Identical wave forms of vena cava and pulmonary artery during pulmonary artery catheter insertion due to kinking: a case report of a rare complication.

BACKGROUND: We experienced a rare malposition of a pulmonary artery catheter due to kinking in a 63-year-old male who was scheduled for an off-pump coronary artery by-pass graft. FINDINGS: Given the difficulty to obtain stable pulmonary artery waveform, we discovered that the two waveforms of the distal and proximal ports of the pulmonary artery catheter were completely identical. Subsequent fluoroscopy revealed that because the catheter had formed a kink around the apex of the right ventricle, the distal port faced the proximal port of the catheter. CONCLUSIONS: We recommend that both ports of the pulmonary artery catheter need to be monitored simultaneously in case neither portable fluoroscopy nor transesophageal echo is available.

[Anesthetic management of a pneumothorax patient with complete situs inversus].

We experienced a case of pneumothorax in a patient with complete situs inversus. A 30-year-old man was scheduled for partial resection of the left lung under video assisted thoracic surgery. He had asymptomatic complete situs inversus. We advanced a bronchial blocker easily into the left (anatomically right) main bronchus under fiberoptic guidance. One lung ventilation during the operation was performed successfully. The chest X-ray after the surgery showed an atelectasis of the left upper lobe. After endotracheal suction, we extubated him and noticed improvement of atelectasis. There are several ways of one lung ventilation in patients with situs inversus. To use a bronchial blocker is one of the effective choices. However, in some cases, it is necessary to consider using a double-lumen tube depending on the case considering the anatomical structure and the characteristics of the procedure.

Preoperative plasma brain natriuretic peptide level is an independent predictor of postoperative atrial fibrillation following off-pump coronary artery bypass surgery.

PURPOSE: Atrial fibrillation (AF) is a frequent complication after coronary artery bypass surgery. Postoperative AF can lead to thromboembolic events, prolonged hospital stay, and increased costs. Recent reports have shown that an elevated plasma brain natriuretic peptide (BNP) level is associated with AF. The purpose of this prospective study was to test the hypothesis that preoperative BNP level is a predictor of postoperative AF following off-pump coronary artery bypass surgery (OPCAB). METHODS: One hundred and fifty patients without a history of AF undergoing elective isolated OPCAB were enrolled. Plasma BNP level was measured preoperatively. Heart rate and rhythm were continuously monitored during the first 72 h after surgery. RESULTS: Twenty-six patients (17.3%) exhibited postoperative AF. This proportion is similar to those reported in earlier studies. Univariate analysis demonstrated that age (odds ratio [OR], 1.060; 95% confidence interval [CI], 1.008 to 1.114; P = 0.023), previous myocardial infarction (MI; OR, 2.628; 95% CI, 1.031 to 6.697; P = 0.043), and BNP level (OR, 7.336; 95% CI, 2.401 to 22.409 / log BNP level; P < 0.001) were accurate predictors of postoperative AF. Stepwise multivariate regression analysis indicated age (OR, 1.059; 95% CI, 1.002 to 1.120; P = 0.043) and BNP level (OR, 6.272; 95% CI, 1.980 to 19.861/log BNP level; P = 0.002) as the only independent predictors of postoperative AF. CONCLUSION: Preoperative BNP level is an independent predictor of postoperative AF following OPCAB. Our findings permit us to stratify the risk of AF and to plan prophylactic strategies in high-risk patients.

[Anesthetic management of an infant girl with cloverleaf syndrome].

We experienced anesthetic management of an infant girl with Cloverleaf syndrome complicated with prenatal diagnosis of craniosynostosis. She received posterior-cranioplasty and foramen magnum decompression at the age of 44 days, ventricuro-peritoneal shunting at 80 days and cranioplasty at 149 days all under general anesthesia without serious complications. In all three occasions, we induced general anesthesia with oxygen, sevoflurane, nitrous oxide and thiopental with a facemask. After we made sure it was not impossible to maintain the airway and ventilation, we performed orotracheal intubation with vecuronium. We maintained anesthesia paying particular attention to intracranial pressure and possible massive hemorrhage particularly during cranioplasty. Postoperative course was uneventful. Anesthesiologists should keep in mind that this syndrome is characterized by severe skull deformity, facial bone abnormalities, hydrocephalus and increased intracranial pressure.