scholarly journals Clinical application of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block in right-thoracoscopic minimally invasive cardiac surgery: a retrospective cohort study

2022 ◽  
Author(s):  
Shenjie Jiang ◽  
Xiaokan Lou ◽  
Meijuan Yan
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Clinical Application ◽  
Fast Track ◽  
Minimally Invasive Cardiac Surgery ◽  
Cardiac Anesthesia ◽  
Opioid Use ◽  
Serratus Anterior ◽  
Extubation Time ◽  
Anterior Plane

Objectives: This study aimed to investigate the effects of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block on the post-operative rehabilitation of patients undergoing right-sided thoracoscopic minimally invasive cardiac surgery, as well as the safety and feasibility of the clinical application of this technique. Background: Regional nerve block has previously been used in cardiac surgery to reduce intraoperative opioid use and promote anesthesia in fast-track and ultra-fast-track cardiac surgery. However, the clinical application of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) in minimally invasive cardiac surgery under thoracoscopy has not been reported. Methods: A total of 102 patients who underwent right-sided thoracoscopic minimally invasive heart valve surgery in our center from January 2021 to August 2021 were enrolled and divided into two groups: an ultrafast channel cardiac anesthesia assisted by serratus anterior plane block (SAPB-GA) group (n=40) and a conventional general anesthesia (GA) group (n=62). The effects of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) on post-operative rapid recovery as well as the safety and feasibility of its clinical application were compared and analyzed. Results: Compared to the GA group, the intraoperative use of sufentanil in the SAPB-GA group was significantly reduced (66.25±1.025, 283.31±11.362, P<0.001); the incidence of postoperative analgesia in ICU was significantly decreased (17%, 48.8%, P<0.001); the incidence of postoperative NRS≥3 in ICU was significantly decreased (15%, 37.1%, P = 0.016); and the postoperative extubation time (1(1-1), 13.84 (10.25-18.36), P<0.001), ICU stay time (28.58±2.838, 61.69±4.125, P<0.001) and postoperative hospital stay (8.08±0.313, 9.74±0.356, P=0.02) were significantly shortened; and the 24 h postoperative thoracic blood drainage was significantly reduced (209.63±25.645, 318.23±20.713, P<0.001). No statistical difference was observed in the incidence of postoperative nausea, vomiting and atelectasis between the two groups (all P>0.05). Both of the groups reported no postoperative cardiovascular events. Conclusions: Ultrafast channel cardiac anesthesia assisted by SAPB could promote the rapid postoperative recovery of patients undergoing minimally invasive cardiac surgery under a thoracoscope. This approach is safe and feasible in the clinic.

scholarly journals Anesthetic Challenges in Minimally Invasive Cardiac Surgery

2019 ◽  
Vol 03 (01) ◽  
pp. 28-35
Author(s):  
Uma Balasubramanyam ◽  
Poonam Malhotra Kapoor
Keyword(s):  
New York ◽  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Perioperative Management ◽  
Lung Ventilation ◽  
Minimally Invasive Cardiac Surgery ◽  
Cardiac Anesthesia ◽  
One Lung Ventilation ◽  
Optimal Outcomes ◽  
Thoracic Anesthesia

AbstractThe transition of cardiac surgery away from the traditional sternotomy approach toward more minimally invasive strategies continues to evolve over time. The first minimally invasive cardiac surgery was performed in 2005 in New York by a team led by Dr. Joseph T. McGinn. Anesthesiologists play in a key role in facilitating optimal outcomes in such procedures. Perioperative management of these patients poses specific challenges to the anesthesia team. The anesthesiologist must be skilled in numerous subspecialty skillsets including regional anesthesia and analgesia techniques, and elements of thoracic anesthesia practice, in particular one-lung ventilation (OLV), cardiac anesthesia, and transesophageal echocardiography.

Abstract 14982: Paravertebral Block With a Paravertebral Catheter May Improve Outcomes After Minimally-invasive Cardiac Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Diane Kim ◽  
Monica Hsieh ◽  
Travis Schisler ◽  
Richard Cook
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Hospital Length ◽  
Vancouver General Hospital ◽  
Minimally Invasive Cardiac Surgery ◽  
Paravertebral Block ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Opioid Use ◽  
Paravertebral Space

Background: Postoperative (post-op) pain following minimally-invasive cardiac surgery (MICS) may complicate outcomes in patients having surgery performed through a right mini-thoracotomy. Regional anaesthesia, by delivery of local anaesthetic agents to the paravertebral space using a paravertebral catheter (paravertebral block, PVB) may be useful to reduce post-op pain, however, few studies have reported outcomes on patients undergoing MICS with the use of a PVB. Methods: Ninety consecutive patients who underwent MICS at Vancouver General Hospital between January 2016 and May 2019 were included in this retrospective study. Data were collected for 53 patients who only had routine pain control (control) and 37 patients who had a PVB (PVB). Primary outcomes were post-op opioid use and hospital length of stay (LOS). Peri-operative (peri-op) death and stroke were secondary outcomes. Statistical analyses were performed using ANOVA single factor and t-tests. Results: Patient demographics and operative times were comparable between the two groups. The average total amount of opioid consumed in the PVB group was lower at 155.3 mg morphine equivalents, compared to 193.9 mg in the control group, however, the difference was not statistically significant (p=0.39) (Figure 1). However, the percentage of patients who did NOT receive any oxycodone was almost double in the PVB group (43.2% vs 24.5%, PVB vs control, respectively. p=0.06). The average LOS for the PVB group was significantly lower than the control group (5.4 vs 8.3 days, PVB vs control, respectively. p=0.006) (Figure 1). There were no peri-op deaths or strokes. Conclusion: In our experience, addition of a regional anesthetic was associated with ~20% reduction in the amount of opioid narcotic required. Although not statistically significant, this may be a clinically important difference, as the LOS was significantly lower in the PVB group. Outcomes in patients undergoing MICS may be improved with the addition of a PVB.

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