Comparison of fast-track anesthesia and conventional cardiac anesthesia for valve replacement cardiac surgery

Background: Fast-track anesthesia has gained widespread use in cardiac centers around the world mainly for coronary artery bypass surgeries. However, only few studies have focused on fast-track anesthesia after valve surgeries. This study examines the feasibility and hemodynamic stability of fast-track anesthesia after valve surgeries

Methodology: The study was designed as a retrospective observational study. A total of 367 patients who underwent valve replacement surgery between January 2006 and November 2015 were included in this study. Conventional cardiac anesthesia [CCA] technique was followed initially from January 2006 to May 2010 while fast-track anesthesia protocol [FTA] was implemented from August 2010 onwards till November 2015. The objectives were to compare the duration of ventilation, the incidence of reintubation and postoperative pneumonia, incidence of low cardiac output syndrome, mortality and postoperative length of stay in the ICU, intermediate care unit and the hospital

Results: The CCA group comprised of 140 patients and the FTA group had 227 patients. There was a significantly shorter median time to extubation [4.30 hrs vs. 18.14 hrs], and reduced intensive care unit stay [40.85 hrs vs. 64.25 hrs] in FTA group. Patients in FTA group required inotropic support only for 12 hours in the immediate postoperative period, whereas CCA group required inotropic drugs for almost 30 hours. One patient in FTA group had pneumonia compared to 5 in CCA group. Two patients in FTA group required re-intubation for re-exploration. The fast-track group had significantly decreased median length of hospital stay [6.28 vs 8.41 days]

Conclusion: This study shows that fast-track anesthesia protocol can be applied safely to patients undergoing cardiac surgery other than coronary artery bypass grafting. Fast-tracking not only reduces ventilation time but also reduces hospital stay, with acceptable morbidity and mortality

Perioperative management of polytrauma in a post MVR patient with severe left ventricular systolic dysfunction

The anesthetic management of a patient with severe left ventricular dysfunction undergoing non cardiac surgery is a challenging task, as left ventricular systolic dysfunction [LVSD] is commonly complicated by progressive congestive heart failure and malignant arrhythmias. When the cause for LVSD is post valve replacement, additional complications like intraoperative thrombosis, bleeding and infective endocarditis need to be addressed peri-operatively. In such situations, the anesthesiologist must have the knowledge of hemodynamic changes, diagnostic and treatment modalities, as well as various drugs used during anesthesia. We report a case of post mitral valve replaced patient with severe LVSD posted for surgery of fracture of femur and facial fractures managed successfully during anesthesia

Anesthetic management of a case of alkaptonuria

Alkaptonuria is a rare inherited autosomal recessive disorder of metabolism due to deficiency of homogentisic acid oxidase. This results in deposition of homogentisic acid in almost all the collagenous structures of the body leading to progressive multisystem involvement [alkaptonuric ochronosis] and poses a big challenge in anesthetizing such patients. We present one such case posted for total hip replacement and its successful management under general anesthesia

Cholecystectomy under segmental thoracic epidural block in a patient with twin gestation

Cholecystectomy represents the second most common surgery during pregnancy. Both general and regional anesthetic techniques have been successfully used for cholecystectomy in pregnant patients. Authors present here a case of a pregnant patient carrying twin gestation who underwent cholecystectomy, which is not frequently encountered by the anesthesiologists. This report enumerates the perioperative issues relating to anesthesia given to a pregnant patient in addition to emphasizing the importance of multidisciplinary approach when such a case is encountered

Perioperative management of a patient with gilberts syndrome and rheumatic heart disease

Anaesthetic management of patients with hepatic dysfunction can be quite challenging, as many anaesthetic agents are metabolized by liver. Heart disease on anti coagulation can pose additional challenge. Here we report a case of Gilbert's syndrome with rheumatic heart disease on anti coagulation posted for elective hernia repair