Respiratory mechanics with volume-controlled auto-flow ventilation mode in cardiac surgery.

AIM: We aimed to investigate the changes in respiratory mechanics in adult patients undergoing open heart surgery (OHS) while using volume-controlled auto-flow (VCAF) ventilation mode. MATERIALS AND METHODS: After obtaining ethics committee's approval and informed consent, 30 patients (17 males and 13 females; mean age: 57.3 ± 17.0 years; mean weight; 74.9 ± 13.6 kg) scheduled for OHS were enrolled. Mechanical ventilation was carried out using VCAF mode (VT: 5-8 mL/kg, I/E: 1/2, 10 ± 2 fr/min). Values of dynamic compliance (Cdyn) and resistance (R) were obtained at six time points (TPs). Normally distributed variables were analyzed with repeated measure of analysis of variance and Bonferroni tests. For abnormally distributed variables, Friedman variance analysis and Wilcoxon signed-rank tests were used. Values were expressed as mean ± standard deviation. P value <0.05 was considered significant. RESULTS: Cdyn (mL/mbar) and R (mbar/L/s) values were as follows - (1) before sternotomy (S): 49.9 ± 17.1 and 7.8 ± 3.6; (2) after S: 56.7 ± 18.3 and 7.1 ± 3.7; (3) after S and after sternal retractor placement: 48.7 ± 16.1 and 8.3 ± 4.4; (4) after weaning from cardiopulmonary bypass and following decannulation while retractor was in place: 49.6 ± 16.5 and 8.1 ± 4.0; (5) after retractor removal: 56.5 ± 19.6 and 7.4 ± 3.7; and (6) after sternal closure: 43.1 ± 14.2 and 9.6 ± 9.1, respectively. Significant differences were observed in Cdyn and R between; first and second TPs, second and third TPs, fourth and fifth TPs, and fifth and sixth TPs. Also, significant difference in Cdyn was found between first and sixth TPs, but it was not found in R. CONCLUSION: Cdyn decreases, but R remains the same in cardiac surgical patients when mechanical ventilation is performed with VCAF ventilation mode. Additionally, Cdyn is negatively affected by the presence of sternal retractor and the sternal closure in OHS.

Anaesthesia for Caesarean Section of Pregnant Women with Idiopathic Thrombocytopenic Purpura.

Women with idiopathic thrombocytopenic purpura (ITP) may become pregnant, or the disease may occur for the first time during pregnancy. Thrombocytopenia is usually noticed in the first months of pregnancy and the platelet count is often quite low. In this case report, we described the anaesthetic method for caesarean section in a pregnant woman at 38 weeks of gestation with refractory ITP.