Annals of cardiac anaesthesia
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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.
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Randomized Controlled Trial Comparative Study
Comparative evaluation of hemodynamic responses and ease of intubation with airtraq video laryngoscope versus macintosh laryngoscope in patients with ischemic heart disease.
Hemodynamic responses during laryngoscopy can potentially precipitate ischemia in patients with coronary artery disease. There are conflicting reports regarding the hemodynamic stress responses between the conventional Macintosh and video laryngoscopes. There is a paucity of studies regarding the same in cardiac surgical patients. ⋯ Airtraq provides the better hemodynamic stability and ease of intubation and may be considered superior to conventional Macintosh laryngoscope for intubation in patients with ischemic heart disease.
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Comparative Study Observational Study
Comparison between computerized tomography-guided bronchial width measurement versus conventional method for selection of adequate double lumen tube size.
Selection of adequate size double lumen tube (DLT) is complicated by marked inter-individual variability in morphology and dimensions of tracheobronchial tree. Computerized tomography (CT)-guided left bronchus width measurement has been used to predict adequate size DLT in European and Singapore population; however, no such data exist for Indian population who are racially different. We compared the effect of DLT size selection based on CT-guided bronchial width measurement to the conventional method of DLT selection on the adequacy of both lungs isolation and on the safety margin of right-sided DLT. ⋯ CT-measured bronchial width predicts the appropriate DLT size better than conventional method. In the absence of CT scan facility, patient height, age, and chest X-ray TW may be used to predict DLT size with reasonable accuracy.
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With liberal availability of high end cardiac implantable devices in recent era, we frequently encounter patients who are recipients of implantable cardioverter defibrillators (ICDs) in our routine clinical practice. Despite improvements in shock detecting algorithms by various manufacturers, incidence of inappropriate shock therapy remains high, it is cause of distress to physicians and patients. Here we present an interesting case of inappropriate shock in one of patient.