American Society of Anesthesiologists physical status: how the obscurity in the system itself contributes to inaccuracies and variations in classification / 대한마취과학회지

No abstract available.

Influence of packed red cell transfusion on risk of acute kidney injury after cardiopulmonary bypass in anemic and non-anemic patients

Background and aim: Acute kidney injury [AKI] after cardiac surgery occurs in approximately 1/3[rd] of the cases that require cardiopulmonary bypass [CPB] and is associated with worsened short and long term consequences. Preoperative anemia and perioperative packed cell transfusion are two important modifiable risk factors for AKI and elucidating their relationship may help in devising preventive strategies. The present study aimed to study the relationship between preoperative anemia and perioperative packed red blood cell transfusion with development of postoperative acute kidney injury in patients who underwent cardiac surgeries under CPB

Methodology: The present prospective cohort study was conducted after ethical committee approval and informed consent from 60 eligible anemic and non-anemic patients [30 each]. They were further sub grouped based on the number of packed red cell [PRC] units transfused. Occurrence and frequency of AKI was determined from the estimated glomerular filtration rate as per RIFLE criteria. The data collected were analysed using INSTAT software for statistical significance

Results: Demographic parameters, type of surgery, preoperative and intraoperative parameters were comparable in both the groups [p > 0.05]. Preoperative hemoglobin level during CPB were significantly different in the anemic and non-anemic groups [p < 0.001]. 50% of anemic patient suffered AKI as compared to 16.67% of the non-anemic patients, with a RR of 3.0 and p 0.01. RIFLE-injury was found in 23.33% of the anemic group as compared to 10% in the non-anemic group with a RR 2.33, p > 0.05. AKI was higher in patients who received 3 units of PRC as compared to lesser units of transfusion with a RR of 2.66 and p 0.01

Conclusion: Both anemia and increased red cell transfusion during cardiac surgeries with cardiopulmonary bypass appear to be risk factors for acute kidney injury

Is majority of requests by anesthesiologists for cardiologist consultation unjustified?

Preoperative consultation of surgical patient by cardiologist is intended to treat an inadequately treated cardiac condition before undergoing surgery. This can yield in terms of new therapy, lead to optimization of the patients' cardiac comorbidity, impact significantly in terms of perioperative management and potentially reduce postoperative adverse cardiac events. However, judicious use of preoperative consultation request is required both for avoiding unnecessary consultation, investigation and delay in proceeding with surgery as well as cost effective health care delivery. This mini review is aimed at finding the practice patterns of anesthesiologists' preoperative requests for cardiology consultations. Different clinical situations faced in preoperative evaluation of cardiac patients planned for non-cardiac surgery with regard to the need for preoperative cardiac consultation and a step wise approach for determining the probable need of request is also presented

Perioperative management of patients with tricuspid atresia and univentriclular congenital cardiac defect

Complex congenital heart diseases like univentricular cardiac defects are relatively common. Tricuspid atresia [TA] with hypoplastic right ventricle is one such univentricular congenital defect which if not corrected surgically leads to fatality. Palliative bidirectional Glenn procedure is usually done as initial measure for such patients. We present this case report based discussion to enumerate the challenges faced by the anesthesiologists while managing such cases for bidirectional Glenn shunt surgery [BDGS] during perioperative period

rare case of pedunculated tonsilar mass in a child

Pedunculated polyps of palatine tonsils are rare and have been described using various terms. Most of the cases have been reported in adults with variable symptoms. We report a two and a half years old male child who presented with history of snoring and inability to lie down flat and sleep due to chocking and difficulty in breathing. Clinical examination revealed a mass extending from nasopharynx to the base of the tongue. A diagnosis of pedunculated palatine tonsilar mass was made intaoperatively and the mass was excised under general anesthesia. An unusual presentation of a rare condition in a pediatric patient has been discussed along with the airway management