Sleep Pattern Changes in Patients Who Are Scheduled for Cardiac Surgery.

Introduction Surgery patients frequently experience sleep deprivation, which is regarded as a stress factor during the perioperative period and can cause physical discomfort, exhaustion, and even postoperative pain. There is a dearth of information on preoperative sleep habits and the consequences that may result. There are both subjective and objective ways to rate the quality of your sleep. We chose the Pittsburgh Sleep Quality Index (PSQI), which employs a questionnaire to provide crucial information on issues like sleep length, efficiency, and interruption. Lower sleep quality is correlated with higher PSQI scores. Study objective Our study aimed to assess the changes in the sleep pattern of cardiac disease patients before cardiac surgery and compare these changes with baseline sleep patterns. Methods This prospective survey was carried out after ethical review committee approval at the Department of Anesthesia, Aga Khan University Hospital. Consent was obtained from all patients undergoing cardiac surgery. Strict inclusion and exclusion criteria were followed. All patients aged 25 to 65 who came from home for elective cardiac surgery under general anesthesia were included. At the same time, patient demographics were noted. Additionally, a printed PSQI questionnaire was distributed to each participant. The native Urdu language was also translated into this questionnaire. The patient was given an explanation of this form by a medical professional. This questionnaire was filled out by the patients on the surgical floor or preoperative area before premedication. The PSQI questionnaire was used to assess baseline sleeping patterns, and then the same questions were asked about the period between decisions for the date of surgery and the time of admission for surgery. Results A total of 83 patients participated in the study. The mean age of the patient was 57 (±13.0), out of which 67 (80.7%) were males and 16 (19.3%) were females. The most common surgeries were coronary artery bypass (CABG) surgery 63 (77.8%), followed by valve replacement nine (11.1%). The overall mean PSQI score was higher (5.27) once the surgery date was decided as compared to the baseline (4.84), but it did not reach the statistically significant level (p-value 0.411). Sleep latency (time to fall asleep while in bed) was the only variable statistically significant between baseline (26.1 (±35.0) and after the surgery date has been finalized (36.1 (±46.6)). No significant differences were found in other variables like sleep quality (feeling of being well-rested), sleep duration (hours of actual sleep), sleep efficiency (sleep efficiency is the ratio of the amount of total time asleep versus the total time in bed), and sleep disturbance (problem initiating and maintaining sleep). Total bedtime was also reduced at night before surgery but did not achieve a significant level. The logistic regression model demonstrated that age, gender, and type of surgery did not influence sleep quality. Conclusion In the present study, lower sleep quality was observed before cardiac surgery, but it did not reach a statistically significant level when compared with baseline. Sleep latency (time to fall asleep while in bed) was significantly prolonged compared to baseline. We could not find any association between quality of sleep and variables like age, gender, and type of surgery.

Awareness during Cardiopulmonary Resuscitation.

Checking responsiveness is the mainstay in cardiopulmonary resuscitation (CPR). It is rare in the clinical situation when the patient requires resuscitation despite the presence of wakefulness. We report a case in which the patient presented with flat arterial line and absence carotid pulse while he was awake. A thorough literature review will also be discussed. HOW TO CITE THIS ARTICLE: Asghar A, Salim B, Tahir S, Islam F, Khan MF. Awareness during Cardiopulmonary Resuscitation. Indian J Crit Care Med 2020;24(2):136-137.

Mode of Coronary Revascularization and Short term Clinical Outcomes in Patients with Chronic Kidney Disease.

BACKGROUND AND OBJECTIVE: Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are two alternative methods for coronary revascularization, but it remains controversial as which one is associated with lower risks of worse clinical outcomes for chronic kidney disease (CKD) patients. We determined the mode of coronary revascularization (PCI vs. CABG) which is associated with lower risk of mortality and morbidity in CKD patients. METHODS: In this cross sectional study, 159 patients with CKD were enrolled from single center of coronary revascularization at Aga Khan University Hospital Karachi between January 2012 and August 2013. All patients with CKD underwent PCI or CABG. The primary outcome was in-hospital composite of death, myocardial infarction (MI), or stroke. We evaluated which mode of coronary revascularization was associated with reduced risks of clinical outcomes. RESULTS: Out of 159 patients with CKD, 85 (53.5%) received PCI and 74 (46.5%) received CABG. The primary finding of this study is that more patients with moderate to severe CKD underwent PCI and more patients with mild to moderate CKD underwent CABG. In both these categories, no difference was observed in clinical outcomes. There are few factors like age, ST- elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and number of coronary artery disease predicted PCI as treatment strategy in patients with moderate to severe CKD. CONCLUSION: Patients with moderate to severe CKD have similar rates of short term clinical outcomes whether they underwent PCI or CABG. Therefore, PCI can be acceptable and less invasive treatment option alternative to CABG, particularly in patients with moderate to severe CKD.