the OR, and at the time of induction of anesthesia. Results: Both groups had comparable child-parent scores, hemodynamic parameters, SpO2, and respiratory rate. However, the dexmedetomidine group had significantly better sedation levels than the midazolam group patients at the time of shifting inside the OR (dexmedetomidine group: 3.55 ± 0.82 vs. midazolam group: 2.80 ± 0.83; P = 0.007) and at the time of induction of anesthesia (dexmedetomidine group: 3.40 ± 0.75 vs. midazolam group: 2.70 ± 0.86; P = 0.009). Conclusion: Intranasal dexmedetomidine provides better sedation than midazolam, with similar child-parent separation scores and hemodynamic parameters, respiratory rate, and SpO2. No adverse events were observed in both groups. A study on a larger population will help in further establishing the safety and superiority of dexmedetomidine and will further its regular use as an intranasal premedication. [ABSTRACT FROM AUTHOR]

Byline: Neeti. Makhija, Amita. Sharma, Rohan. Magoon, Abhinav. Kumar Sir, Following a gun-shot trauma, a middle-aged male was conservatively managed for the resultant grade II hepatic injury only to eventually [...]

Abdominal aortic aneurysm repair has undergone remarkable improvements from conventional open reconstruction to minimally invasive endovascular techniques since the early 90s to curtail morbidity and mortality. The transcendence of minimal invasiveness led to endovascular aortic aneurysm repair (EVAR) a viable alternative to open surgical technique. However, EVAR is more complex, and requires appropriate patient selection, comprehensive pre-operative assessment, optimization, intraoperative hemodynamic consideration, early detection of postoperative complications, and prompt management. As complexity and versatility increase, it poses an anesthetic challenge as well as requires multidisciplinary intervention. The present article aims to review the perioperative concerns of EVAR with currently available literature. [ABSTRACT FROM AUTHOR]

Objectives: Cyanotic heart disease leads to increase in blood viscosity which may reduce tissue perfusion. Intraoperative autologous blood donation (IABD) is a technique of replacing patient's blood with crystalloids followed by reinfusion after CPB. We studied the effect of intra-operative red cell volume reduction on CPB in cyanotic heart disease patients with high haematocrit. Materials and Methods: The patients were divided into two groups of 30 each. Group A received standard perioperative care without IABD, and Group B received standard care along with IABD. Post intubation, blood was collected from the central venous line in group B as per maximum allowable blood loss with a target HCT of 45%. Parameters recorded for analysis at various time points include heart rate, blood pressure, rSO2 via NIRS, pH, haematocrit, lactate, base deficit, and P/F ratio. Results: Demographic and baseline characteristics were comparable between the groups. Total mean perfusion flow rate was slightly lower in group A as compared to group B (p-value=0.075). There is no significant difference in perfusion pressure and line pressures except at T1 (30min in CPB) where it is lower in group B. NIRS values were higher in group B which becomes insignificant after CPB and in the ICU. Patients in group B have lower haematocrit, higher pH, lower base deficit and lower lactate levels. Conclusion: Reduction in haematocrit is safe and led to better tissue perfusion including cerebral perfusion both before and during CPB which was reflected by higher pH, lower lactate levels and higher NIRS value. [ABSTRACT FROM AUTHOR]

Surgery and anaesthesia are known to cause stress response. Attenuation of stress response can decrease morbidity, postoperative hospital length of stay and, thus, cost. Intrathecal and epidural techniques produce reliable analgesia in patients undergoing surgery along with stress response attenuation. The present study was undertaken to evaluate the efficacy of caudal sufentanil and bupivacaine combination on perioperative stress response in paediatric patients undergoing open heart surgery. Thirty patients (ASA grade II-III) undergoing elective corrective cardiac surgery for acyanotic congenital heart disease, were randomly allocated to two groups. In group GA ( n = 15), patients received balanced general anaesthesia. In group GC ( n = 15), in addition to general anaesthesia, caudal block with bupivacaine and sufentanil combination was given after endotracheal intubation. Monitoring included electrocardiography, invasive arterial pressure, end-tidal carbon dioxide, pulse oximetry, arterial blood gases including serum electrolytes, blood glucose, serum cortisol, urine output, central venous pressure and temperature. Haemodynamic responses in both groups were statistically similar. Serum cortisol levels were significantly lower in GC group than GA group ( P < 0.05) after sternotomy (9.8±7.5 vs. 34.74±27.35), on cardiopulmonary bypass (CPB) (12.17 ± 6.2 vs. 35.36 ± 24.15), after sternal closure (14.03 ± 5.1 vs. 37.62 ± 20.69), 4 hours (26.64 ± 14.61 vs. 37.62 ± 9.13) and 24 hours (14.30 ± 8.11 vs. 28.12 ± 16.31) after intubation. Blood glucose levels were significantly higher in GA group as compared to GC group at sternal closure (277.46 ± 77.25 vs.197.73 ± 42.17) and 4 hours (255.26 ± 73.73 vs. 185.26 ± 57.41) after intubation ( P < 0.05). To conclude, supplementation of caudal epidural bupivacaine and sufentanil could effectively attenuate the stress response in paediatric patients undergoing cardiac surgery under CPB in acyanotic congenital heart anomaly.

Acute kidney injury (AKI) could well be regarded as a sentinel complication given it is relatively common and associated with a substantial risk of subsequent morbidity and mortality. On the aegis of 'prevention is better than cure', there has been a wide interest in evaluating haemodynamic predisposition to AKI so as to provide a favourable renoprotective haemodynamic milieu to the subset of patients presenting a significant risk of developing AKI. In this context, the last decade has witnessed a series of evaluation of the hypotension value and duration cut-offs associated with risk of AKI across diverse non-operative and operative settings. Nevertheless, a holistic comprehension of the haemodynamic predisposition to AKI has been a laggard with only few reports highlighting the potential of elevated central venous pressure, intra-abdominal hypertension and high mean airway pressures in considerably attenuating the effective renal perfusion, particularly in scenarios where kidneys are highly sensitive to any untoward elevation in the afterload. Despite the inherent autoregulatory mechanisms, the effective renal perfusion pressure (RPP) can be modulated by a number of haemodynamic factors in addition to mean arterial pressure (MAP) as the escalation of renal interstitial pressure, in particular hampers kidney perfusion which in itself is a dynamic interplay of a number of innate pressures. The present article aims to review the subject of haemodynamic predisposition to AKI centralising the focus on effective RPP (over and above the conventional 'tunnel-vision' for MAP) and discuss the relevant literature accumulating in this area of ever-growing clinical interest [ABSTRACT FROM AUTHOR]