ABSTRACT
Background:Acute kidney injury (AKI) is a common complication after on pump coronary artery bypass grafting (CABG) surgery and is associated with a poor prognosis. Postoperative AKI is associated with morbidity, mortality, and increase in length of intensive care unit (ICU) stay and increases the financial burden. Identifying individuals at risk for developing AKI in postoperative period is extremely important to optimize outcomes. The aim of the study is to evaluate the association between the intraoperative transesophageal echocardiography (TEE) derived renal resistive index (RRI) and AKI in patients undergoing on?pump CABG surgery. Methods: This prospective observational study was conducted in patients more than 18 years of age undergoing elective on pump CABG surgery between July 1, 2018, and December 31, 2019, at a tertiary care center. All preoperative, intraoperative, and postoperative parameters were recorded. TEE measurement was performed in hemodynamically stable patients before the sternum was opened. Postoperative AKI was diagnosed based on the serial measurement of serum creatinine and the monitoring of urine output. Results: A total of 115 patients were included in our study. Thirty?nine (33.91%) patients had RRI >0.7 while remaining seventy?six (66.08%) patients had RRI <0.7. AKI was diagnosed in 26% (30/115) patients. AKI rates were significantly higher in patients with RRI values exceeding 0.7 with 46.15% (18/39) compared to 15.75% (12/76) in RRI values of less than 0.7. Multivariate analysis revealed that AKI was associated with an increase in RRI and diabetes mellitus. The RRI assessed by receiver operating characteristic (ROC) curve and the area under the curve (AUC) to distinguish between non?AKI and AKI groups were 0.705 (95% CI: 0.588–0.826) for preoperative RRI. The most accurate cut?off value to distinguish non?AKI and AKI groups was a preoperative RRI of 0.68 with a sensitivity of 70% and specificity of 67%. Conclusions: An increased intraoperative RRI is an independent predictor of AKI in the postoperative period in patients undergoing CABG surgery. The cutoff value of TEE?derived RRI in the intraoperative period should be >0.68 to predict AKI in the postoperative period.
ABSTRACT
Anisometropic myopia is a rare and unique entity in which the two eyes of the same individual have grown unequally. This poses the risk of amblyopia in the more myopic eye if not detected and corrected early in life. Here, we present a case series of four cases of uniocular amblyopia. In all the four cases, there was a disparity in axial length of the two eyes. The other parameters including keratometry readings were normal in all the cases. This led to uniocular myopia. The anisometropic amblyopia hence caused led to a decrease of vision in the concerned eyes. This unilateral amblyopia caused could have been easily prevented if the timely diagnosis had been made and treatment instituted early in life
ABSTRACT
Central venous catheterization is an essential procedure in patient undergoing cardiac surgery, as it provides central venous pressure monitoring, fluid administration, and infusion of inotropes during perioperative period. In the cardiac surgery, where the patients are anticoagulated, an inadvertent arterial puncture can lead to serious complications. Hematoma following inadvertent arterial puncture is one of the common complications, which can compromise cerebral circulation. We report a rare case of inadvertent cannulation of internal carotid artery in patients of tetralogy of Fallot undergoing intracardiac repair during an attempt to cannulate internal jugular vein.
ABSTRACT
Unilateral microspherophakia without systemic associations is a rare condition and so is congenital palsy of the superior division of the third nerve. Here, we report both these rarities together in a 32-year-old male who had microspherophakia in his right eye and congenital palsy of the superior division of the third nerve in his left eye. The intraocular pressure (IOP) in the right eye was normal with no glaucomatous change in the fundus, but the patient had developed cataractous changes in the microspherophakia lens. The left eye of the patient had low vision due to congenital ptosis which led to stimulus deprivation amblyopia
ABSTRACT
Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42‑year‑old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber‑optic bronchoscope is very helpful in decision‑making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42‑year‑old patient who underwent elective distal aortic arch and descending aortic aneurysm repair.