Massive subcutaneous emphysema after off-pump coronary bypass surgery

Subcutaneous emphysema is a condition when air gets accumulated into the tissues under the skin and in the soft tissues of the chest wall or neck but can also spread to other parts of the body. It generally causes minimal symptoms and nonlethal; sometimes, it may be severe and life-threatening if deeper tissues of the thoracic outlet and chest are involved. It is essential to know the mechanisms of subcutaneous emphysema after cardiac surgery.

Superior vena cava clamping during thoracic surgery: Implications for the anesthesiologist

Resection and reconstruction of the SVC is a challenging Intraoperative situation owing to the potential complications after clamping a patent vessel. Hemodynamic imbalance and neurological effects of SVC clamping can be life threatening. These complications can be prevented by careful intraoperative monitoring and management. Anaesthesiologist must be aware of different options to manage such challenging situations.

Undiagnosed aortic dissection in patient with intra‑aortic balloon pump.

60 years old lady presented with chest pain and was admitted in local hospital. Electrocardiogram was suggestive of anterior myocardial ischemia. Patient underwent coronary angiography which revealed severe triple vessles coronary artery disease. As patient was hemodynamically unstable and in cardiogenic shock, intraaortic balloon pump was inserted .IABP augmented diastolic blood pressure was less than unassisted systolic blood pressure despite setting maximum augmentation on IABP machine.

Rare postoperative delayed malignant hyperthermia after off‑pump coronary bypass surgery and brief review of literature.

Postoperative malignant hyperthermia (MH) is a very rare phenomena. It is generally observed within less than an hour after discontinuation of the anesthetic trigger. Present case describes rare delayed postoperative presentation of MH after off‑pump coronary bypass surgery. Prompt recognition and immediate treatment with dantrolene can effectively treat the fatal syndrome. Family education and genetic counseling should be encouraged.

Left ventricular mass: Myxoma or thrombus.

Patient with embolic episode should always be evaluated for cardiac mass. Mass in left ventricular can be a myxoma or thrombus even in a normal functioning heart . In either case, mobile mass with embolic potential should be surgically resected.

Localized pericardial tamponade: Does it always need exploration.

A 48-year-old female patient underwent coronary artery bypass surgery. One‑hour after surgery, the patient developed hemodynamic instability. Transthoracic echocardiography (TTE) was inconclusive. Transesophageal echocardiography (TEE) was performed and it revealed localised collection around right atrium. In spite of the evidence of localized tamponade, wait and watch policy was employed rather than re‑exploring the patient emergently. The patient recovered uneventfully. If hemodynamics remain stable and there is no fall in hematocrit and no increase in effusion on TEE/TTE examination, then localized tamponade can be managed conservatively without reexploring the patient.

Management of a case of left tracheal sleeve pneumonectomy under cardiopulmonary bypass: Anesthesia perspectives.

The lung tumors with carinal involvement are frequently managed with tracheal sleeve pneumonectomy and tracheobronchial anastomosis without use of cardiopulmonary bypass (CPB). Various modes of ventilation have been described during tracheal resection and anastomosis. Use of CPB during this period allows the procedure to be conducted in a more controlled way. We performed tracheal sleeve pneumonectomy for adenoid cystic carcinoma of left lung involving carina. The surgery was performed in two stages. In the first stage, left pneumonectomy was performed and in the second stage after 48 h, tracheobronchial resection and anastomosis was performed under CPB. Second stage was delayed to avoid excessive bleeding (due to heparinization) from the extensive vascular raw area left after pneumonectomy. Meticulous peri‑operative planning and optimal post‑operative care helped in successful management of a complex case, which is associated with high morbidity and mortality.

How standard transesophageal echocardiography views change with dextrocardia.

Dextrocardia with situs inversus is a rare condition. Situs inversus with dextrocardia is also called as "situs inversus totalis". Transesophageal echocardiography (TEE) views in dextrocardia patient are not discussed in the literature. The cardiac position and the cardiac chambers are mirror image of the normal anatomy. Because of this positional change, certain TEE probe and multiplane angle manipulations are required to obtain the recommended views.