Massive primary pulmonary artery rhabomyosarcoma: A case report.

BACKGROUND: Pulmonary artery sarcomas (PAS) are rare tumours causing an insidiously progressive obstruction of the pulmonary circulation. The clinical presentation is often indistinguishable from chronic thromboembolic pulmonary hypertension (CTEPH). However, the atypical appearance of a heterogeneous filling defect in CT pulmonary angiography (CTPA) should prompt further investigation. CASE PRESENTATION: A previously healthy young man presented with massive haemoptysis, acute respiratory distress, and progressive exertional dyspnea since the year before. Echocardiography demonstrated severe right ventricular dysfunction and highly probable pulmonary hypertension. CTPA revealed an extensive filling defect with an appearance concerning PAS. Due to syncopal episodes at rest, the patient underwent urgent pulmonary artery endarterectomy (PEA). A massive tree-like tumour was excised as a result. Post-operatively, reperfusion injury and refractory pulmonary oedema mandated extracorporeal membrane oxygenation (ECMO). Unfortunately, ECMO was complicated with massive haemolysis and acute kidney injury. The patient succumbed to multi-organ failure. Through tissue analysis established a diagnosis of embryonal rhabdomyosarcoma. DISCUSSION: Unfortunately, the patient had not reached out for his worsening dyspnea. PASs should not be mistaken for a thrombus and anticoagulation should be avoided. The urgent condition precluded biopsy and tissue diagnosis. Similarly, neoadjuvant chemotherapy was not feasible. Post-operatively, reperfusion injury and pulmonary oedema ensued, which mandated ECMO. This complication should be anticipated preoperatively. There is a need for more data on PASs to establish a consensus for management.

Diagnosis and treatment of cardiovascular manifestations of COVID-19: a narrative review.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was the main pathogen in the COVID-19 pandemic. This viral infection has been associated with several respiratory and non-respiratory complications contributing to a higher mortality rate, especially in patients with underlying heart diseases worldwide. Once considered a respiratory tract disease, it is now well-known that COVID-19 patients may experience a wide range of cardiac manifestations. Because of its remarkable direct and indirect effects on the cardiovascular system, herein, we examined the published literature that studied the hypothetical mechanisms of injury, manifestations, and diagnostic modalities, including changes in molecular biomarkers with a predictive value in the prognostication of the disease, as well as emerging evidence regarding the long-term cardiac complications of the disease.

A Comparison Between Low-Level Laser Therapy and Intra-articular Ozone Injection in Knee Osteoarthritis Treatment: A Randomized Clinical Trial.

Introduction: Knee osteoarthritis (KOA) is a common degenerative joint disease, causing deformity, pain and a limited joint range of motion. Modification of the lifestyle and an exercise training program are the cornerstone of treatment. Alternative therapies such as laser or ozone are commonly used, but there is not any comparative study of low-level laser therapy (LLLT) versus ozone therapy. The aim of the study was to compare the efficacy and safety of the LLLT versus ozone in patients with KOA. Methods: In this single-blinded randomized clinical trial, 60 patients with KOA were assigned to LLLT or ozone groups (n=30). The First basic pain severity, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and physical function were determined. Then in the LLLT group, the patients were provided with 12 sessions of LLLT. In the ozone group, 6 sessions of intra-articular injection of ozone were organized (in each session a mixture of 10 mL of bupivacaine 0.25% with 15 mL of ozone 30 µg/mL). In the middle and at the end of the intervention period, we reassessed the joint pain and physical function and the degree of improvement compared between the two groups. Results: In the middle and at the end of the treatment period in both groups, the joint pain decreased significantly. The same as pain, the self-administrated WOMAC score and the range of joint motion improved significantly in both groups. All of these variables exposed more improvement in the ozone group patients. Conclusion: The study showed that both LLLT and ozone are acceptable non-invasive methods in the non-surgical treatment of KOA. Compared to LLLT, the ozone was more effective. These methods must be considered in any patient who is not suitable for surgical interventions or does not experience enough improvement in symptoms following long periods of common exercise training programs.

The Evaluation of Factors Affecting Hemodynamic Variability in Mechanically-Ventilated Patients After Cardiac Surgery.

BACKGROUND: Optimizing cardiac preload is usually the first step in patients with unstable hemodynamic. However, it should be remembered that an unnecessary volume expansion may exacerbate the hemodynamic. In mechanically ventilated patients, the ventilatory induced hemodynamic variations (VIHV) can be used to predict the fluid requirement. These variations (called dynamic indices of cardiac filling pressure), are superior to static indices (central venous and pulmonary artery occlusion pressure) in diagnosing any volume requirement. We theorized that some conditions other than hypovolemia might affect these hemodynamic variations. OBJECTIVES: The current study aimed to discover these conditions in adult patients admitted to post-cardiac surgery ICU. METHODS: This antegrade cross-sectional study was conducted on 304 adult patients who were admitted to ICU after elective cardiac surgery in a teaching hospital (Tabriz-Iran). During the first 3 hours of the admission, the systolic (ΔSBP), diastolic (ΔDBP), mean (ΔMAP), and arterial blood pulse pressures (ΔPP) were invasively monitored and calculated in percent value. Because of the return of spontaneous breathing in most of the patients, the calculations were done only during the first 3-hour. All patients with spontaneous breathing, irregular cardiac rhythm, or re-admission to OR in this period were excluded from the study. We recorded demographic and surgical characteristics, perioperative hemodynamic and echocardiographic, and complications data and surveyed the correlation between VIHV and perioperative data. RESULTS: Two hundred and ninety two patients met the inclusion criteria. Coronary artery bypass grafting (CABG) was the most common surgery (64.4 %). Cardiopulmonary bypass (CPB) was used in 95.55% of the surgeries. In the first 24-hour, 51 patients required re-operation because of sternum closure, bleeding control, cardiac tamponade, and coronary artery revascularization. Mortality and morbidity occurred in 2 (0.68%) and 50 (17.12%) patients, respectively. Among VIHVs, the ΔPP had the most significant value. Thus, mean ΔPP was calculated and the correlation between its severity (≤ 20% vs. > 20%) and other values surveyed. It was high in patients with cardiac dysfunction and tamponade (P value < 0.001). No significant correlation was found between mean ΔPP severity and hemorrhage rate, fluid balance, need to vasoactive agents, blood products, or bleeding control, redo CABG or sternum closure surgery, time to tracheal extubation, ICU stay, and postoperative complications. Patients with closed sternum were the same as those with the unclosed sternum. CONCLUSIONS: The ΔPP was the most sensitive VIHV parameter. Cardiac dysfunction and tamponade increased ΔPP. Unclosed sternum did not affect its value. ΔPP value did not affect postoperative complications rate, time to tracheal extubation, or ICU stay.

Effect of Pressure on the Yinmen Point in Relief of Pain After Middle Ear Surgery: A Randomized Clinical Trial.

BACKGROUND: Postoperative pain is a common problem after middle ear surgery. Several analgesic agents are available for pain relief, but they cause numerous side effects. Therefore, complementary analgesic methods are developed to reduce patient's postoperative pain and discomfort. OBJECTIVES: The current study aimed to investigate the effect of the acupressure on post middle ear surgery pain, applying pressure on the Yinmen acupoint of the sciatic nerve. METHODS: In this randomized clinical trial, 100 adult patients who were candidate for elective middle ear surgery were selected and divided into two groups of Yinmen and placebo, each with 50 subjects. After admission to the ward, patients' postoperative pain score was measured using the visual analog score (VAS) tool. Then, patients were placed in the prone position. In the Yinmen group, using a fist, we applied a continuous pressure (11 - 20 kg) to the posterior aspect of the thighs at the Yinmen acupoint for 2 minutes. In the placebo group, only soft contact was kept between the fist and Yinmen point for the same period. The maneuver repeated every two hours for four times. The pain intensity surveyed 10 minutes after the first maneuver, then every hour for 8 hours. For those with a VAS score ≥ 4, intravenous paracetamol and/or meperidine was administered. Any nausea and vomiting was managed using ondansetron 2 mg, IV. The pain score, paracetamol, and meperidine consumption were recorded and compared between the two groups. The chi-square and student t-tests were used to compare the two groups. RESULTS: No significant difference was found between patients' characteristics and the first pain score. For all measurements, pain intensity was lower in the Yinmen group (P value < 0.01). The pain after the first maneuver was relieved exactly when the acupressure was true. The intervention could reduce patients' need to take paracetamol (6.68 ± 2.58 vs. 10.42 ± 3.87 mg/kg) and meperidine (0.21 ± 0.17 vs. 0.39 ± 0.23 mg/kg) in the Yinmen group. The two groups were not significantly different concerning the need to take ondansetron to manage postoperative nausea and vomiting. CONCLUSIONS: Applying 2 minutes pressure (11 - 20 kg) on the Yinmen acupoint of the sciatic nerves can reduce post middle ear surgery pain and analgesic consumption.

The effect of passive leg-raising maneuver on hemodynamic stability during anesthesia induction for adult cardiac surgery.

INTRODUCTION: Some cardiac patients do not tolerate the intravenous fluid load commonly administered before anesthesia induction. This study investigated preinduction passive leg-raising maneuver (PLRM) as an alternative method to fluid loading before cardiac anesthesia. METHODS AND MATERIALS: During a 6-month period, 120 adult elective heart surgery patients were enrolled in this study and allocated into 2 groups: PLRM group vs control group (n=60). Anesthesia was induced using midazolam, fentanyl, and cisatracurium. Initially, 250 mL of fluid was administrated intravenously in all of patients before anesthesia induction. Then in the PLRM group, PLRM was performed starting 2 minutes before anesthesia induction and continued for 20 minutes after tracheal intubation. In the control group, anesthesia was induced in a simple supine position. Heart rate, invasive mean arterial blood pressure (MAP), and central venous pressure (CVP) were recorded before PLRM, before anesthetic induction, before laryngoscopy, and at 5, 10, and 20 minutes after tracheal intubation. The hypotension episode rate (MAP <70 mmHg) and CVP changes were compared between the 2 groups. The predictive value of the ≥3 mmHg increase in CVP value in response to PLRM for hypotension prevention was defined. RESULTS: Hypotension rates were lower in the PLRM group (63.3% vs 81.6%; P-value 0.04), and MAP was higher among PLRM patients immediately before anesthetic injection, before laryngoscopy, and 20 minutes after intubation, compared to the control group. PLRM increased CVP by 3.57±4.9 mmHg (from 7.50±2.94 to 11.05±3.55 mmHg), which required several minutes to reach peak value, returning to baseline after 15 minutes. This change did not correlate to subsequent MAP changes; an increase in the CVP value ≥3 mmHg decreased the postinduction hypotension rate by 62.50%. CONCLUSION: Preinduction PLRM can provide a more stable hemodynamic status in adult cardiac surgery patients and decreases anesthesia-induced hypotension rates by 62.50%. Rate of the changes in the CVP value caused by PLRM is not predictive of subsequent MAP changes.

Classic versus Inguinal Approach for Obturator Nerve Block in Transurethral Resection of Bladder Cancer under Spinal Anesthesia: A Randomized Controlled Trial.

Single spinal anesthesia in transurethral resection of bladder tumor (TURBT) has been reported to be unable to prevent obturator nerve stimulation and adductor muscle contraction, which can cause complications like bladder perforation. The present study aimed to compare the effectiveness of the classic and inguinal approaches for obturator nerve block (ONB ). Seventy patients with cancers of the lateral wall of the bladder, scheduled to undergo TURBT at Imam Reza Hospital (Tabriz, Iran) during a 6-month period as of June 2016, were randomly allocated to groups of inguinal and classic methods (n=35). After the infusion of 500 mL of normal saline, spinal anesthesia was commenced using 3 mL (15 mg) of bupivacaine. Then ONB was performed using 10 mL of 1% lidocaine via the inguinal or classic approach in the inguinal group or the classic group, respectively. The success rate, defined as lack of post-block contraction with stimulation or during surgery, number of puncture attempts, time of block onset, and patient and surgeon satisfaction, was compared between the 2 methods using SPSS, version 19. The success rate of ONB was significantly higher in the inguinal group (97.1% vs. 71.4%; P=0.003). The number of puncture attempts in the classic group was more than that in the inguinal group (3.71±1.10 vs. 1.66±0.68, respectively; P<0.001). The block onset time was shorter in the inguinal group (1.5±0.66 min vs. 2.9±1.18 min; P<0.001). Dissatisfaction of the patient (19 cases vs. 2 cases) and the surgeon (10 cases vs. no case) was higher in the classic group (P<0.001). Compared to the classic approach, the inguinal approach for ONB appeared to be an easily performable, effective block with a high success rate, rapid onset, and good patient and surgeon satisfaction. TRIAL REGISTRATION NUMBER: IRCT 201608171772N21.

Effect of corrective or palliative procedures on arterial to end-tidal carbon dioxide pressure difference in pediatric cardiac surgery.

BACKGROUND: The normal small difference (3-5 mmHg) between arterial (partial pressure of carbon dioxide [PaCO2]) and end-tidal carbon dioxide pressure (ETPCO2) increases in children with congenital heart disease. The present study was conducted to evaluate the effect of corrective or palliative cardiac surgery on this difference (known as DPCO2). PATIENTS AND METHODS: In a prospective study, 200 children (aged <12 years old) candidate for corrective or palliative cardiac surgery were studied. Using arterial blood gas measurement and simultaneous capnography, DPCO2 was calculated at various intra- and postoperative periods. DPCO2 values were compared within and between corrective or palliative procedures. RESULTS: Corrective and palliative procedures were carried out on 154 and 46 patients, respectively. Initial DPCO2 was higher than normal values in corrective or palliative procedures (15.50 ± 13.1 and 10.75 ± 9.1 mmHg, respectively). DPCO2 was higher in patients who underwent palliative procedure, except early after procedure. The procedure did not have any effect on the final DPCO2 in palliative group. Although DPCO2 decrease was significant in the corrective group, it did not return to normal values. Operation time was longer, and the need to inotropic support was higher in corrective procedures; however, longer periods of ventilatory support were needed in the palliative group. Complication rate and Intensive Care Unit stay time were the same in two operation types. CONCLUSIONS: DPCO2 did not change after palliative cardiac procedures. DPCO2 decreased after corrective procedures; however, it did not return to normal values at early postoperative period. Thus, DPCO2 may not have any clinical value in monitoring the quality of corrective or palliative procedures.

The correlation between preoperative erythrocyte sedimentation rate and postoperative outcome in adult cardiac surgery.

INTRODUCTION: Over the past decades, it has been recommended that preoperative assessment mainly relies on history and physical examination rather than unnecessary laboratory tests. In Iranian hospitals, erythrocyte sedimentation rate (ESR) has been routinely measured in most of the patients awaiting major surgery, which has in turn exacted heavy costs on the health system. Therefore, the aim of the present study was to assess the preoperative routine measurement of ESR in such patients. MATERIALS AND METHODS: This is a retrospective study, in which we evaluated the medical files of 620 patients. Patients older than 18 years, who had undergone elective heart surgery in our hospital in 2014, were included in the study. The data associated with demography, heart disease diagnosis, type of surgery, significant preoperative tests, delay or postponing of surgery and the reason for it, type and characteristics of the subspecialty consultation, and finally, postoperative complication and mortality rate were collected and analyzed. The patients were categorized into four groups according to ESR value: normal (<15 mm/h in females or <20 mm/h in males), moderately increased (<40 mm/h), severely increased (≥40 mm/h), and not measured. RESULTS: Of the 620 patients' files, 402 were of males and 218 were of females. Demographic values and preoperative characteristics were similar in the four groups. A total of 105 consultations were given to 79 patients preoperatively, where only in five cases, the elevation in ESR was the main reason for consultation. In no other cases did the consultations result in new diagnoses. Overall, postoperative complication and mortality rate were the same in all four groups; in severely increased ESR group, on the other hand, the need for long periods of intensive care unit (ICU) and hospital stays was higher than that of other groups. CONCLUSION: It is concluded that elevated preoperative ESR does not cancel or defer the surgery, nor does it help diagnose a new, previously undiagnosed disease. Furthermore, it does not generally affect postoperative morbidity or mortality rate unless increased to ≥40 mm/h, where it can increase postoperative ICU and hospital stay. Ultimately, routine preoperative ESR measurement in patients is not conducive to elective heart surgery.

Pregnancy after allogeneic hematopoietic stem cell transplantation in a Fanconi anemia patient.

Pregnancy in patients with Fanconi anemia (FA) is rare. However, there are reports of successful pregnancy in Fanconi patients after bone marrow transplantation (BMT, hematopoietic stem cell transplantation). We describe the case of a term pregnant woman with FA who was treated with BMT 2 years earlier. She underwent successful delivery with cesarean section using spinal anesthesia without any complications.

Prophylactic furosemide infusion decreasing early major postoperative renal dysfunction in on-pump adult cardiac surgery: a randomized clinical trial.

INTRODUCTION: Acute renal dysfunction is a common complication of cardiac surgery. Furosemide is used in prevention, or treatment, of acute renal dysfunction. This study was conducted to evaluate the protective effects of intra- and early postoperative furosemide infusion on preventing acute renal dysfunction in elective adult cardiac surgery. METHODS: Eighty-one patients, candidates of elective cardiac surgery, were enrolled in this study in either the furosemide (n=41) or placebo (n=40) group. Furosemide (2 mg/h) or 0.9% saline was administered and continued up to 12 hours postoperatively. We measured serum creatinine (Scr) at preoperative and on the second and fifth postoperative days. Then calculated estimated glomerular filtration rate (eGFR) at these times. An increase in Scr of >0.5 mg/dL and/or >25%-50%, compared to preoperative values, was considered as acute kidney injury (AKI). In contrast, an increase in Scr by >50% and/or the need for hemodialysis was regarded as acute renal failure (ARF). At the end we compared the AKI or ARF incidence between the two groups. RESULTS: On the second and fifth postoperative days, Scr was lower, and the eGFR was higher in the furosemide group. AKI incidence was similar in the two groups (11 vs 12 cases; P-value 0.622); however, ARF rate was lower in furosemide group (1 vs 6 cases; P-value 0.044). During the study period, Scr was more stable in the furosemide group, however in the placebo group, Scr initially increased and then decreased to its preoperative value after a few days. CONCLUSION: This study showed that intra- and early postoperative furosemide infusion has a renal protective effect in adult cardiac surgery with cardiopulmonary bypass. Although this protective effect cannot be discovered in mild renal dysfunctions, it apparently reduces the rate of the more severe renal dysfunctions. A more multidisciplinary strategy may be needed in reducing the milder renal damage.

Using central venous catheter for suprapubic catheterization in cardiac surgery.

Suprapubic catheterization is an alternative method for urinary drainage that is used when transurethral catheterization fails. Traditionally, inserted large-bore suprapubic catheters may cause fatal complications. During the past decade, we used a small central venous catheter (CVC) suprapubicly in 16 male patients for the purpose of urinary drainage, when transurethral catheterization failed. The procedure is performed in no more than 10 minutes. Success rate was 100% and this approach did not lead to any complications. In conclusion, placing a CVC for suprapubic drainage is a safe method with a high success rate and we recommend it in patients with failed transurethral catheterization after a few attempts (2-3 attempts).

Effect of prophylaxis of magnesium sulfate for reduction of postcardiac surgery arrhythmia: Randomized clinical trial.

BACKGROUND: Arrhythmia is a common complication after heart surgery and is a major source of morbidity and mortality. AIMS: This study aimed to study the effect of magnesium sulfate (MgSO4) for reduction of postcardiac surgery arrhythmia. SETTING AND DESIGN: This study is performed in the cardiac operating room and Intensive Care Unit (ICU) of Shahid Madani Hospital of Tabriz (Iran) between January 1, 2014, and September 30, 2014. This study is a double-blind, randomized controlled trial. MATERIALS AND METHODS: In Group 1 (group magnesium [Mg]), eighty patients received 30 mg/kg MgSO4in 500 cc normal saline and in Group 2 (group control), eighty patients received 500 cc normal saline alone. STATISTICAL ANALYSIS: The occurrence of arrhythmia was compared between groups by Chi-square and Fisher's exact test. In addition, surgical time, length of ICU stay, and length of hospital stay were compared by independent t-test. P< 0.05 was considered as significant. RESULTS: There was a significant difference in the incidence of arrhythmia between two groups (P = 0.037). The length of ICU stay was 3.4 ± 1.4 and 3.73 ± 1.77 days in group MgSO4and control group, respectively, and there was no statistically significant difference between two groups (P = 0.2). CONCLUSION: Mg significantly decreases the incidence of all type of postcardiac surgery arrhythmia and hospital length of stay at patients undergo cardiac surgery. We offer prophylactic administration of Mg at patients undergo cardiac surgery.

A Large Left Ventricle Myxoma: Presenting with Epigastric Pain and Weight Loss.

Cardiac myxomas are the most common benign tumors found in the heart. They usually appear in the left atrium. Those originating from the left ventricle (LV) are rare. Although clinical presentation may vary, dyspnea and embolism are the most commonly reported symptoms. In the present case study, a 27-year-old woman with a large myxoma originating from the left ventricular free wall is studied. She had atypical complaints, mainly epigastric discomfort, nausea, vomiting, and anorexia. She was hospitalized for acute abdomen, but subsequent investigations revealed a large myxoma that fully filled the LV and severely compromised the flow of the aortic and mitral valves. After successful emergency tumor resection, all symptoms disappeared. The uncommon presentation caused by these tumors is discussed in this study.

Simultaneous operation of hydatid cyst of the heart and liver: a case report.

Primary echinococcosis of the heart is exceptionally uncommon and is reported 0.5% to 2% of all hydatid cyst sites in comparison with liver (70%) or lung (20%) involvement. Hydatid disease of the heart is caused by the cestode tapeworm echinococcosis granulosis or alveolaris. We present a 29-year-old female with hydatid disease of the liver and heart. She only complained of abdominal pain and palpitation. Echocardiography and multi-slice computed tomography (MSCT) showed a 120×101 mm cyst in the liver and 64 mm in the right ventricular free wall. Both cysts were excised within one procedure successfully.

Dexamethasone added to bupivacaine prolongs duration of epidural analgesia.

BACKGROUND: Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind, controlled clinical trial to evaluate the effect of dexamethasone added to bupivacaine-fentanyl on the duration of postoperative analgesia via epidural catheterization. METHODS: Seventy two adult patients scheduled for elective abdominal or thoracic surgery under epidural anesthesia were randomly allocated into two groups to receive either bupivacaine (0.5%) - fentanyl (50 microg) and dexamethasone (8 mg) in lumbar or thoracic epidural anesthesia (Dexa group, n=36), or bupivacaine-fentanyl and saline normal (control group, n=36) via epidural catheter. Duration of analgesia, postoperative pain score and IV analgesic use at first 24 hours were recorded and compared. RESULTS: Two patients were excluded (one in each group) due to unsuccessful blockade. Age, gender and duration of surgery were similar in the two groups (p>0.05). The duration of analgesia (372< or = 58.1 vs. 234.6+/- 24.3 min) was significantly longer and pain score and pentazocine use were less in the Dexa than the control group (37.1+/- 19.7 mg v.s. 73.1 +/- 17.6 mg, respectively; p=0.001). CONCLUSIONS: This study revealed that dexamethasone added to bupivacaine-fentanyl solution in epidural analgesia prolongs the duration of analgesia in abdominal or thoracic surgery.

Do pediatric patients undergoing cardiac surgeries require larger-size cuffed endotracheal tubes? A prospective study.

BACKGROUND: There is a controversy over using either smaller- or larger-size endotracheal tubes (ETT) in children undergoing cardiac surgery, and some anesthesiologists prefer to use ETT sizes different from the formula-based sizes. The aim of the present study was to compare proper-size cuffed ETT in children undergoing cardiac vs noncardiac surgeries. METHODS: In an observational prospective study, 80 children planned to undergo noncardiac elective surgeries (NCS group) and 80 children scheduled for cardiac surgeries (CS group) were recruited. For intubation, initial cuffed ETT size was calculated based on the following formula: Tube size (mm ID) = age (year)/4 + 3.5. The estimated ETT size for each age group and the size of final utilized tubes for each age range were recorded. RESULTS: Patients of tube sizes 4.5, 5, and 5.5 in the CS group were of lower age, weight, height, and body surface area compared with the patients of the same tube sizes in the NCS group (P < 0.05). The compatibility of the predicted vs actual required tube sizes was more in the NCS group compared to the CS group (72.5% vs. 56.2%; P = 0.02). Additionally, the cases with underestimated tube sizes were significantly more in the CS group compared with the NCS group (38.8% vs. 18.8%, P = 0.01). CONCLUSION: Children undergoing cardiac surgeries in relation to their age and body size do require larger-size ETTs compared with the children scheduled for noncardiac surgeries.

Evaluation of the prevalence and risk factors of delirium in cardiac surgery ICU.

INTRODUCTION: Delirium is defined as an acute cognitive disorder presenting with fluctuation in cognition, apathy and non-organized thinking. It may increase morbidity, mortality, ICU stay and cost. In patients who underwent heart surgery delirium may increase post-operative complications such as respiratory insufficiency, sternum instability and need to re-operation of the sternum. The aim of this study was to evaluate the prevalence and risk factors of delirium in patients admitted to cardiac surgery. MATERIALS AND METHODS: 18 years or older patients who had undergone cardiac surgeries and stayed for more than 24 hours in ICU following surgery were recruited. All subjects were assessed for signs & symptoms of delirium using CAM-ICU and its risk factors. All data were analyzed by SPSS 16 at the end of the study. RESULTS: The prevalence of delirium in these patients was 23.5% (47 patients). The mean age of patients with delirium was more than other patients (P=0.001). The Incidence of delirium in the patients with cardiopulmonary bypass surgery (CPB) was higher than the patients without CPB (P=0.01). The Incidence of delirium in the patients with Atrial fibrillation was higher than patients without it (P=0.002). The Incidence of delirium in the patients with CVA history was higher than the patients without CVA history (P=0.032). The mean time of mechanical ventilation in the delirious patients was more than other patients (P=0.01). CONCLUSION: Older Age, CPB, history of CVA, Atrial Fibrillation, and prolonged mechanical ventilation are considered as the risk factors of delirium in cardiac surgery patients.

Cost-effectiveness of intraoperative transesophageal echocardiography in cardiac valve surgery.

INTRODUCTION: Being a unique diagnostic technique, transesophageal echocardiography (TEE) has influenced many different aspects of cardiac surgery including valve repair surgery. The cost-effectiveness of this method however is questioned considering the conditions of every region and country. In this study we aimed at answering the question if utilizing TEE throughout valve repair surgery could be cost-effective. METHODS: Twenty four patients were studied within two groups of case "valve repair operation plus intra-operative TEE (IO-TEE)" and control "valve replacement operation". Variables including age, gender, left ventricle ejection fraction (LVEF), re-operation, intensive care unit (ICU) stay, hospital stay and cost were studied and compared. RESULTS: There was no significant difference regarding age, gender and LVEF between two groups (p=0.559, p=0.413, and p=0.408, respectively). ICU stay in repair group was less than replacement group (p=0.009). Hospital stay difference however was not statistically significant (p=0.928). The cost of valve repair under IO-TEE monitoring was significantly less than valve replacement (p=0.001). CONCLUSION: IO-TEE not only would assist surgeons by increasing their interest toward valve repair operation instead of replacing impaired cardiac valves but also consequently decrease hospital costs. It is also advised for the cardiac anesthesiologists to use IO-TEE routinely in the valve repair operations provided that there are no contraindications.