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   2017| September  | Volume 61 | Issue 9  
    Online since September 13, 2017

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Valvular heart disease and anaesthesia
Abhijit Paul, Sucharita Das
September 2017, 61(9):721-727
DOI:10.4103/ija.IJA_378_17  PMID:28970630
Valvular heart disease presents as mixed spectrum lesion in healthcare settings in the third-world and developing countries. Rheumatic heart disease still forms the bulk of the aetiopathology of valve lesions. Mitral and aortic valve lesions top the list of valvular pathology. A thorough understanding of the pathophysiology of valvular heart disease is essential while planning anaesthesia and perioperative care for such patients. Meticulous use of optimal fluids, close monitoring of the changing haemodynamics and avoidance of situations that can cause major reduction of cardiac output and fluid shifts are mandatory to achieve good clinical outcome. We searched MEDLINE using combinations of the following: anaesthesia, aortic, mitral, regurgitation, stenosis and valvular heart disease. We also hand searched textbooks and articles on valvular heart disease and anaesthesia. This article mainly focuses on the understanding the pathophysiology of valvular heart disease in patients presenting for non-cardiac surgeries in secondary and tertiary care setting.
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The patient with ischaemic heart disease undergoing non cardiac surgery
Jagadish Hedge, PR Balajibabu, Thirunavukkarasu Sivaraman
September 2017, 61(9):705-711
DOI:10.4103/ija.IJA_384_17  PMID:28970628
The incidence of ischaemic heart disease (IHD) is increasing. The patients with IHD with or without interventions coming for non-cardiac surgical procedures are also increasing. These patients have increased risk of myocardial ischaemia, myocardial infarction (MI), conduction disturbances, morbidity and mortality during the peri-operative period. The risks of these events are even higher in patients with recent MI. An anaesthesiologist should be aware of the pathophysiology and the need to thoroughly evaluate the patient for peri-operative management. We searched Pubmed using combinations of terms like “ischemic heart disease” and “anaesthesia”, “perioperative”, and “anaesthetic implications”. We reviewed the current practices and guidelines regarding evaluation, risk stratification and management.
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Systemic hypertension and non-cardiac surgery
Satyajeet Misra
September 2017, 61(9):697-704
DOI:10.4103/ija.IJA_377_17  PMID:28970627
Primary systemic hypertension affects 10%–25% of individuals presenting for surgery and anaesthesia and constitutes an important cause of cancellation of elective surgeries. Much of the fear stems from the fact that hypertension may lead to adverse perioperative outcomes. Although long-standing hypertension increases the risk of stroke, renal dysfunction or major adverse cardiovascular events, the same is usually not seen in the perioperative period if blood pressure is <180/110 mmHg and this has been the overriding theme in the recent guidelines on perioperative blood pressure management. Newer concepts include isolated systolic hypertension and pulse pressure hypertension that are increasingly used to stratify risk. The aim of this review is to focus on the adult patient with chronic primary systemic hypertension posted for elective non-cardiac surgery and outline the perioperative concerns.
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Basics of cardiopulmonary bypass
Manjula Sarkar, Vishal Prabhu
September 2017, 61(9):760-767
DOI:10.4103/ija.IJA_379_17  PMID:28970635
Cardiopulmonary bypass (CPB) provides a bloodless field for cardiac surgery. It incorporates an extracorporeal circuit to provide physiological support in which venous blood is drained to a reservoir, oxygenated and sent back to the body using a pump. Team effort between surgeon, perfusionist and anaesthesiologist is paramount for the successful use of CPB. However, it also has its share of complications and strategies to reduce these complications are the area of the current research.
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Cardiomyopathies and anaesthesia
Rajiv Juneja, Prajeesh M Nambiar
September 2017, 61(9):728-735
DOI:10.4103/ija.IJA_385_17  PMID:28970631
Cardiomyopathy is considered as a heart muscle disease of multiple aetiologies, unlike other cardiac diseases related to a definitive pathophysiology. With more and more research and with the advent of genetic analysis pin pointing the disease causing mutations, causative factors have been defined and classifications and definitions have changed over time. Patients with these conditions present to anaesthesiologists in elective and emergency situations, placement of automated internal cardioverter defibrillator (AICD) devices or biventricular pacing but may also be diagnosed at anaesthetic pre-assessment. We describe cardiomyopathies such as dilated cardiomyopathy, hypertrophic cardiomyopathy, post-partum cardiomyopathy and Takotsubo cardiomyopathy in brief and their anaesthetic management.
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Cardiac tachyarrhythmias and anaesthesia: General principles and focus on atrial fibrillation
Satyen Parida, Chitra Rajeswari Thangaswamy
September 2017, 61(9):712-720
DOI:10.4103/ija.IJA_383_17  PMID:28970629
Cardiac tachyarrhythmias are encountered commonly during the perioperative period and need to be promptly identified and appropriately managed by the anaesthesiologist. This review intends to highlight important aspects of these tachyarrhythmias and explore a temporal relationship between common medications employed in the perioperative period and their causation. Mechanisms of initiation of tachyarrhythmias, drugs that can trigger those, as well as their diagnosis and management, are also parts of the current review. Cardiac tachyarrhythmias may not always require treatment, and sometimes, aggressive management can trigger more serious types of arrhythmias. A thorough understanding of these tachyarrhythmias and their pathogenesis enables adopting a more objective approach, eschewing risks of inappropriate or unnecessary management strategies. We performed a MEDLINE search using combinations of MeSH terms such as 'cardiac', 'arrhythmias', 'anaesthesia', 'perioperative', 'tachyarrhythmias' and 'anaesthetic implications'. We reviewed the relevant publications with regard to cardiac tachyarrhythmias occurring in the perioperative period.
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Congenital heart diseases and anaesthesia
Sandip Waman Junghare, Vinayak Desurkar
September 2017, 61(9):744-752
DOI:10.4103/ija.IJA_415_17  PMID:28970633
Patients with congenital heart diseases (CHDs) are at increased risk of developing complications during anaesthesia. Improvements in medical and surgical management in recent decades have resulted in significantly more children with CHD surviving to adulthood. The aim of this article is to focus on broad classification of CHD and to provide an updated review on the current perioperative anaesthetic management of CHD patients in different settings such as (a) interventional cardiac procedures that have dominated the field, (b) uncorrected patients for non-cardiac surgery and (c) corrected patients for non-cardiac surgery. The complexity of the defects along with a variety of non-cardiac surgery makes it impossible to have one single-anaesthesia technique. Search on Ovid, PubMed, Google Scholar and Medline were done with MeSH terms such as 'congenital heart disease', 'cardiac catheterisation', 'anaesthetic management' and 'non-cardiac surgery' mainly focusing on review articles and controlled studies for preparing the article.
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Anaesthetic consideration in patients with cardiac implantable electronic devices scheduled for surgery
Murali Chakravarthy, Dattatreya Prabhakumar, Antony George
September 2017, 61(9):736-743
DOI:10.4103/ija.IJA_346_17  PMID:28970632
With advances in cardiology and cardiothoracic surgery, several newer implantable cardiac devices have become common in the surgical population. Multichamber pacemakers, implanted cardiac defibrillators and ventricular assist devices are frequent in current day practice. Many of the newer implantable cardiac electronic devices are targeted at managing heart failure. While managing such patients for non-cardiac surgeries, specific issues related to equipment characteristics and troubleshooting should be a priority for the anaesthesiologists. There is a possibility of malfunction of the devices resulting in catastrophic outcomes. Therefore, it is imperative to understand the pathophysiology, device characteristics and troubleshooting before embarking on anaesthetising patients with implantable cardiac electronic devices.
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Severe pulmonary hypertension and right ventricular failure
Ajay Kumar, Praveen Kumar Neema
September 2017, 61(9):753-759
DOI:10.4103/ija.IJA_420_17  PMID:28970634
Perioperative management of severe pulmonary hypertension (PH) is challenging. Anaesthesiologists come across perioperative management of such cases during incidental surgeries, surgery for various congenital heart diseases and valvular heart diseases and for caesarean section or painless labour in pregnant patient with Eisenmenger syndrome. Knowledge of pathophysiology of PH and novel drugs acting through different mechanisms is paramount in managing such patients. This review will help understanding pathophysiology of PH, anaesthetising patients with PH, use of novel drugs for PH and use of new mechanical devices for rescue of failing right ventricle.
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Post-cardiac transplant recipient: Implications for anaesthesia
Minati Choudhury
September 2017, 61(9):768-774
DOI:10.4103/ija.IJA_390_17  PMID:28970636
The annual heart transplant rate is gradually increasing worldwide. A proportion of this patient population present for an elective or emergency surgery which may or may not be related to the transplanted heart. A MEDLINE search for heart transplant, anaesthesia, adult, paediatric and surgery was conducted to review anaesthetic management for heart transplant recipients. Anaesthesia and perioperative management are different in these cases. A thorough understanding of the physiology of denervated heart, post-transplant morbidities and pharmacology of immunosuppressants is essential for best perioperative management and improved post-operative outcome.
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The post-graduate issue on cardiovascular diseases and anaesthesia
R Gopinath, Jigeeshu V Divatia
September 2017, 61(9):695-696
DOI:10.4103/ija.IJA_565_17  PMID:28970626
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