|KOPS AWARD ABSTRACTS: CARDIAC ANAESTHESIA
|Year : 2020 | Volume
| Issue : 13 | Page : 2-7
KOPS award abstracts: cardiac anaesthesia
|Date of Web Publication||6-Feb-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. KOPS award abstracts: cardiac anaesthesia. Indian J Anaesth 2020;64, Suppl S1:2-7
| Abstract ID: ISAP743: Frailty, functional and nutritional status as predictors of post operative outcomes in elderly patients undergoing cardiac surgery: A descriptive observational study.|| |
Kavya H, Nalini Kotekar, Dinesh Kumar
JSS Medical College, Mysore
Background and aims: A multitude of risk-stratification scores have been developed to predict post-operative morbidity and mortality outcomes in patients undergoing cardiac surgeries (CS). Society of Thoracic Surgeons (STS) risk score and EUROSCORE are considered to be the gold standard but these are not specific to the geriatric population and do no include frailty, disability and nutrtion. In view of exponential increase in the geriatric population, a comprehensive geriatric assessment which includes the above criteria, would be a realistic surrogate for outcome prediction in this vurnerable population. To compare STS cardiac risk score with frailty, functional status and nutritional status in predicting postoperative morbidity and mortality in geriatric patients posted for CS.
Methods: A total of 100 patients, meeting the inclusion criteria, posted for cardiac surgeries were assessed for frailty, nutrition and functional status using different evaluation scales prior to surgery. STS scores were calculated and post-operative outcomes were documented.
Results: Frailty, functional and nutrition scores could predict post-operative outcomes of 30 day mortality, prolonged mechanical ventilation and length of stay>7days. Tests of significance could not be applied for permanent stroke(2), reoperation(1), renal failure(3) and DSWI(1) as there were very few outcomes.
A strong positive correlation of preoperative assessment of frailty with STS outcomes – length of stay, prolonged mechanical ventilation, renal failure, permanent stroke, mortality, deep sternal wound infection and reoperation whereas a negative correlation was found with functional status and nutrition.
COMPARISON OF OUTCOMES OF SURGERY WITH FRAILTY, FUNCTIONAL STATUS AND NUTRITION SCORES
Conclusion:In conclusion, frailty, nutrition and functional status assessment along with STS risk scores, predict outcomes in elderly patients undergoing cardiac surgeries .
- Afilalo J, Mottillo S, Eisenberg M, Alexander K, Noiseux N, Perrault L et al. Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients at High Risk of Mortality or Major Morbidity. Circ Cardiovasc Qual Outcomes. 2012; 5(2): 222-8.
- Kovacs J, Moraru L, Antal K, Cioc A, Voidazan S, Szabo A. Are frailty scales better than anesthesia or surgical scales to determine risk in cardiac surgery?. Korean J Anesthesiol. 2017; 70(2): 157.
| Abstract ID: ISAP732: Comparison of ultrasound guided unilateral thoracic paravertebral block with ultrasound guided unilateral serratus anterior plane block in perioperative pain management in patients undergoing minimally invasive cardiac surgeries|| |
Ragavendran S, Nagaraja PS, Singh NG, Arasu T
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Background & aims: Minimally invasive cardiac surgery (MICS) requires anterior or anterolateral mini-thoractomy. Traditional opioid based anesthetic technique interferes with the elements of enhanced recovery after surgery (ERAS) protocol. Neuraxial techniques have risk of neuraxial hematoma in cardiac surgeries. Regional techniques like paravertebral block (PVB) have provided post operative analgesia in MICS. Recently, serratus anterior plane (SAP) block has been found to provide effective analgesia in rib fractures, and video assisted thoracoscopic surgery (VATS). The present study aimed to compare ultrasound guided (USG) continuous PVB with SAP block in MICS.
Methods: It was a prospective comparative clinical study enrolling 40 adult patients who underwent elective MICS. Randomization was performed by open label method into group A(PVB) and group B(SAP block) of 20 patients in each group. Pain assessment at rest and deep breathing or cough was performed using visual analog scale (VAS) till 48h post-extubation. Rescue analgesics were administered on patients request or VAS >4 at rest. Incentive spirometry, oxygenation, duration of ventilation and hospital stay were reported as outcome measures.
Results: Intraoperative fentanyl consumption was more in group B when compared to group A (p<0.05). VAS scores at rest and during deep breathing, incentive spirometry, duration of mechanical ventilation and hospital stay were comparable between the two groups. PaO2/FiO2 ratios were comparable at 0.5h, 3h, 6h, 12h, and 48h post-extubation between the two groups. However, PaO2/FiO2 ratios were significantly higher in group B at 24h and 36h post-extubation when compared to group A (p<0.05).
Conclusion: SAP block provided effective analgesia and could serve as an alternative to thoracic PVB in perioperative pain management in MICS.
- Barbera C, Milito P, Punturieri M, Asti E, Bonavina L. Serratus anterior plane block for hybrid transthoracic esophagectomy: a pilot study. J Pain Res. 2017;10:73-7.
- Okmen K, B Metin Okmen. Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery. Anaesth Crit Care Pain Med. 2018;37:349-53
| Abstract ID: ISAP166: Comparison of ultrasound guided serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA) for perioperative analgesia in thoracotomy patients. a prospective randomize control study.|| |
Dusu Lalin, Swati, Alok Kumar Bharti
Indira Gandhi Institute of Medical Sciences, Patna, Bihar
Background and aims: Thoracotomy is one of the most painful surgical procedures. The aim of this study was to assess the efficacy and safety of ultrasound- guided serratus anterior plane block (SAPB) compared with thoracic epidural analgesia (TEA) for controlling acute thoracotomy pain.
Methods: A prospective, randomized, observer–blinded, controlled study involving 40 cancer patients scheduled for thoracotomy. Forty patients scheduled for thoracotomy under general anesthesia were allocated randomly into1of 2 groups with 20 patients each. SAPB was performed before extubation with an injection of 30 mL of 0.25% levobupivacaine followed by 5mL/hour of 0.125% levobupivacaine. In the TEA group, thoracic epidural catheters were inserted preoperatively to be activated before extubation using a lower dose regimen compared to the SAPB group. Heart rate, mean arterial pressure, and the visual analogue pain score (VAS) measurements were recorded for 24hours. Rescue analgesia using intravenous morphine 0.1mg/kg, was administered if the VAS was above 3.
Results: Compared with preoperative values, the mean arterial pressure in the SAPB group did not change significantly (p =0.181), where as it decreased significantly (p = 0.006) in the TEA group. VAS scores and the total dose of morphine consumed were comparable in the 2groups.
Conclusions: SAPB appeared to be a safe and effective alternative for postoperative analgesia after thoracotomy.
- Drasner K. Thoracic epidural anesthesia: A sleep at the wheal. Anesth Analg 2004;99:578–9.
- Broseta AM, Errando C, De Andres J, et al. Serratus plane block: The regional analgesia technique for thoracoscopy? Anaesthesia 2015;70: 1329–30.
| Abstract ID: ISAP 364: Comparative study of plethysmograph variability index and perfusion index in predicting hypotension with propofol induction|| |
Radhika K T, Nethra H N, Sudheesh K, Ramachandraiah R
Bangalore Medical College and Research Institute
Background and aims: Induction with Propofol is often associated with hypotension. The deleterious effects of hypotension may be avoided if its occurrence can be predicted prior to induction. Plethysmograph Variability Index (PVI) and Perfusion Index (PI) are new, non invasive and dynamic measures of fluid responsiveness which can be used in prediction of hypotension occurring with induction agents. In our study, we compared PVI and PI in prediction of hypotension based on standard cut off values (PVI>15 and PI<1).
Methods: In our double blind observational study, we included 106 surgical in-patients requiring general anaesthesia. All study cases were induced with Injection Propofol 2mg/kg. Heart rate, Blood pressure, oxygen saturation , Perfusion Index, Plethysmograph Variability Index were recorded at baseline and every minute for 5 minutes after induction. Receiver operating characteristic curve analysis was employed to compare Plethysmograph Variability Index and Perfusion Index.
Results: The incidence of hypotension after induction was 82.07%. As per the criteria, baseline cut-off values of PVI >15 could predict incidence of hypotension with a sensitivity of 81.0%. The baseline cut-off of PI<1 could predict incidence of hypotension with a positive predictive value of 73.68%
Conclusion: As PVI has a high sensitivity it can be used as a good screening tool for predicting hypotension. Though both PVI and PI are not of good diagnostic values clinically can be used to predict hypotension.
- Mehandale SG et al. Perfusion index as predictor of hypotension following propofol induction- A prospective observational study. Ind J Anaesth 2017;61:990-5
- Tsuchiya M et al. Pleth variability index predicts hypotension during anesthesia induction. Acta Anaesthesiolscand 2010;54: 596-602
| Abstract ID: ISAP433: TITLE: Effect on oxygenation with high flow nasal cannula (HFNC) vs conventional oxygen therapy (Venturi mask) after extubation in patients undergoing cardiac surgery|| |
Pompy Devraj, VR Shrotey, Yogesh, Zanwar,
Background and Aims: Postoperative pulmonary complications following cardiac surgery leads to low PaO2, subsequently requiring NIV,re-intubation.Technological improvements have enabled high flow humidified oxygen therapy delivery through nasal cannula. Aim was to Compare the effect on oxygenation of HFNC vs venturi mask after extubation in patients undergoing cardiac surgery with midline sternotomy.
Methods : Randomized control study carried out on patients undergoing cardiac surgery, stable hemodynamics. Patients preoperatively on NIV or requiring postop ventilation for more than 24 hours excluded.After extubation patients randomly assigned (computer generated random number table) at FiO2(0.6):Group1oxygen with HFNC, Group2oxygen by venturi mask PO2, PCO2, respiratory rate noted 6 hourly till 48 hours.Requirement of NIV,Re intubation,patient discomfort requiring termination of therapy in 48 hrs noted
Results: PO2 at different time intervals is significantly higher, patients more comfortable with respiratory rate in HFNC.One in HFNC Vs four in Venturi Mask group required NIV, two in Venturi Mask group Re-Intubated vs None from HFNC group.
Conclusion: HNFC provides better oxygenation than Venturi mask after extubation in patients undergoing cardiac surgery with midline sternotomy.
- Maggiore SM, Idone Fa,Vaschetto R, et al. Nasal High-flow vs Venturi Mask Oxygen Therapy After Extubation:Effects on Oxygenation,Comfort and Clinical Outcome. Am J Respir Crit Care Med 2014;190:282–288.
- Rittayamai N,Tscheikuna J,Rujiwit P. High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study. Respir Care. 2014;59:485–90
| Abstract ID: ISAP460: Pre- operative screening of diabetic patients for heart rate variability and their hemodynamic responses during induction of general anaesthesia|| |
Nithya Dinesh, Geetha L, Smita Musti
M.S.Ramaiah Medical College, Bangalore
Background & aims: Cardiovascular autonomic neuropathy (CAN) is one of the least frequently diagnosed and the most clinically significant complications of Diabetes mellitus. It is associated with increased morbidity and mortality. Impaired heart rate variability(HRV) is the earliest indicator of CAN. Peri-operative haemodynamic stability is one of the major concerns while performing general anaesthesia in patients with autonomic dysfunction. The purpose of this study was to assess and compare the autonomic function using HRV in diabetic and non-diabetic patients pre-operatively and to study the haemodynamic responses of these patients during induction of general anaesthesia.
Methods: A total of 68 patients; 34 patients with diabetes and duration of diabetes less than 5years with RBS<200mg/dl (ASAII) in the age group of 30-65years were selected as subjects. Thirty four healthy (ASA I) non-diabetics were controls. Participants HRV was assessed pre-operatively using ECG recorded in lead II, at rest, in supine position for 5 minutes. The haemodynamic parameters were monitored from baseline, preinduction, postinduction, postintubation followed by every 3 minutes till 15 minutes.
Results: The diabetics patients group had significantly lower total power when expressed in absolute units (p value<0.003) and had an increased susceptibility to develop hypotension especially post intubation (p value<0.04).
Conclusion: Data from the study demonstrated that asymptomatic diabetics with <5 years history had already developed autonomic dysfunction. Short term analysis of HRV can be used for the early diagnosis of autonomic dysfunction in diabetics and non diabetics preoperatively. This can be used for the diagnosis and management of peri-operative of haemodynamic fluctuations.
| Abstract ID: ISAP575: Role of central venous oxygen saturation in decision making for intraoperative transfusions in cardiac surgeries.|| |
K.Shiva Priya, Suryanarayan, Padmaja Durga, A. Syama Sunder
Nizams Institute of Medical Sciences, Hyderabad
Background and aims: Although a number of guidelines are of help in transfusion practice, haemoglobin continues to be the key trigger for transfusion in practice. But transfusing at fixed levels of haemoglobin as recommended, without considering the oxygenation may result in possible excess blood transfusions. This study was undertaken to evaluate if central venous oxygen saturation (ScVO2) can improve decision making in transfusion therapy as it reflects balance between oxygen delivery and consumption. Aim was to compare the ScvO2 between patients who received transfusion and who did not, using haemoglobin or haemodynamics as a trigger.
Methods: Patients aged 18-60 years undergoing elective cardiac surgery under CPB were included in the study and patients with low cardiac output syndrome and chronic anaemia were excluded. Induction done as per institutional protocol and CPB was initiated using moderate hypothermia. Rewarmed to core temp of 37°C and weaned off CPB using. Central venous samples are obtained for blood gas analysis after weaning off CPB and are repeated 30 minutes after transfusion or at the end of the surgery.
Results: 66 patients were recruited and 52 were included in the analysis.39 received intraoperative single unit blood transfusions.
In patients with pretransfusion ScVO2 < 70% the mean increase in ScVO2 was 11.7 ± 4.0mmHg. ( p = 0.000). 19 transfusions could have been avoided if ScVO2 was used as a trigger.
Conclusion: Central venous oxygen saturation appears to be an useful parameter to help with decisions for transfusions in cardiac surgeries, and helps in avoiding single unit transfusions.
- Adamczyk S, Robin E, Barreau O. [Contribution of central venous oxygen saturation in postoperative blood transfusion decision] Ann Fr Anesth Reanim. 2009;28:522–530.
- Orlov D, O'Farrell R, McCluskey SA. The clinical utility of an index of global oxygenation for guiding red blood cell transfusion in cardiac surgery. Transfusion. 2009;49:682–688.
| Abstract ID: ISAP 705: Applicability of risk stratification methods in children undergoing congenital heart surgery|| |
Mahalaxmi Tulashigeri, Harish B R, Shreedhar Joshi
Narayana Hrudayalaya, Bangalore
Background & aims: To determine the applicability of risk stratification models in congenital heart surgery for in hospital mortality and morbidity in single large volume teritiary care center. Studies that compare all four scoring systems are limited. Therefore, in this study, we have aimed to evaluate the surgical results of our institution according to presumption systems of Risk adjusted for congenital heart surgery (RACHS-1), Aristotle basic score (ABC), Aristotle comprehensive score(ACC ) and STS-EACTS.
Methods: After obtaining ethical clearance we retrospectively reviewed consecutive patients younger than 18 years who underwent surgical treatment for congenital heart disease, from January 2018 to July 2018. Scoring for ABC, ACC, STS-EACTS and assigning to RACHS-1 categories were done from retrived case files. The hospital mortality and morbidity were calculated for each category from four models. Categorical variables were expressed using frequency percentage. Continous variables were expressed using mean and standard deviation.The Discriminative power of scoring systems was assessed with area under the curve (AUC). Statistical analysis was done using SPSS version 21.
Results: A total of 896 cases were assessed for mortality using 4 methods. Multivariate regression analysis showed, RACHS (X2=31.78, P=0.000), STS-EACTS category (X2 =41.29, P=0.00), STS-EACTS score (P=0.000), ABC (P=0.000),ACC (P=0.000) scores showed good overall performance. The AUC was 0.695 for RACHS, 0.685 for ABC, 0.694 for ACC, 0.805 for STS-EACTS score & 0.779 for STS-EACTS category.
Conclusion: STS-EACTS score has the highest ROC-AUC among the tested methods hence having the highest predictive ability to predict mortality in the present cohort.
| Abstract ID: ISAP880: To study effect of subcutaneous periradial administration of papaverine on radial artery diameter using ultrasound in patients undergoing cardiac surgery|| |
Sachin Chavadi, Ramesh Chand Kashav, Mohandeep Kaur, Namita Saraswat
ABVIMS and DR.RML Hospital, New Delhi
Background & aims: Radial artery cannulation is routinely done for invasive BP monitoring in cardiac patients. Radial artery spasm is a known complication following instrumentation. Various drugs including Papaverine have been used to prevent spasm and to increase the artery diameter to achieve higher success rate. In this study we aim to monitor the effect of papaverine on radial artery diameter and hemodynamic stability following subcutaneous administration.
Methods: Ethical committee approval and written informed consent was obtained. The randomized comparative study was conducted comprising of two groups with 30 patients in each group of either sex belonging to NYHA class I-III, undergoing elective cardiac surgery.
Group C - received 2 ml of 1% lignocaine and 1ml of saline.
Group P – received 2ml of 1% lignocaine and 1ml of papaverine (30mg/ml).
Using ultrasound, baseline radial artery diameter and change in diameter after drug administration if any were noted and compared.
Results: With similar demographic profile in both groups, no significant changes were noted with respect to SBP (P=0.293), DBP (P=0.535), MBP (P=0.331) and HR (P=0.218) among both the groups. Compared to group C, group P patients had comparable pre-drug administration diameter (mm) (2.1 ± 0.22 vs 2.15 ± 0.25, P=0.448); significantly higher post-drug administration diameter (mm) (2.63 ± 0.26 vs. 2.16 ± 0.25, P<0.0001); and significantly higher % increase in radial artery diameter (mm) (1.06 vs. 25.39%).
Conclusion: The use of subcutaneous papaverine increases the radial artery diameter significantly as compared to lignocaine alone with minimal effects on the hemodynamic parameters.
| Abstract ID: ISAP903R1: A retrospective study of use of cerebral oximetry in adult aortic surgery to predict the post operative sequelae|| |
Megha A, Muralidhar Kanchi, Pooja Natarajan, Varun Shetty
Narayana Hrudayalaya, Bangalore
Background and aims: Surgical repair of the aorta is technically challenging, associated with considerable morbidity and mortality. Cerebral oximetry non-invasively monitors the regional cerebral oxygen saturation (rSo2). Aim was to analyse the applicability cerebral oximetry and the correlation between decreased rSo2 and adverse post-operative events.
Methods: Following ethical committee clearance, data of 40 patients aged 18-60 years of either sexes collected retrospectively. Cerebral oximeter was applied, baseline values recorded followed by every 30 minutes thereafter. The management of patient was by MAP, PaCO2, PO2, PCV, pump flow and left carotid was cannulated when left sided desaturation (rSo2 < 20% of baseline) occurred during ACP. All patients were shifted to AITU and followed up.
Conclusion: Cerebral oximeter allows for the early detection of the cerebral desaturation and timely intervention to correct the desaturation helps prevent the adverse outcome.
- Murkin JM, Adams SJ et al Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007;104:51–8.
- Fischer GW1, Lin HM, Krol M, Galati MF, Di Luozzo G, Griepp RB, Reich DLZ J Thorac Cardiovasc Surg. 2011 Mar;141(3):815-21.