A survey of cardiopulmonary resuscitation in COVID-19 patients.

BACKGROUND AND AIMS: The novel coronavirus 2 (SARS-CoV-2) pandemic has placed severe resource constraints on hospitals. High mortality rates of the COVID-19 have overwhelmed the resuscitation services. The constant fear of virus infection during cardiopulmonary resuscitation (CPR) has placed severe restrictions on the resuscitation services. Reports of poor outcomes after CPR further dampened the spirits of CPR providers. Hence we surveyed CPR practices for COVID -19 patients across hospitals in India by health care providers. MATERIAL AND METHODS: An online survey using Google Forms was initiated to collect data on performance of CPR in diagnosed cases of COVID-19 after in-hospital cardiac arrest. The survey's web-link was publicized using social media, and participation sought of all personnel involved in CPR delivery in COVID-19 patients. The responses received were analyzed. The main outcome measured were determination of the percentage of COVID-19 patients discharged home who were administered CPR. RESULTS: There were 248 responses from different parts of India. At the time of cardiac arrest, 194 victims had diffuse lung infiltrates, 22 had mild lung disease, while 32 had no documented lung lesion. Twenty-five victims had evidence of pulmonary embolism, 39 had cardiac involvement, and 3 had brain involvement. Return of spontaneous circulation (ROSC) was achieved in 59.27% of cases but ROSC sustained in only 22.59%. 7.25% of patients, who received CPR, could be discharged home. CONCLUSION: The survey has shown reasonable survival rates after CPR administration in COVID-19 patients suffering from IHCA. We should not ignore the need to maximize live outcomes after CPR, even in COVID-19 patients.

Comparison of leakage test and ultrasound imaging to validate ProSeal supraglottic airway device placement.

BACKGROUND AND AIMS: To validate the placement of ProSeal supraglottic airway device using ultrasound (USG) with leakage test in adult population of both sexes. MATERIAL AND METHODS: This single-arm observational study was conducted on 80 American Society of Anesthesiology (ASA) I-III patients, undergoing elective surgery under general anesthesia with ProSeal supraglottic airway device. Leakage pressure test was conducted in all cases. The position of the ProSeal laryngeal mask airway (LMA) was assessed by USG in the pharyngeal, laryngeal, and the cranial-caudal axis plane. The fiberoptic examination was done to confirm the position of ProSeal if the seal pressure was <27 cm H2O, to confirm suboptimal placement. The position of the ProSeal in the three USG planes was allocated a predetermined score. This score was compared with the leakage test to determine the strength of the correlation, sensitivity, and specificity for predicting a need for reinsertion. RESULTS: Leakage seal pressure was recorded as <27 cm H2O in 6 (7.5%) patients and fiberoptic bronchoscopy was done in these cases to determine the need for reinsertion. ProSeal was reinserted in 5 (6.25%) cases. Patients with a composite ultrasound score of 0-1 required ProSeal reinsertion while those with a score of 2-3 did not require reinsertion. Seventy-one patients had seal pressure >27 cm H2O and a score of 3. USG examination is comparable with leakage test in predicting the requirement of reinsertion (P = 0.003) and a score of 19 equating 0-1 predicted the need for reinsertion with a sensitivity and specificity of 80% and 100%, respectively. CONCLUSION: USG is comparable with the leakage test for confirmation of ProSeal placement.

Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 1: The problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia.

The association with cardiac surgery with cognitive decline was first reported in the 1960s after the introduction of coronary artery surgery. The incidence in cognitive decline was thought to be more after cardiac surgery, especially with the use of the cardiopulmonary bypass. Anesthesia and surgery are both associated with cognitive decline but many other factors appear to contribute its genesis. On-pump surgery, microembolization during manipulation of the heart and great vessels, temperature changes, pH changes, and altered cerebral perfusion, during cardiac surgery, have all been blamed for this. Postoperative cognitive decline is associated with poor clinical outcomes and higher mortality. Several studies have been conducted in the last decade to determine the genesis of this malady. Current evidence is absolving cardiac surgery and anesthesia to be the primary causes per se of cognitive dysfunction.

Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 2: Cognitive dysfunction after critical illness; potential contributors in surgery and intensive care; pathogenesis; and therapies to prevent/treat perioperative neurological dysfunction.

Severe cognitive decline and cognitive dysfunction has been attributed to patient's stay in the cardiovascular intensive care unit. Prolonged mechanical ventilation, long duration of stay, sedation protocols, and sleep deprivation contribute to patients developing neurocognitive disorder after intensive care admission and it is associated with poor clinical outcomes. Trauma of surgery, stress of critical care, and administration of anaesthesia evoke a systemic inflammatory response and trigger neuroinflammation and oxidative stress. Anaesthetic agents modulate the function of the GABA receptors. The persistence of these effects in the postoperative period promotes development of cognitive dysfunction. A number of drugs are under investigation to restrict or prevent this cognitive decline.

Use of dopamine infusion improved oxygenation in a patient of Ebstein's anomaly with atrial septal defect.

We present the successful perioperative management of an adult patient with Ebstein's anomaly for abdominal rectopexy surgery. The patient developed mild hypotension and a fall in peripheral oxygen saturation (SpO 2 ) after administration of a graded epidural block. Correction of the fall in the blood pressure; however, did not improve the SpO 2 . The patient was administered an intravenous infusion of dopamine to improve the cardiac output and this led to improvement in the SpO 2 .

Fluid infusion into the pericardium resulting from accidental displacement of a subclavian venous cannula.

A patient for double valve replacement developed an unusual complication consequent to extra-vascular displacement of a port of a central venous catheter, placed through the right subclavian vein. The patient had an uneventful surgical course and the trachea extubated after routine mechanical ventilation. Patient developed excessive mediastinal drainage later, which was noticed to be watery in nature. The source of the drainage was found to be a port of the central venous catheter, draining extra-vascular into the subclavian vascular sheath and thereafter through the pericardium into the mediastinal drains.

Takayasu's arteritis: Anesthetic significance and management of a patient for cesarean section using the epidural volume extension technique.

Takayasu's arteritis (TA) is a rare, chronic progressive pan-endarteritis involving the aorta and its main branches. Anesthesia for patients with TA is complicated by severe uncontrolled hypertension, end-organ dysfunction, stenosis of major blood vessels, and difficulties in monitoring arterial blood pressure. We present the successful anesthetic management of a 23-year-old woman having TA with bilateral subclavian and renal artery stenosis posted for emergency cesarean section by using the epidural volume extension technique, which offers the combined advantage of both spinal and epidural anesthesia and, at the same time, also avoids the need of sophisticated neurological monitors like EEG and transcranial Doppler.