Severe hypothermia is a life-threatening condition that often causes hemodynamic instability or cardiac arrest
and carries a high risk of mortality. The use of VA-ECMO in this
indication has greatly improved the prognosis of patients.
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
1. Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are important life support therapies used in intensive care units.
2. ECMO uses an external circuit to oxygenate blood and remove carbon dioxide, functioning as a bridge to recovery, transplant, or decision. CRRT slowly removes waste and fluid from the blood of patients with kidney failure or injury.
3. The document discusses the principles, indications, techniques, and complications of ECMO and CRRT, highlighting their roles in supporting critically ill patients with cardiac, respiratory, or renal issues.
Extracorporeal membrane oxygenation, also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an
adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation.
This intervention has mostly been used on children, but it is seeing more use in adults with cardiac and respiratory failure. ECMO works by removing blood from the person's body and artificially removing the carbon dioxide and oxygenating red blood cells. Generally, it is used either post-cardiopulmonary bypass or in late stage treatment of a person with profound heart and/or lung failure, although it is now seeing use as a treatment for cardiac arrest in certain centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation are supported.
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryPaul Molloy
OBJECTIVES:
Incomplete drainage of blood from around the heart and lungs can lead to retained blood syndrome (RBS) after cardiac sur-
gery. The aim of this study was to assess the incidence of and the outcome after procedures for RBS in patients undergoing isolated coronary artery bypass grafting (CABG)-
This case report describes a 48-year-old man who was in a serious motorcycle accident and suffered multiple traumatic injuries including cardiac and pulmonary contusions. He developed cardiogenic shock and refractory hypoxemia. Venoarterial extracorporeal membrane oxygenation (ECMO) was initiated and provided total cardiorespiratory support. ECMO was successfully discontinued after 4 days but the patient later died on day 7 from an extensive brain infarction caused by the trauma. The report concludes that ECMO can be an effective rescue procedure for simultaneous post-traumatic cardiac and pulmonary dysfunction in polytrauma patients.
1) The document reports a case study of a 48-year-old male polytrauma patient who was admitted to the ICU after a serious traffic accident with multiple injuries including cardiac and pulmonary contusions.
2) Due to rapidly worsening cardiogenic shock and refractory hypoxemia, the patient was placed on venoarterial extracorporeal membrane oxygenation (ECMO) as a rescue procedure.
3) ECMO successfully supported the patient's heart and lungs until respiratory and cardiac recovery occurred 4 days later, however the patient ultimately died on day 7 from an extensive brain infarction caused by the trauma.
From vertigo to coma basilar artery occlusion بالاتر از سیاهی رنگی نیستramtinyoung
This document discusses standards of care for acute management of posterior circulation stroke patients. It summarizes that the patient presented with vertigo, blurred vision and other symptoms from an occlusion of the basilar artery, and received IV thrombolysis followed by a drug to promote recanalization, with improvement in symptoms. It also reviews general treatment approaches for posterior circulation strokes, including antiplatelet therapy, anticoagulation, management of blood pressure, and cautions around hemorrhagic transformation.
1. The study examined the incidence of junctional ectopic tachycardia (JET) in 343 patients after surgery for congenital heart defects.
2. JET occurred in 37 patients (10.8%), most frequently after repair of tetralogy of Fallot. JET significantly increased ventilation time and intensive care unit stay.
3. Treatment for JET, including surface cooling and amiodarone, was associated with further increases in ventilation time and intensive care unit stay, though it successfully converted the arrhythmia in most patients.
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
1. Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are important life support therapies used in intensive care units.
2. ECMO uses an external circuit to oxygenate blood and remove carbon dioxide, functioning as a bridge to recovery, transplant, or decision. CRRT slowly removes waste and fluid from the blood of patients with kidney failure or injury.
3. The document discusses the principles, indications, techniques, and complications of ECMO and CRRT, highlighting their roles in supporting critically ill patients with cardiac, respiratory, or renal issues.
Extracorporeal membrane oxygenation, also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an
adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is largely derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation.
This intervention has mostly been used on children, but it is seeing more use in adults with cardiac and respiratory failure. ECMO works by removing blood from the person's body and artificially removing the carbon dioxide and oxygenating red blood cells. Generally, it is used either post-cardiopulmonary bypass or in late stage treatment of a person with profound heart and/or lung failure, although it is now seeing use as a treatment for cardiac arrest in certain centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation are supported.
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryPaul Molloy
OBJECTIVES:
Incomplete drainage of blood from around the heart and lungs can lead to retained blood syndrome (RBS) after cardiac sur-
gery. The aim of this study was to assess the incidence of and the outcome after procedures for RBS in patients undergoing isolated coronary artery bypass grafting (CABG)-
This case report describes a 48-year-old man who was in a serious motorcycle accident and suffered multiple traumatic injuries including cardiac and pulmonary contusions. He developed cardiogenic shock and refractory hypoxemia. Venoarterial extracorporeal membrane oxygenation (ECMO) was initiated and provided total cardiorespiratory support. ECMO was successfully discontinued after 4 days but the patient later died on day 7 from an extensive brain infarction caused by the trauma. The report concludes that ECMO can be an effective rescue procedure for simultaneous post-traumatic cardiac and pulmonary dysfunction in polytrauma patients.
1) The document reports a case study of a 48-year-old male polytrauma patient who was admitted to the ICU after a serious traffic accident with multiple injuries including cardiac and pulmonary contusions.
2) Due to rapidly worsening cardiogenic shock and refractory hypoxemia, the patient was placed on venoarterial extracorporeal membrane oxygenation (ECMO) as a rescue procedure.
3) ECMO successfully supported the patient's heart and lungs until respiratory and cardiac recovery occurred 4 days later, however the patient ultimately died on day 7 from an extensive brain infarction caused by the trauma.
From vertigo to coma basilar artery occlusion بالاتر از سیاهی رنگی نیستramtinyoung
This document discusses standards of care for acute management of posterior circulation stroke patients. It summarizes that the patient presented with vertigo, blurred vision and other symptoms from an occlusion of the basilar artery, and received IV thrombolysis followed by a drug to promote recanalization, with improvement in symptoms. It also reviews general treatment approaches for posterior circulation strokes, including antiplatelet therapy, anticoagulation, management of blood pressure, and cautions around hemorrhagic transformation.
1. The study examined the incidence of junctional ectopic tachycardia (JET) in 343 patients after surgery for congenital heart defects.
2. JET occurred in 37 patients (10.8%), most frequently after repair of tetralogy of Fallot. JET significantly increased ventilation time and intensive care unit stay.
3. Treatment for JET, including surface cooling and amiodarone, was associated with further increases in ventilation time and intensive care unit stay, though it successfully converted the arrhythmia in most patients.
This document discusses monitoring in the intensive care unit (ICU). It covers both non-invasive monitoring such as temperature, heart rate, respiratory rate, blood pressure, oxygen saturation, and capnography as well as invasive monitoring like central venous pressure, pulmonary artery pressure, and intracranial pressure. Key parameters are continuously monitored to optimize patients' hemodynamics, ventilation, and other functions critical to their survival in the ICU. Both non-invasive and invasive monitoring provide vital information to the care team but require awareness of potential interference and effects of physiotherapy treatment.
This document provides an outline and overview of shock classification and management. It begins with introductions to shock and definitions. It then discusses the pathophysiology of shock and outlines four main classifications: hypovolemic, cardiogenic, distributive, and obstructive. For each classification, it provides details on causes, clinical presentation, diagnosis, and management principles. It goes into significant depth on sepsis/septic shock as a form of distributive shock, outlining stages of sepsis and key signs of septic shock. The goal is to help physicians understand shock pathophysiology and priorities for diagnosis and treatment.
This document provides an overview of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for adults. It discusses how VA-ECMO can support patients with refractory cardiopulmonary failure for weeks. It describes the hemodynamics of cardiogenic shock and how VA-ECMO impacts pressure-volume loops. It outlines strategies to reduce pulmonary congestion on VA-ECMO and lists contraindications and predictors of mortality. It also discusses the use of ECMO for cardiac arrest (ECPR) and criteria for its use for refractory ventricular tachycardia or cardiogenic shock.
Post cardiac surgery monitoring & follow upRubayet Anwar
This document provides information on post-cardiac surgery monitoring and follow up. It discusses admission to the ICU, initial assessment, monitoring techniques, complications that can occur like bleeding and hemodynamic issues, and management strategies for those complications. The early focus is on stabilizing vital signs, addressing hypothermia, identifying potential issues like low cardiac output, and treating medical causes of bleeding through correcting coagulation abnormalities.
Shock is a clinical syndrome resulting from inadequate tissue perfusion. Cardiogenic shock is a type of shock caused by acute or chronic cardiac dysfunction, with a mortality rate over 50%. It is characterized by reduced cardiac output and systemic/coronary hypoperfusion leading to a vicious cycle of worsening myocardial function. Diagnosis involves assessing clinical manifestations, labs, ECG, echo, and hemodynamics via pulmonary artery catheter. Initial therapy focuses on vasopressors, fluids, and inotropes to support perfusion while evaluating for revascularization if indicated. Mechanical circulatory support may be needed for refractory cases.
This document discusses post-resuscitation care after return of spontaneous circulation (ROSC) following cardiac arrest. The main goals are to ensure neurologically intact survival, treat the underlying cause, maintain adequate ventilation and oxygenation, achieve stable cardiac rhythm and hemodynamics, and perform targeted temperature management (TTM). Complications that can occur after ROSC include post-cardiac arrest brain injury, myocardial dysfunction, and systemic ischemia-reperfusion response. The document provides guidance on airway management, ventilation, oxygenation, hemodynamic support, TTM, and prognostication.
1) Shock in trauma patients can result from hemorrhage, cardiac issues, tension pneumothorax, or other causes like sepsis. Initial treatment involves rapid fluid resuscitation and identifying the source of shock.
2) For hemorrhagic shock, the most effective treatment is stopping the source of bleeding through surgery or other interventions, while restoring volume through fluid and blood product administration.
3) Non-hemorrhagic shock requires identifying the specific cause like cardiac tamponade and treating it through methods like drainage, while continuing fluid resuscitation and monitoring the patient's response. Teamwork and following ATLS principles are important for managing profound shock.
The document describes external counterpulsation (ECP) therapy for patients with coronary artery disease. ECP involves inflation and deflation of pressure cuffs on the lower limbs synchronized with the cardiac cycle to increase blood flow to the heart. It is administered as 35 one-hour sessions over 7 weeks or twice daily sessions over 3.5 weeks. Approximately 75% of patients experience relief of angina symptoms following treatment. ECP improves cardiac output and blood flow, recruits new collaterals, and reduces inflammation and arterial stiffness through effects on endothelial function and vascular resistance.
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a temporary, mechanical, circulatory, and respiratory support system. Its main use is in patients with heart and/or respiratory failure, allowing complete support by ensuring continuous systemic perfusion and oxygenation.
This document discusses a case of blunt traumatic pericardial rupture and cardiac herniation in a 21-year old male following a motorbike accident. Key findings from imaging included a 10cm tear in the right pericardium, pneumopericardium, and herniation of the heart into the right hemithorax. The patient underwent thoracotomy for repair of the pericardial tear. Diagnosis of blunt traumatic pericardial rupture can be difficult due to subtle clinical signs and associated injuries from polytrauma. Imaging modalities like CT are useful for diagnosis. Surgical closure is usually required for moderate to large tears to prevent further herniation and hemodynamic compromise.
Thoraco Abdominal Aortic Aneurysm technique for present ok.pptxPeter Flash
1) The document discusses various techniques for organ protection during surgery for thoracoabdominal aortic aneurysm (TAAA), including spinal cord, renal, and visceral protection.
2) For spinal cord protection, techniques discussed include maintaining adequate blood pressure and cerebrospinal fluid drainage to decrease pressure on the spinal cord. Renal protection methods include intermittent cold crystalloid perfusion or localized hypothermia to protect the kidneys from ischemia.
3) The document also discusses maintaining perfusion to other organs like the brain and heart, as well as distal perfusion techniques using left heart bypass or fem-fem bypass to maintain lower body blood flow during aortic clamping.
This document provides an overview of extracorporeal membrane oxygenation (ECMO) in 3 parts. It discusses the history and evolution of ECMO from its origins in the 1950s to more modern applications. ECMO can be used in veno-venous or veno-arterial modes, with veno-venous providing oxygenation support for lung failure and veno-arterial providing both oxygenation and circulatory support. The document outlines common indications for ECMO and considerations for cannulation approaches and placements. It also previews topics that will be covered in more depth in the second part such as monitoring, complications, and guidelines.
This document provides an overview of cardiovascular surgery and management of postoperative patients. It discusses surgical approaches for cardiac surgery, including coronary artery bypass grafting (CABG) and treatment of ischemic heart disease. Pre-operative preparation and the intraoperative phase for CABG are described. Post-operative recovery and potential complications are summarized. The document also reviews valvular heart diseases, surgical repair and replacement options, and indications for surgery for different heart valves.
This document discusses anesthesia considerations for neurosurgery patients. It covers common neurosurgical procedures, intracranial hypertension, cerebral edema, and the goals of anesthesia which include maintaining stable intracranial pressure and hemodynamics. It then focuses on anesthesia management for patients undergoing craniotomy for mass lesions, including preoperative evaluation and preparation, induction, maintenance with goals of optimal surgical conditions and neurological protection, and controlled emergence.
1) Coronary artery bypass grafting (CABG) is performed to improve quality of life and reduce mortality for patients with coronary artery disease.
2) Anesthesia for CABG involves monitoring the patient throughout various stages including pre-bypass, maintenance on bypass, and weaning from bypass.
3) Key aspects include induction, myocardial protection through hypothermia and cardioplegia, and monitoring the patient closely during and after coming off bypass.
This document discusses several key points regarding anesthesia for pediatric cardiac transplantation:
1) Pediatric patients often have a history of previous cardiac surgery, making intravenous and arterial access more difficult and increasing risks of repeat sternotomy.
2) The hemodynamic goals of anesthesia must account for both end-stage heart failure and the underlying complex congenital heart disease in each patient.
3) Preoperative pulmonary hypertension in neonates and infants must be carefully assessed, as increases in pulmonary vascular resistance after bypass can overwhelm the thin-walled right ventricle of the new transplant. Undersized donors less than 75% of the recipient's weight are generally avoided.
Cardiopulmonary bypass (CPB) is a technique used during open heart surgery to temporarily take over the function of the heart and lungs. The blood is diverted to an external circuit for oxygenation and pumping before being returned to the body. CPB allows surgeons to operate on a still, dry heart. It involves cannulating major vessels to initiate extracorporeal circulation, cooling and arresting the heart, and using a heart-lung machine to oxygenate and circulate the blood. Heparin is given to prevent clotting and the heart is protected with cardioplegia solution. After surgery, patients are rewarmed and weaned off bypass before closing the chest. Complications can include bleeding, infection
Cardiogenic shock - Anesthesiology and ICUIshfak Maisoor
Cardiogenic shock is characterized by low cardiac output and tissue hypoxia due to inadequate pumping function of the heart. It is a leading cause of death for acute myocardial infarction patients without aggressive medical care. Clinically, cardiogenic shock patients appear pale with cool skin and demonstrate signs of hypoperfusion. Treatment involves fluid resuscitation, inotropes to support blood pressure, mechanical circulatory support like IABP, and most importantly reversal of the underlying cause through procedures like PCI or CABG. While supportive care buys time, definitive treatment of the precipitating cardiac problem is needed for long term recovery from cardiogenic shock.
This document discusses cardiac arrest in special populations, focusing on traumatic injury, asthma, and pregnancy. For traumatic arrest, interventions include airway management, ventilation, hemorrhage control, and potentially resuscitative thoracotomy. For asthma arrest, therapies aim to overcome hypoxia and bronchoconstriction through endotracheal intubation and continuous nebulized beta agonists. Pregnancy presents challenges of aortocaval compression and potential for perimortem cesarean delivery to improve outcomes.
When and Where? Hybrid Procedure after Percutaneous Coronary Interventionsemualkaira
Invasive angiography in high risk of significant disease is class A of recommendation. Myocardial infarction caused by dissection of
coronary artery is very rare complication. The infarct-related artery (IRA) should be treated during the initial intervention. If PCI of the
IRA cannot by performed coronary artery bypass (CABG) should be considered.
Incidence of VTE in the First Postoperative 24 Hours after Abdominopelvic Sur...semualkaira
A good number of research reports the incidence of postoperative venous thromboembolism (VTE) mostly
looks at longer postoperative duration, usually days after surgery.
1.2. Objective: We investigated the incidence of early asymptomatic VTE (24 hours postoperatively) to assess the relevance of generalisation of extended post-hospital discharge chemoprophylaxis
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Similar to A Case Report of Hypothermia Rescued by Veno-Arterial Extracorporeal Membrane Oxygenation
This document discusses monitoring in the intensive care unit (ICU). It covers both non-invasive monitoring such as temperature, heart rate, respiratory rate, blood pressure, oxygen saturation, and capnography as well as invasive monitoring like central venous pressure, pulmonary artery pressure, and intracranial pressure. Key parameters are continuously monitored to optimize patients' hemodynamics, ventilation, and other functions critical to their survival in the ICU. Both non-invasive and invasive monitoring provide vital information to the care team but require awareness of potential interference and effects of physiotherapy treatment.
This document provides an outline and overview of shock classification and management. It begins with introductions to shock and definitions. It then discusses the pathophysiology of shock and outlines four main classifications: hypovolemic, cardiogenic, distributive, and obstructive. For each classification, it provides details on causes, clinical presentation, diagnosis, and management principles. It goes into significant depth on sepsis/septic shock as a form of distributive shock, outlining stages of sepsis and key signs of septic shock. The goal is to help physicians understand shock pathophysiology and priorities for diagnosis and treatment.
This document provides an overview of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for adults. It discusses how VA-ECMO can support patients with refractory cardiopulmonary failure for weeks. It describes the hemodynamics of cardiogenic shock and how VA-ECMO impacts pressure-volume loops. It outlines strategies to reduce pulmonary congestion on VA-ECMO and lists contraindications and predictors of mortality. It also discusses the use of ECMO for cardiac arrest (ECPR) and criteria for its use for refractory ventricular tachycardia or cardiogenic shock.
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This document provides information on post-cardiac surgery monitoring and follow up. It discusses admission to the ICU, initial assessment, monitoring techniques, complications that can occur like bleeding and hemodynamic issues, and management strategies for those complications. The early focus is on stabilizing vital signs, addressing hypothermia, identifying potential issues like low cardiac output, and treating medical causes of bleeding through correcting coagulation abnormalities.
Shock is a clinical syndrome resulting from inadequate tissue perfusion. Cardiogenic shock is a type of shock caused by acute or chronic cardiac dysfunction, with a mortality rate over 50%. It is characterized by reduced cardiac output and systemic/coronary hypoperfusion leading to a vicious cycle of worsening myocardial function. Diagnosis involves assessing clinical manifestations, labs, ECG, echo, and hemodynamics via pulmonary artery catheter. Initial therapy focuses on vasopressors, fluids, and inotropes to support perfusion while evaluating for revascularization if indicated. Mechanical circulatory support may be needed for refractory cases.
This document discusses post-resuscitation care after return of spontaneous circulation (ROSC) following cardiac arrest. The main goals are to ensure neurologically intact survival, treat the underlying cause, maintain adequate ventilation and oxygenation, achieve stable cardiac rhythm and hemodynamics, and perform targeted temperature management (TTM). Complications that can occur after ROSC include post-cardiac arrest brain injury, myocardial dysfunction, and systemic ischemia-reperfusion response. The document provides guidance on airway management, ventilation, oxygenation, hemodynamic support, TTM, and prognostication.
1) Shock in trauma patients can result from hemorrhage, cardiac issues, tension pneumothorax, or other causes like sepsis. Initial treatment involves rapid fluid resuscitation and identifying the source of shock.
2) For hemorrhagic shock, the most effective treatment is stopping the source of bleeding through surgery or other interventions, while restoring volume through fluid and blood product administration.
3) Non-hemorrhagic shock requires identifying the specific cause like cardiac tamponade and treating it through methods like drainage, while continuing fluid resuscitation and monitoring the patient's response. Teamwork and following ATLS principles are important for managing profound shock.
The document describes external counterpulsation (ECP) therapy for patients with coronary artery disease. ECP involves inflation and deflation of pressure cuffs on the lower limbs synchronized with the cardiac cycle to increase blood flow to the heart. It is administered as 35 one-hour sessions over 7 weeks or twice daily sessions over 3.5 weeks. Approximately 75% of patients experience relief of angina symptoms following treatment. ECP improves cardiac output and blood flow, recruits new collaterals, and reduces inflammation and arterial stiffness through effects on endothelial function and vascular resistance.
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is a temporary, mechanical, circulatory, and respiratory support system. Its main use is in patients with heart and/or respiratory failure, allowing complete support by ensuring continuous systemic perfusion and oxygenation.
This document discusses a case of blunt traumatic pericardial rupture and cardiac herniation in a 21-year old male following a motorbike accident. Key findings from imaging included a 10cm tear in the right pericardium, pneumopericardium, and herniation of the heart into the right hemithorax. The patient underwent thoracotomy for repair of the pericardial tear. Diagnosis of blunt traumatic pericardial rupture can be difficult due to subtle clinical signs and associated injuries from polytrauma. Imaging modalities like CT are useful for diagnosis. Surgical closure is usually required for moderate to large tears to prevent further herniation and hemodynamic compromise.
Thoraco Abdominal Aortic Aneurysm technique for present ok.pptxPeter Flash
1) The document discusses various techniques for organ protection during surgery for thoracoabdominal aortic aneurysm (TAAA), including spinal cord, renal, and visceral protection.
2) For spinal cord protection, techniques discussed include maintaining adequate blood pressure and cerebrospinal fluid drainage to decrease pressure on the spinal cord. Renal protection methods include intermittent cold crystalloid perfusion or localized hypothermia to protect the kidneys from ischemia.
3) The document also discusses maintaining perfusion to other organs like the brain and heart, as well as distal perfusion techniques using left heart bypass or fem-fem bypass to maintain lower body blood flow during aortic clamping.
This document provides an overview of extracorporeal membrane oxygenation (ECMO) in 3 parts. It discusses the history and evolution of ECMO from its origins in the 1950s to more modern applications. ECMO can be used in veno-venous or veno-arterial modes, with veno-venous providing oxygenation support for lung failure and veno-arterial providing both oxygenation and circulatory support. The document outlines common indications for ECMO and considerations for cannulation approaches and placements. It also previews topics that will be covered in more depth in the second part such as monitoring, complications, and guidelines.
This document provides an overview of cardiovascular surgery and management of postoperative patients. It discusses surgical approaches for cardiac surgery, including coronary artery bypass grafting (CABG) and treatment of ischemic heart disease. Pre-operative preparation and the intraoperative phase for CABG are described. Post-operative recovery and potential complications are summarized. The document also reviews valvular heart diseases, surgical repair and replacement options, and indications for surgery for different heart valves.
This document discusses anesthesia considerations for neurosurgery patients. It covers common neurosurgical procedures, intracranial hypertension, cerebral edema, and the goals of anesthesia which include maintaining stable intracranial pressure and hemodynamics. It then focuses on anesthesia management for patients undergoing craniotomy for mass lesions, including preoperative evaluation and preparation, induction, maintenance with goals of optimal surgical conditions and neurological protection, and controlled emergence.
1) Coronary artery bypass grafting (CABG) is performed to improve quality of life and reduce mortality for patients with coronary artery disease.
2) Anesthesia for CABG involves monitoring the patient throughout various stages including pre-bypass, maintenance on bypass, and weaning from bypass.
3) Key aspects include induction, myocardial protection through hypothermia and cardioplegia, and monitoring the patient closely during and after coming off bypass.
This document discusses several key points regarding anesthesia for pediatric cardiac transplantation:
1) Pediatric patients often have a history of previous cardiac surgery, making intravenous and arterial access more difficult and increasing risks of repeat sternotomy.
2) The hemodynamic goals of anesthesia must account for both end-stage heart failure and the underlying complex congenital heart disease in each patient.
3) Preoperative pulmonary hypertension in neonates and infants must be carefully assessed, as increases in pulmonary vascular resistance after bypass can overwhelm the thin-walled right ventricle of the new transplant. Undersized donors less than 75% of the recipient's weight are generally avoided.
Cardiopulmonary bypass (CPB) is a technique used during open heart surgery to temporarily take over the function of the heart and lungs. The blood is diverted to an external circuit for oxygenation and pumping before being returned to the body. CPB allows surgeons to operate on a still, dry heart. It involves cannulating major vessels to initiate extracorporeal circulation, cooling and arresting the heart, and using a heart-lung machine to oxygenate and circulate the blood. Heparin is given to prevent clotting and the heart is protected with cardioplegia solution. After surgery, patients are rewarmed and weaned off bypass before closing the chest. Complications can include bleeding, infection
Cardiogenic shock - Anesthesiology and ICUIshfak Maisoor
Cardiogenic shock is characterized by low cardiac output and tissue hypoxia due to inadequate pumping function of the heart. It is a leading cause of death for acute myocardial infarction patients without aggressive medical care. Clinically, cardiogenic shock patients appear pale with cool skin and demonstrate signs of hypoperfusion. Treatment involves fluid resuscitation, inotropes to support blood pressure, mechanical circulatory support like IABP, and most importantly reversal of the underlying cause through procedures like PCI or CABG. While supportive care buys time, definitive treatment of the precipitating cardiac problem is needed for long term recovery from cardiogenic shock.
This document discusses cardiac arrest in special populations, focusing on traumatic injury, asthma, and pregnancy. For traumatic arrest, interventions include airway management, ventilation, hemorrhage control, and potentially resuscitative thoracotomy. For asthma arrest, therapies aim to overcome hypoxia and bronchoconstriction through endotracheal intubation and continuous nebulized beta agonists. Pregnancy presents challenges of aortocaval compression and potential for perimortem cesarean delivery to improve outcomes.
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Invasive angiography in high risk of significant disease is class A of recommendation. Myocardial infarction caused by dissection of
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IRA cannot by performed coronary artery bypass (CABG) should be considered.
Incidence of VTE in the First Postoperative 24 Hours after Abdominopelvic Sur...semualkaira
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Rare Case Of Primary Pulmonary Dedifferentiated Liposarcomasemualkaira
Liposarcoma is a relatively common soft tissue sarcoma, but primary pulmonary liposarcomas are extremely rare, expecially for
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Psychological Impact and Sexual Behavior in Patients with Genital and Anal Co...semualkaira
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Asia Syndrome and Breast Implants, Report of A Case and Review of the Literaturesemualkaira
Over the past decades, evidence has accumulated that autoimmune symptoms can be triggered by exposure to environmental immunostimulatory factors that act as adjuvants in genetically susceptible individuals, with several unexplained symptoms. Adjuvant-induced autoimmune/autoinflammatory syndrome
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Volume 8 Issue 8 -2022 Case Report
in the left femoral artery and right vein and VA ECMO was com-
menced. Lung-protective ventilation, paralysis, and sedation were
maintained. Therapeutic hypothermia was carried out through the
ECMO circuit, and the target temperature (32°C) was obtained
within 2 hours after the system was started. No apparent abnor-
malities were shown by coronary angiography and echocardiogra-
phy. At 11:39 a.m., after repeated defibrillation, the sinus rhythm
resumed as shown by the monitor, and blood pressure has risen
to 85/48mmHg. After nearly 10 hours, we observed a decrease in
the oxygen saturation of the patient’s right fingertip on the mon-
itor, while the blood pressure of the left brachial artery remained
normal, and the ECMO flow also decreased, which did not match
the rotational speed. Hence, we consider gradual recovery of car-
diac function. The oxygen saturation of the patient’s right hand
improved after the downregulation of ECMO rotational speed. The
ECMO system and mechanical ventilation were used to maintain
oxygenation to treat respiratory distress, while meropenem, vanco-
mycin, and ornidazole are used to treat lung infections. Therapeu-
tic mild hypothermia was maintained for 7 days with deep sedation
by intravenous administration of midazolam and vecuronium was
used to combat shivering. Rewarming was carried out at a rate
of 0.5°C every 12 hours, and temperature changes were strictly
controlled during resuscitation. BIS monitoring system and intrac-
ranial Doppler were also used to monitor changes in consciousness
and intracranial blood flow. VA-ECMO and Intra-Aortic Balloon
Pump (IABP) was removed on day 2. Continuous Renal Replace-
ment Therapy (CRRT) was also used to treat progressive renal
failure until satisfied urine volume was obtained on day 9. Neuro-
logical complications and the patient’s consciousness were closely
assessed by the Glasgow Coma Scale. The patient awoke on day
10 and gradually transitioned to rehabilitation on day 16. The pa-
tient was discharged from the hospital on day 20.
4. Discussion
Out-of-hospital cardiopulmonary arrest patients who remain un-
conscious after resuscitation still have a poor prognosis [4]. The
poor neurologic outcome is related to the ‘reperfusion injury’ of
brain cells after the return of spontaneous circulation [5]. It has
been reported that Cardiopulmonary Resuscitation (CPR) for pa-
tients with out-of-hospital cardiac arrest using Cardiopulmonary
Bypass (CPB), coronary artery reperfusion therapy, and mild hy-
pothermia has achieved good results [6-8]. In this case, we timely
used various circulatory auxiliary devices such as VA-ECMO, and
Intra-Aortic Balloon Pump (IABP) for effective resuscitation and
combined with CRRT for renal replacement therapy. At the same
time, according to our experience, the protection of the nervous
system in circulatory assistance and later rehabilitation treatment
is extremely vital.
As a protective measure, the lower pacemaker will emit one or
a series of excitations that excite the atria or ventricles when the
higher pacemaker is diseased or inhibited, resulting in arrest or
significantly reduced frequency. Ventricular escape rhythm and
ventricular fibrillation is more common in patients with severe
heart disease, such as acute myocardial infarction [9], myocarditis
[10], electrolyte disturbance [11], and low-temperature anesthesia.
Ventricular escape rhythm without atrial excitement is often an ar-
rhythmia near the end of life, which can lead to rapid death if de-
layed in treatment or not treated. In this case, the hypothermia in-
hibited the function of the sinoatrial node, resulting in ventricular
escape rhythm, repeated ventricular fibrillation, and hemodynamic
collapse. For such patients, our center advocates the establishment
of extracorporeal life support as soon as possible to replace the
cardiopulmonary function, to maintain a relatively stable circula-
tion to ensure the blood supply of organs throughout the body.
Hypothermia can be divided into four stages according to clinical
symptoms and core temperature. Severe hypothermia will lead to
functional failure of cardiovascular, respiratory, nervous, and oth-
er systems, and even lead to death. The treatment strategy is to
restore body temperature and organ functions, and for rewarming,
our center prefers slow rewarming to prevent left ventricular dias-
tolic dysfunction and ischemia-reperfusion injury [12, 13]. In ad-
dition, Extracorporeal Life Support (ECLS) has been recommend-
ed as the gold standard for the treatment of severe hypothermia [3].
Extracorporeal Membrane Oxygenation (ECMO) is a develop-
ment of extracorporeal circulation, which began to be used in the
1970s as temporary cardiopulmonary support for critically ill pa-
tients [14]. The generalized ECMO is often used to describe VV
or VA ECMO. VV ECMO is indicated for patients who require
only respiratory function support, such as severe Acute Respira-
tory Distress Syndrome (ARDS). VA ECMO is suitable for severe
heart disease, refractory ventricular fibrillation, or fulminant myo-
carditis. The establishment of VA ECMO requires the implantation
of two percutaneous vascular catheters, including an arterial cath-
eter and an intravenous catheter with the tip of the venous catheter
located at the inferior vena cava and atrial junction and the tip of
the arterial catheter located at the common iliac artery. The blood
flows into the extracorporeal oxygenator through the venous cath-
eter and into the systemic circulation through the arterial catheter
to supply blood and oxygen to the whole body. When the patient’s
heart resumes beating, IABP is used to reduce the patient’s cardiac
afterload and increase coronary blood flow to improve myocardial
oxygen supply. IABP is the implantation of an inflatable balloon
in the descending aorta. When the aortic valve opens during the
systolic period, the balloon deflates to form negative pressure in
the aorta, thus reducing systolic blood pressure and cardiac after-
load. The balloon is inflated when the aortic valve closes during
the diastolic period, thereby increasing diastolic blood pressure to
increase coronary blood flow [15].
Hypothermia-induced ischemia and hypoxia can cause liver and
kidney insufficiency, hence organ replacement therapy such as
CRRT is particularly important [16]. At the same time, considering
3. clinicsofsurgery.com 3
Volume 8 Issue 8 -2022 Case Report
the protective effects of low temperatures on brain metabolism, for
patients with cardiogenic shock receiving ECMO support, we rou-
tinely use ice caps for head cooling to protect brain function. Strict
temperature control in therapeutic hypothermia is very helpful to
the patient’s nervous system [17]. In addition, nutritional support
and rehabilitation therapy play an integral role in the whole treat-
ment process. Therefore, it is recommended that such patients be
managed by an experienced cardiac team that can evaluate the pa-
tient’s condition in multiple aspects.
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