Postcardiosurgical Pseudoaneurysm.

Takayasu's arteritis is an autoimmune inflammatory disease of large arteries. We report a case of postcardiac surgery pseudoaneurysm. Anesthetic concerns, high risk related to surgery, necessary anesthetic preparations, and considerations will be mentioned here.

Cardiovascular Complications Related to COVID-19 Disease.

Coronavirus disease-2019 (COVID-19) is a world epidemic disease and is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In addition to the respiratory manifestations, it may also cause cardiovascular complications, such as, myocarditis, arrhythmias, myocardial infarction, heart failure, and venous thromboembolic events. This review article will discuss in detail pathophysiology, manifestations, and management of these cardiac complications. A literature review was performed, it included meta-analyses studies, cohort studies, publications, and case series from the largest COVID-19 outbreak centers around the world. Cardiac complications of COVID-19 disease can lead to significant cardiovascular morbidity and mortality. It is important to recognize and treat these complications as early as possible.

Bentall procedure for an adult patient with supravalvular aortic stenosis and coronary aneurysms.

We describe the surgical management of a 35-year-old male with multiple coronary aneurysms and a diffuse form of supravalvular aortic stenosis who presented with acute myocardial infarction and left ventricular dysfunction. The patient underwent a Bentall procedure with left internal mammary artery to left anterior descending artery bypass grafting with the use of cardiopulmonary bypass utilizing the right axillary artery for arterial cannulation.

Assessment of the hemodynamic changes following fluid preloading in cardiac surgery.

BACKGROUND: This prospective double-blind randomized study aims to study the hemodynamic changes following fluid preloading with Hydroxyethyl starch (HES) 6% (130/0.4) compared with normal saline (NS) in cardiac surgery patients. METHODS: Forty patients undergoing coronary artery bypass grafting (CABG) were enrolled in this study, then they were divided in 2 equal groups, HES and NS. After fast administration of 10 mL/kg from either solutions over 5 min only, hemodynamic parameters, such as heart rate, mean arterial pressure (MAP), central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), mean pulmonary artery pressure, systemic vascular resistance, and pulmonary vascular resistance were measured every 5 min for the total duration of 40 minutes. RESULTS: There were significant differences in the cardiac index measurements between both groups at 15 min onward; also PAOP was significantly higher in HES group at 10 min onward. CVP was higher in HES group but statistically significant at 10 min only. MAP was higher in HES group, but that was statistically significant at 40 min only. On the other hand PAP was significantly higher at 10 and 40 min. CONCLUSION: Fluid preloading with HES led to a significant increase in filling pressure of the left ventricle (PAOP) and cardiac index compared with NS. We believe that HES (130/0.4) could be a suitable solution for fluid preloading in CABG surgery patients. However, further studies are needed on different fluid preloading modalities with different dosing regimens.

Mini cardiopulmonary bypass: Anesthetic considerations.

This review article is going to elaborate on the description, components, and advantages of mini-cardiopulmonary bypass (mini-CPB), with special reference to the anesthetic management and fast track anesthesia with mini-CPB. There are several clinical advantages of mini-CPB like, reduced inflammatory reaction to the pump, reduced need for allogenic blood transfusion and lower incidence of postoperative neurological complications. There are certainly important points that have to be considered by anesthesiologists to avoid sever perturbation in the cardiac output and blood pressure during mini-CPB. Fast-track anesthesia provides advantages regarding fast postoperative recovery from anesthesia, and reduction of postoperative ventilation time. Mini bypass offers a sound alternative to conventional CPB, and has definite advantages. It has its limitations, but even with that it has a definite place in the current practice of cardiac surgery.

Comparison of ultrasound-guided anterior versus transgluteal sciatic nerve blockade for knee surgery.

BACKGROUND: Ultrasound-guided sciatic nerve block, in combination with femoral nerve and lateral femoral cutaneous nerve blocks, is frequently used to induce anesthesia for lower limb surgery. The anterior approach to the sciatic nerve is performed in the supine position and repositioning of the patient between injections is avoidable. We compared the relative utility and efficiency of anterior versus transgluteal sciatic nerve blocks in conjunction with femoral nerve and lateral femoral cutaneous nerve blockade. MATERIALS AND METHODS: Twenty-four patients were enrolled in this prospective double-blind randomized study and were randomly divided into two equal groups: Anterior (Group A) and transgluteal (Group T). We evaluated the following parameters: ultrasound view quality, procedural duration, onset time to block, quality of anesthesia during surgery and postoperative analgesia, required administration of supplemental sedation or narcotics during surgery, amount of pethidine administered within 24 hours post surgery, and overall patient satisfaction. RESULTS: There were no significant differences between patient groups with regard to the demographic data, onset time to block, quality of ultrasound view, use of narcotics to augment the anesthesia during surgery, and patient satisfaction. Although procedural completion time for the sciatic injection alone was shorter in Group T, the total completion time of all blocks together was significantly less in Group A. CONCLUSION: Ultrasound-guided anterior blockade of the sciatic nerve has advantages over the transgluteal approach - it provides efficient anesthesia and results in excellent patient satisfaction.

Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postcesarean section delivery analgesia--a double-blind, placebo-controlled, randomized study.

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block has been used for intra-operative and postoperative analgesia. Here we evaluate the efficacy of TAP block for postoperative cesarean delivery analgesia. METHOD: A randomized, double-blind, placebo-controlled trial was performed at King Khalid University Hospital on 40 patients undergoing cesarean delivery under spinal anesthesia with bupivacaine and fentanyl. At the end of surgery they received bilateral ultrasound-guided TAP block either with bupivacaine 0.25% (B group) 20 patients, or saline (S group, or placebo group) 20 patients, followed by patient controlled analgesia with i.v. morphine only. Each patient was assessed 24 hours after delivery for pain, morphine consumption, nausea, vomiting, sedation, patient's satisfaction, and also pain relief during mobilization (24 hours post-cesarean section). RESULTS: All 40 participants completed the study. Total morphine consumption was reduced more than 60% in the bupivacaine group; the bupivacaine group also reported improved satisfaction with their pain relief over 24 hours after surgery, reduced morphine consumption, less nausea, vomiting, and better patient's satisfaction. CONCLUSION: Ultrasound-guided TAP block improved postoperative analgesia, reduced morphine consumption and improved patient's satisfaction regarding analgesia after cesarean delivery.

Ultrasound-guided insertion of pulmonary artery catheter: Case report.

This is a case report of a 17-year old girl, who presented with aortic valve regurgitation and patent ductus arteriosus, and she underwent aortic valve replacement (AVR) and (PDA) ligation. Because of the extensive thrill and pulsation in the neck due to carotid artery dilatation, pulmonary artery catheter (PAC) was inserted under ultrasound guidance. This case report is to encourage the use of ultrasound for the safe puncture of internal jugular vein for the insertion of central line and PAC, particularly in the case of aortic valve regurge patients where carotid artery dilatation expected.

Traumatic aortic pseudoaneurysm.

A case report of a 5 years old male child, with a history of crash injury--(blunt trauma)--on the chest. Computed tomography (CT) scan, magnetic resonance imaging (MRI) of the chest revealed an aneurysm involving the arch of the aorta. An aortogram showed its exact extension. Chest X-Ray showed collapsed left lung (due to pressure of aneurysm on left main bronchus). Surgery was done o aortic arch: Resection of the aneurysm, and patch repair of aorta, under profound hypothermic circulatory arrest (PHCA) and CPB. Left bronchial tear was also closed. Post operatively the patient was ventilated for about 36 hours to allow for lung expansion. The patient had a smooth postoperative course. Intensive chest physiotherapy and repeated bronchoscopies helped in recovering the left lung function.