Trauma care and COVID-19 pandemic.

The Coronavirus SARS- CoV-2 (COVID-19) pandemic has overwhelmed the ability of health care systems all over the world. With the spread of the disease, countries have adopted different models to reorganize infrastructure and reallocate the resources to deal with the pandemic. All the nonurgent hospital services have been postponed. But, trauma and emergency services continue to function according to the established protocols with few modifications. During the pandemic, trauma care is based on clinical urgency, safety of the patient as well as health care workers (HCWs) and conservation of resources. The strategies include non-operative management if possible, restricting the number of personnel and utilization of remote consultation or telemedicine. In the present article, we discuss the triage and management of trauma victim during the pandemic, indications for emergency surgery and psychological impact of the pandemic. We also discuss the future challenges during the post-COVID-19 phase.

Cardiac surgery during pregnancy: continuous fetal monitoring using umbilical artery Doppler flow velocity indices.

The fetal death rate associated with cardiac surgery with cardiopulmonary bypass (CPB) is as high as 9.5-29%. We report continuous monitoring of fetal heart rate and umbilical artery flow-velocity waveforms by transvaginal ultrasonography and their analyses in relation to events of the CPB in two cases in second trimester of pregnancy undergoing mitral valve replacement. Our findings suggest that the transition of circulation from corporeal to extracorporeal is the most important event during surgery; the associated decrease in mean arterial pressure (MAP) at this stage potentially has deleterious effects on the fetus, which get aggravated with the use of vasopressors. We suggest careful management of CPB at this stage, which include partial controlled CPB at initiation and gradual transition to full CPB; this strategy maintains high MAP and avoids the use of vasopressors. Maternal and fetal monitoring can timely recognize the potential problems and provide window for the required treatment.

Cardiac output monitoring: comparison of a new arterial pressure waveform analysis to the bolus thermodilution technique in patients undergoing off-pump coronary artery bypass surgery.

OBJECTIVE: To analyze the clinical agreement between the conventional intermittent bolus thermodilution (TD) technique and a new arterial pressure waveform analysis (APCO) technique (FloTrac; Edward Lifesciences, Irvine, CA) for cardiac output (CO) estimation. DESIGN: Prospective observational clinical study. SETTING: Cardiac surgery operating room of a tertiary care cardiac center. PARTICIPANTS: Twelve patients undergoing elective off-pump coronary artery bypass (OPCAB) surgery. MEASUREMENTS AND MAIN RESULTS: CO was determined by 2 different methods: TD and APCO at 8 time points (preinduction, postinduction, poststernotomy, left internal mammary artery to left anterior descending artery anastomosis, left [obtuse marginal/diagonal] anastomosis, right [right coronary/posterior descending coronary artery] anastomosis, postprotamine administration, and poststernal closure) in 12 patients undergoing elective OPCAB surgery. The mean bias and limits of agreement (2 standard deviations) expressed in liters per minute at respective points of measurement were -0.54 +/- 1.12, -0.37 +/- 1.0, -0.42 +/- 1.50, -0.25 +/- 1.18, -0.31 + 1.28, +/-0.41 +/- 1.0, 0.06 +/- 1.50, and 0.09 +/- 1.40. CONCLUSION: Good agreement was found between the CO values obtained by the APCO and TD techniques throughout the intraoperative period including the period of coronary artery graft surgery.

Anesthetic considerations in a patient with severe aortic stenosis for craniotomy.

Severe aortic stenosis can pose a serious hazard for noncardiac surgery as patients with this condition have a high risk for developing perioperative cardiac complications. We describe the anesthetic management of a patient with a malignant brain tumor who was found to have severe aortic stenosis during preanesthetic evaluation. She underwent palliative balloon aortic valvuloplasty prior to surgery, and this combined with appropriate monitoring and drug therapy resulted in a satisfactory outcome. Adverse intraoperative events like hypotension and left ventricular failure occurred; however, these events were transient and responded to treatment.