Annals of cardiac anaesthesia
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Randomized Controlled Trial Comparative Study
ICU sedation with haloperidol-propofol infusion versus midazolam-propofol infusion after coronary artery bypass graft surgery: a prospective, double-blind randomized study.
Combinations of hypnotics with or without opiates are commonly used in agitated patients. We hypothesized that combination of haloperidol-propofol in comparison with midazolam-propofol would lower consumption of propofol and lead to better hemodynamic and respiratory profile during sedation of agitated patients. Among 108 patients admitted in our ICU, 60 patients were agitated according to Ramsay Sedation Score (RSS) and randomly divided into two groups. ⋯ There was no significant difference in hemodynamic variables between two groups, but the episodes of respiratory depression was significantly higher in propofol-midazolam group (P = 0.02). We conclude that haloperidol-propofol infusion decreases propofol requirements in the agitated patients. Besides, this combination showed a better profile in terms of occurrence of respiratory depression.
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Case Reports
Compression of undiagnosed aberrant right subclavian artery during transesophageal echocardiography probe insertion.
Transesophageal echocardiography (TEE) has become an important monitoring tool for the anesthesiologist during repair of intracardiac defects. Although the incidence of reported complications associated with its use is low, one should be careful during the insertion and use of TEE probe, as it may result in potential devastating problems. We present a case of undiagnosed aberrant right subclavian artery (ARSA) that got compressed by the TEE probe during its insertion. It was noticed because of the presence of the right radial artery catheter, else it would have passed unnoticed.
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Case Reports
Dexmedetomidine controls junctional ectopic tachycardia during Tetralogy of Fallot repair in an infant.
Dexmedetomidine is a highly selective α2 -adrenergic agonist approved for short-term sedation and monitored anesthesia care in adults. Although not approved for use in the pediatric population, an increasing number of reports describe its use in pediatric patients during the intraoperative period and in the intensive care unit. Dexmedetomidine can potentially have an adverse impact on the cardiovascular system secondary to its negative chronotropic and dromotropic effects. ⋯ Within 15 min of increasing the dexmedetomidine infusion from 0.5 to 3 μg/kg/h, JET converted to normal sinus rhythm. This case report provides additional anecdotal evidence that dexmedetomidine may have a therapeutic role in the treatment of perioperative tachyarrhythmias in pediatric patients with CHD. The specific effects of dexmedetomidine on the cardiac conduction system are reviewed followed by a summary of previous reports describing its use as a therapeutic agent to treat perioperative arrhythmias.
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A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB) as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. ⋯ However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.
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Comparative Study
A comparison of a continuous noninvasive arterial pressure (CNAP™) monitor with an invasive arterial blood pressure monitor in the cardiac surgical ICU.
Accurate measurement and display of arterial blood pressure is essential for rational management of adult cardiac surgical patients. Because of the lower risk of complications, noninvasive monitoring methods gain importance. A newly developed continuous noninvasive arterial blood pressure (CNAP™) monitor is available and has been validated perioperatively. ⋯ The mountain plot showed similar results as the Bland Altman plots. We conclude CNAP™ is a reliable, noninvasive, continuous blood pressure monitor that provides real-time estimates of arterial pressure comparable to those generated by an invasive arterial catheter system. CNAP™ can be used as an alternative to IAP.