Annals of cardiac anaesthesia
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Case Reports
Erector spinae plane block using clonidine as an adjuvant for excision of chest wall tumor in a pediatric patient.
Erector spinae plane block has been described to manage post-thoracotomy pain. It is a simple block and shown to be provide effective analgesia. ⋯ In this case, we describe a case of chest wall tumor excision in a child who received clonidine in addition to local anesthetic for the erector spinae plane block. This provided long lasting and effective postoperative analgesia and may be considered to prolong the analgesia achieved with erector spinae plane block.
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Randomized Controlled Trial Comparative Study
Comparison of pectoral Nerve (PECS1) block with combined PECS1 and transversus thoracis muscle (TTM) block in patients undergoing cardiac implantable electronic device insertion - A pilot study.
Pectoral nerve (PECS1) block has been used for patients undergoing cardiac implantable electronic device (CIED) insertions, however, PECS1 block alone may lead to inadequate analgesia during tunneling and pocket creation because of the highly innervated chest wall. Transversus thoracis muscle plane (TTM) block targeting the anterior branches of T2-T6 intercostal nerves can be effectively used in combination with PECS1 for patients undergoing CIED insertion. The present study hypothesized that combined PECS1 and TTM blocks would provide effective analgesia for patients undergoing CIED insertion compared to PECS1 block alone. ⋯ Combined PECS1 and TTM blocks provide superior analgesia, reduced net consumption of local anesthetic, sedative agents, and rescue analgesics compared to PECS1 block alone in patients undergoing CIED insertion.
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Randomized Controlled Trial
Combined effect of left stellate ganglion blockade and topical administration of papaverine on left internal thoracic artery blood flow in patients undergoing coronary revascularization.
Left stellate ganglion blockade (LSGB) may have additive effect to topical administration of papaverine on prevention of vasospasm of left internal thoracic artery (LITA). ⋯ Combining LSGB with papaverine does not increase the LITA blood flow compared to when the papaverine is used alone. However, ganglion blockade reduces radial-femoral arterial pressure difference after CPB. Blockade can be achieved successfully under the ultrasound guidance without any complications.
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Myocardial protection in cardiac surgeries is a must and requires multimodal approaches in perioperative period to decrease and prevent the increase of myocardial oxygen demand and consumption that lead to postoperative cardiac complications including myocardial ischemia, dysfunction, and heart failure. ⋯ The use of propofol-dexmedetomidine in CPB surgeries offers more cardioprotective effects than the use of propofol alone.
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Off-pump coronary artery bypass (OPCAB) surgery is associated with evasion of complications of cardiac bypass. The incidence of postoperative atrial fibrillation (POAF) may also be reduced because of less ischemia and inflammation. ⋯ CHA2DS2-VASc score is useful in predicting POAF after OPCAB surgery. Higher the CHA2DS2-VASc score, greater is the possibility of development of POAF.