Infectious complications of invasive blood pressure monitoring in open heart surgery patients

To analyze the incidence of infectious complications of invasive blood pressure monitoring. Study was conducted at the Anaesthesia Department of Punjab Institute of Cardiology, Lahore. Design: Arterial catheter tip of 100 adult patient was sent for culture. Both right and left radial arteries were used for cannulation. Outcome Studied: Mean duration of arterial cannulation, any evidence of local or systemic infection, incidence of positive catheter tip culture and types of organism grown were noted. Positive arterial tip culture was seen in 31 patients. Staph epidermidis was the most common organism being seen in 17 patients. Mean duration of cannulation was 34.24 +/- 09.54 hours post operatively. None of these developed any local or systemic evidence of infection. Adherence to the aseptic technique during insertion and maintenance of arterial connulas is very important to prevent the infectious complications related to the procedure. Minimum handling of the whole monitoring system and limiting the duration of cannulation will certainly be helpful in this regard

Risk of developing right bundle branch block [R. B. B. B.] and complete heart block [C. H. B.] during pulmonary artery catheterization in open heart surgery patients

To analyze the incidence and associated haemodynamic disturbances of a new Right Bundle Branch Block [R.B.B.B] induced by Pulmonary Artery Catheter [P.A.C] with a particular emphasis in patients with preexisting Left Bundle Branch Block [L.B.B.B.] in a prospective manner. To establish whether prophylactic placement of a ventricular pacemaker in patients with pre existing L.B.B.B. during pulmonary artery cotheterization is necessary. The study was conducted at the department of Anaesthesiology and intensive care of the Aga Khan University Hospital, Karachi. Pulmonary artery catheterization was performed in 125 adult patients who underwent various open heart surgical procedures. Outcome studied: Incidence of new R.B.B.B induced by P.A.C. and its associated haemodynamic disturbances with a particular emphasis in patients with a pre existing L.B.B.B. was recorded. New R.B.B.B. occurred in 13 [10.4%] patients while none of the 1 1 patients with a preexisting R.B.B.B. developed C.H.B. during the procedure. Development of new block was not associated with any haemodynamic disturbance. Prophylactic temporary pacing is recommended in patients having a pre-existing R.B.B.B. before placement of P.A.C. in previous studies. However, our study does not show that previous R.B.B.B. is at risk of developing complete heart block [C.H.B.] during the procedure. In view of grave consequences of C.H.B. It is recommended that facilities of pacing should be on board in case it happens

Complications of pulmonary artery catheterization: a prospective study in open heart surgery patients

Pulmonary artery was catheterized in 125 adult patients undergoing various open-heart surgical procedures for perioperative haemodynamic monitoring. A standard approach to right internal jugular vein was used in all patients. Complications noted were related either to central venous access, pulmonary artery catheter [PAC] threading and during stay of catheter in the pulmonary artery. Post-operatively, X-ray chest was done in every patient and tip of the catheter was sent for culture once the PAC was removed. There was 8.8 percent incidence of inadvertent carotid artery puncture. Pneumothorax occurred in one patient. Arrhythmias occurred in 49.6 percent of the patients. New right bundle branch block occurred in 10.4 percent of the patients, while none of the 11 patients with a pre-existing left bundle branch block developed complete heart block during pulmonary artery catheterization. There was no incidence of pulmonary artery rupture associated with the use of PAC. There was a 9.6 percent incidence of PAC colonization, which was seen on culture of catheter tip. This investigation revealed a low incidence of morbidity associated with the use of PAC

Ectopic placement of central venous catheter, importance of x-ray chest

A case of malpositioning of central venous catheter which was judged to be correctly placed on clinical criteria is being presented. Abberant positioning was picked up on X-ray chest

Combined carotid endarterectomy and myocardial revascularization - anaesthetic management

Coronary and carotid artery disease frequently coexist. When a patient who requires myocardial revascularization is found to have significant carotid artery disease as well it raises the question that whether simultaneous or staged operations should be done. Anaesthetic management of a case of simultaneous myocardial revascularization and carotid endarterectomy is being presented