Intraoperative Right Ventricular Fractional Area Change Is a Good Indicator of Right Ventricular Contractility: A Retrospective Comparison Using Two- and Three-Dimensional Echocardiography.

OBJECTIVE: Intraoperative two-dimensional echocardiography is technically challenging, given the unique geometry of the right ventricle (RV). It was hypothesized that the RV fractional area change (RVFAC) could be used as a simple method to evaluate RV function during surgery. Therefore, the correlation between the intraoperative RVFAC and the true right ventricular ejection fraction (RVEF), as measured using newly developed three-dimensional (3D) analysis software, was evaluated. DESIGN: Retrospective study. SETTING: University hospital. PARTICIPANTS: Patients who underwent cardiac surgery with transesophageal echocardiography monitoring between March 2014 and June 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sixty-two patients were included in this study. After the exclusion of poor imaging data and patients with arrhythmias, 54 data sets were analyzed. RVFAC was measured by one anesthesiologist during surgery, and full-volume 3D echocardiographic data were recorded simultaneously. The 3D data were analyzed postoperatively using off-line 3D analysis software by a second anesthesiologist, who was blinded to the RVFAC results. The mean RVFAC was 38.8% ± 8.7%, the mean RVEF was 41.4% ± 8.3%, and there was a good correlation between the RVFAC and the RVEF (r(2) = 0.638; p<0.0001). CONCLUSIONS: The RVFAC was well-correlated with the RVEF calculated using 3D echocardiography; therefore, RVFAC provides a simple and useful method for anesthesiologists to evaluate intraoperative RV function.

[Anesthetic Management of a Patient with Quasi-moyamoya Disease Undergoing Total Thyroidectomy for Graves' Disease].

Quasi-moyamoya disease defined as moyamoya disease combined with autoimmune diseases such as Graves' disease is rare. We report anesthetic management of a patient with quasi-moyamoya disease undergoing total thyroidectomy for Graves' disease resistant to medical therapy. This disease is characterized by the aggravation of cerebral ischemic symptoms with hyperthyroidism. We, therefore, applied steroid pulse therapy before the operation to induce temporal normalization of the thyroid function, and could perform safe anesthetic management of this patient with quasi-moyamoya disease.

[Sugammadex reversal after extubation under muscle relaxation to prevent cough reflex in a patient with intractable spontaneous pneumothorax].

A 40-year-old man (168 cm tall and weighing 71 kg) with intractable pneumothorax was operated for resection of a bulla in the left lung. After insertion of epidural catheter via T 5-6 interspace, general anesthesia was induced and maintained with propofol, remifentanil and rocuronium. The duration of surgery was 1h 48 min and rocuronium given during surgery was 110 mg. After completion of surgery, the double-lumen tube was replaced with laryngeal mask airway to prevent cough reflex. However, infusion of sugammadex 200 mg induced mild cough reflex, resulting in air leakage from thoracic drainage. Because air leakage still continued after extubation, reoperation must be done and re-intubation was required. Since rocuronium 50 mg did not provide satisfactory muscle relaxation measured by train of four, additional dose of rocuronium 40 mg was administered and re-intubation was successfully performed without cough reflex. Reoperation lasted for 43 minutes and rocuronium infused was 100 mg. Nasal airway was inserted to prevent airway obstruction by the tongue and extubation was performed under muscle relaxation with infusion of rocuronium 10 mg. And then, immediate administration of sugammadex 400 mg could elicit spontaneous respiration without cough reflex.

Brachiocephalic Vein Perforation During Cannulation of Internal Jugular Vein: A Case Report.

We report a rare complication of right brachiocephalic vein perforation during ultrasound-guided cannulation of the right internal jugular vein (IJV) in a patient with a tortuous common carotid artery (CCA). We suspect that the tortuous CCA displaced the IJV, which caused misplacement of the J-tip guidewire into the subclavian vein. The stiff dilator sheath introduced over the guidewire then perforated the wall of the brachiocephalic vein, causing massive hemothorax. This was diagnosed by videothoracoscopy. Anesthesiologists should be aware of the possibility of guidewire malposition during IJV catheterization in patients with a tortuous CCA.

Prevalence and Prognostic Value of Early Repolarization in Low Risk Surgical Patients.

Recent epidemiological studies documented that early repolarization may be associated with increased risk of serious cardiac events, including cardiac death. Little is known about the prognostic significance of this pattern in low risk surgical patients. This retrospective study included 3028 patients over 18 years of age and with ASA class I and II risk, undergoing noncardiac elective surgery. We followed the patients for one year. Early repolarization in preoperative ECG was found in 219 patients (7.2%) and patients with early repolarization were more likely to be male and younger. Newly observed cardiac events were significantly higher in the early repolarization group (1.37% versus 0.21%; P = 0.003). Multivariate regression analysis reveals that early repolarization (odds ratio: 6.019, P = 0.013) significantly increased newly observed cardiac events. Our retrospective study suggests that low risk surgical patients with early repolarization have statistically higher opportunity of newly observed cardiac events within one year after surgery.

An analysis of the factors influencing pulmonary artery catheter placement in anesthetized patients.

BACKGROUND: Pulmonary artery catheters are usually placed by resident anesthesiologists with pressure wave monitoring from educational point of view. In some cases, the placement needs longer time or is difficult only by observing the pressure waves. AIMS: We sought to examine the time required for the catheter placement in adult patients and determine factors influencing the placement. SETTINGS AND DESIGNS: Prospective, observational, cohort study. METHODS: We examined the time required for the catheter placement. If the catheter is placed in longer than 5 min, this could be a difficult placement. We examined the effect of the patient's age, body mass index, cardiothoracic ratio (CTR) and tricuspid regurgitation, left ventricular ejection fraction (LVEF) and training duration of a resident on the difficult catheter placement. Next, we excluded the difficult cases from the analysis and examined the effect of these factors on the placement time. STATISTICAL ANALYSIS: The data were analyzed by logistic regression analysis to assess factors for the difficult catheter placement and multiple linear regression analysis to evaluate the factors to increase the placement time after univariate analyses. RESULTS: The difficult placement occurred in 6 patients (5.7%). The analysis showed that LVEF was a significant factor to hinder the catheter placement (P = 0.02) while CTR was a significant factor to increase the placement time (P = 0.002). CONCLUSION: LVEF and CTRs are significant factors to be associated with the difficult catheter placement and to increase the placement time, respectively.