ABSTRACT
Background: Low cardiac output is a common complication following cardiac surgery and it is associated with higher mortality in the pediatric population. A gold standard method for cardiac output (CO) monitoring in the pediatric population is lacking. The present study was conducted to validate cardiac output and cardiac index measured by transthoracic echocardiography and Pressure recording analytical method, a continuous pulse contour method, MostCare Up in postoperative pediatric cardiac surgical patients. Materials and Methods: This was a prospective observational clinical study conducted at a tertiary care hospital. A total of 23 pediatric patients weighed between 2 and 20 kg who had undergone elective cardiac surgery were included in the study. Results: Spearman抯 correlation coefficient of CO between transthoracic echocardiography (TTE) and Pressure Recording Analytical Method (PRAM) showed of positive correlation (r = 0.69, 95% Confidence interval 0.59?0.77, P < 0.0001) Linear regression equations for CO between TTE and PRAM were y = 0.55 + 0.88x (R2 = 0.46, P < 0.0001). (y = PRAM, x = TTE), respectively. Bland? Altman plot for CO between TTE and PRAM showed a bias of ?0.397 with limits of the agreement being ?2.01 to 1.22. Polar plot analysis showed an angular bias of 6.55� with radial limits of the agreement being ?21.46 to 34.58 for CO and angular bias of 6.22� with radial limits of the agreement being ?22.4 to 34.84 for CI. Conclusion: PRAM has shown good trending ability for cardiac output. However, values measured by PRAM are not interchangeable with the values measured by transthoracic echocardiography.
ABSTRACT
Aim:To determine the factors associated with an inadequate response to adenosine infusion during cardiac stress magnetic resonance imaging (MRI). Study Design: It is a retrospective cohort study. Introduction: Stress cardiac MRI is a highly accurate and non?invasive method to diagnose coronary artery disease (CAD). Stress MRI is performed by inducing stress with adenosine infusion.There is an increase in systemic andmyocardial blood flow (MBF) with vasodilator agents. Capillaries are maximally dilated in a diseased artery and cannot sustain increased myocardial oxygen demand. It results in delayed delivery of contrast, which leads to an area of perfusion defect in the myocardium. These perfusion defects can be accurately seen by cardiovascular magnetic resonance (CMR) and help in the prognosis of patients. Methods: A retrospective study on patients subjected to cardiac stress MRI was conducted in a Tertiary Care Cardiac Center from January 2019 to January 2022. In total, 99 patients underwent adenosine stress perfusion cardiac MRI. All patients received an adenosine infusion of 140 mcg/kg/min for 2 min. Subsequently, the dosage was increased by 20 mcg/kg/min every 2 min to a maximum of 210 mcg/kg/min until an adequate stress response was achieved. Adequate stress was defined as two or more of the following criteria: 1) Increase in heart rate >/= 10 beats perminute. 2) Decrease in systolic blood pressure SBP by >/= 10mmHg Symptoms like chest discomfort, breathlessness, and headache. Patients who satisfied two or more of the above criteria were labeled as responders and the patients who did not satisfy the above criteria with the maximum dose of 210 mcg/kg/min of adenosine infusion were labeled as non?responders. Multivariable logistic regression analysis with forward and backward stepwise selection was used to identify predictors in non?responders. Basic demographic variables with P value </= 0.2 were examined for inclusion in the model. A P value </= 0.05 was considered significant. Results: Nine patients (9.1%) showed inadequate stress response to adenosine infusion even with a maximum dose of 210 mcg/kg/min. Multivariate logistic regression analysis showed that left ventricular end?diastolic volume (LVEDV) was a predictor of inadequate response to adenosine infusion. Conclusion: Inadequate stress response to adenosine occurred in 9.1% of subjects with an infusion of 140–210 ug/kg/min. LVEDV is an independent and strong predictor in non?responders.
ABSTRACT
Objective:Thoracic Epidural Analgesia (TEA) was compared with ultrasound?guided bilateral erector spinae plane (ESP) block in aorto?femoral arterial bypass surgery for analgesic efficacy, hemodynamic effects, and pulmonary rehabilitation. Design: Prospective randomized. Setting: Tertiary care centre. Participants: Adult patients, who were scheduled for elective aorto?femoral arterial bypass surgery. Interventions: It was a prospective pilot study enrolling 20 adult patients who were randomized to group A (ESP block = 10) and group B (TEA = 10). Monitoring of heart rate (HR) and mean arterial pressure (MAP) and pain assessment at rest and deep breathing using visual analog scale (VAS) were done till 48?h post?extubation. Rescue analgesic requirement, Incentive spirometry, oxygenation, duration of ventilation and stay in Intensive Care Unit (ICU) were reported as outcome measures. Statistical analysis was performed using unpaired Student T?test or Mann?Whitney U test. A value of P < 0.05 was considered significant. Results: HR was lower in group B than group A at 1 and 2 h post? surgery and at 0.5, 16, 20, and 32 h post?extubation (P < 0.05). MAP were lower in group B than A at 60, 90, 120, 150, 180, 210, 240, 270 minutes and at 0 hour post?surgery and at 4 hours, every 4 hours till 32 hours post?extubation (P < 0.05). Intraoperative midazolam and fentanyl consumption, ventilatory hours, VAS at rest, incentive spirometry, oxygenation, and ICU stay were comparable between the two groups. VAS during deep breathing was more in group A than B at 0.5, 4 hours and every 4 hours till 44 hours post?extubation. The time to receive the first rescue analgesia was shorter in group A than B (P < 0.05). Conclusion: Both ESP block and TEA provided comparable analgesia at rest. Further studies with larger sample size are required to evaluate whether ESP block could be an alternative to TEA in aorto?femoral arterial bypass surgery