scholarly journals Preoperative and perioperative management of patients with pericardial diseases

2011 ◽  
Vol 58 (2) ◽  
pp. 45-53 ◽  
Author(s):  
Arsen Ristic ◽  
Dejan Simeunovic ◽  
Ivan Milinkovic ◽  
Jelena Seferovic-Mitrovic ◽  
Ruzica Maksimovic ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Pericardial Effusion ◽  
Surgical Procedure ◽  
Elective Surgery ◽  
Hemodynamic Instability ◽  
Systemic Resistance ◽  
Positive Pressure ◽  
Low Cardiac Output ◽  
Pericardial Diseases ◽  
Elective Surgical Procedure

Hemodynamic instability is the major concern in surgical patients with pericardial diseases, since general anesthesia and positive pressure ventilation may precipitate cardiac tamponade. In advanced constriction diastolic impairment and myocardial fibrosis/atrophy may cause low cardiac output during and after surgery. Elective surgery should be postponed in unstable patients with pericardial comorbidities. Pericardial effusion should be drained percutaneously (in local anesthesia) and pericardiectomy performed for constrictive pericarditis before any major surgical procedure. In emergencies, volume expansion, catecholamines, and anesthetics keeping cardiac output and systemic resistance should be applied. Etiology of pericardial diseases is an important issue is the preoperative management. Patients with neoplastic pericardial involvement have generally poor prognosis and any elective surgical procedure should be avoided. For patients with acute viral or bacterial infection or exacerbated metabolic, uremic, or autoimmune diseases causing significant pericardial effusion, surgery should be postponed until the causative disorder is stabilized and signs of pericarditis have resolved.

Low cardiac output syndrome requiring extracorporeal membrane oxygenation following pericardiocentesis in an adolescent with Hodgkin Lymphoma: a case report

Perfusion ◽  
2020 ◽  
pp. 026765912095060
Author(s):  
Toni Matic ◽  
Matija Bakos ◽  
Dalibor Saric ◽  
Miran Cvitkovic ◽  
Zrinko Salek ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Pericardial Effusion ◽  
Extracorporeal Membrane Oxygenation ◽  
Hodgkin Lymphoma ◽  
Hemodynamic Instability ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Membrane Oxygenation ◽  
Drainage Rate ◽  
Large Pericardial Effusion

We present a case of a 16-year-old male with large pericardial effusion due to Hodgkin Lymphoma (HL). Shortly after drainage of pericardial effusion he developed a low cardiac output syndrome which had to be treated with extracorporeal membrane oxygenation (ECMO). This 9-day ECMO support helped the patient to recover his cardiac function, and thereafter a remission of his primary disease was successfully achieved with chemotherapy. It is a matter of discussion whether a large pericardial effusion with moderate symptoms in patients with HL should be evacuated or just observed since the effusion should ameliorate with chemotherapy. But based upon our experience in this case of hemodynamic instability due to a large effusion requiring evacuation, we propose that pericardiocentesis procedure should be performed with caution at a slow drainage rate of 0.5-1 ml/kg/hour with a maximum rate of 50 ml/hour, to help avoid the low cardiac output syndrome in patients with similar disease conditions.

Cardiac tamponade

ESC CardioMed ◽  
2018 ◽  
pp. 1575-1580
Author(s):  
Arsen D. Ristić ◽  
Petar M. Seferović ◽  
Bernhard Maisch ◽  
Vladimir Kanjuh
Keyword(s):  
Cardiac Output ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Interventional Procedures ◽  
Loop Diuretics ◽  
Diastolic Filling ◽  
Pericardial Space ◽  
Pericardial Diseases

Cardiac tamponade is a pericardial syndrome characterized by compression of the heart by the exudate accumulating within the pericardial space and impairing diastolic filling and cardiac output. Pericardial diseases of any aetiology but also haemorrhage during interventional procedures may cause tamponade. If pericardial effusion accumulates slowly, 2000 mL or more could be tolerated (unless precipitated by dehydration, loop diuretics, vasodilators, anticoagulants, or thrombolytics), but acute accumulation of more than 250 mL is fatal.

scholarly journals Metoclopramide Pretreatment for Prevention of Pain on Propofol Injection: A Randomized Placebo-Controlled Study

2020 ◽  
Vol 7 (2) ◽  
pp. 71-75
Author(s):  
Muhammad Sazzad Hossain ◽  
Syed Ariful Islam ◽  
Md Afzalur Rahman ◽  
Md Mahiuddin Alamgir ◽  
Md Waliullah
Keyword(s):  
Surgical Procedure ◽  
Elective Surgery ◽  
Saline Group ◽  
Controlled Study ◽  
Induction Agent ◽  
Intravenous Anaesthetic ◽  
Group A ◽  
Elective Surgical Procedure ◽  
Group B ◽  
Considerable Concern

Background: Propofol, the most frequently used intravenous anaesthetic, is used for induction, maintenance of anaesthesia and for sedation in patients scheduled for routine elective surgical procedure. Pain on propofol injection still remains a considerable concern for the anaesthesiologist. Objective: Aim of this study was to observe the efficacy of metoclopramide as pretreatment for the prevention of pain caused by the propofol injection in patients undergoing elective surgery under general anaesthesia. Materials and method: A total of 80 patients were taken up in the study in the age group of 20 to 50 years of either sex, ASA grade I/II, scheduled for routine elective surgical procedure under general anesthesia with endotracheal intubation and using propofol as induction agent. The patients enrolled were divided randomly into two groups of 40 patients each. Group A received 10 mg metoclopramide IV diluted in 5 ml saline. Group B received 5 ml of normal saline as placebo before propofol injection. The patients were asked to report their pain according to the scale provided to them in the form of none, mild, moderate and severe after injection of propofol. Results: The overall incidence and severity of pain were significantly less in Group A (metoclopramide group) than in group B (placebo group) (p< 0.05). The incidence of mild and moderate pain in Group A versus group B was 15% vs 45% and 5% vs 25% respectively (p<0.05). The incidence of score ‘0’ (no pain) was higher in Group A (80%) thanGroup B (25%) (p< 0.05). Conclusion: Intravenous metoclopramide is effective for relief of pain on propofol injection without any significant side effects. Delta Med Col J. Jul 2019 7(2): 71-75

Cardiac tamponade and graft versus host disease: one more reason to remember

2018 ◽  
Vol 104 (6) ◽  
pp. NP14-NP16 ◽  
Author(s):  
Luigi Vetrugno ◽  
Serana Tomasino ◽  
Alessandra Battezzi ◽  
Laura Parisella ◽  
Mattia Bernardinetti ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Pericardial Effusion ◽  
Brain Natriuretic Peptide ◽  
Graft Versus Host Disease ◽  
Venous Pressure ◽  
Central Venous ◽  
Low Cardiac Output ◽  
Output State ◽  
Graft Versus Host ◽  
Lactate Levels

Purpose: In patients with cutaneous graft versus host disease (GvHD) that is resistant to traditional steroid therapy, imatinib is a first-generation tyrosine kinase inhibitor that seems to be a viable option. However, its antifibrotic activity can be associated with serosal inflammation and fluid retention. Methods: We report a case of an adult patient who, after allogenic hematopoietic stem cell transplantation, developed a GvHD treated with imatinib at low dosage, followed by multiorgan failure. Clinical examination and cardiac ultrasound were unable to clearly recognize the low cardiac output state; laboratory analysis, filling pressure, and computed tomography examination clarified the correct diagnosis. Results: Low cardiac output state, secondary to pericardial effusion, is a diagnostic challenge. However, the association of four elements can help in its early recognition: increase in lactate levels and central venous pressure, associated with a low central venous saturation and a low brain natriuretic peptide level. Conclusions: Pericardial effusion with cardiac tamponade is a difficult diagnosis even with ultrasound. Lactate levels, central venous pressure plus venous saturation, and brain natriuretic peptide could help in early detection.

scholarly journals Preoperative Pericardial Effusion is Associated with Low Cardiac Output Syndrome After Pericardiectomy for Constrictive Pericarditis

2021 ◽  
Vol 24 (3) ◽  
pp. E427-E432
Author(s):  
Jing-bin Huang ◽  
Zhao-ke Wen ◽  
Wei-jun Lu ◽  
Chang-chao Lu ◽  
Xian-ming Tang
Keyword(s):  
Cardiac Output ◽  
Pericardial Effusion ◽  
Constrictive Pericarditis ◽  
Multivariate Analyses ◽  
Nyha Class ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Histopathologic Finding ◽  
Short Time

Background: Low cardiac output syndrome is the main cause of death after pericardiectomy. Methods: Patients who underwent pericardiectomy for constrictive pericarditis from January 2009 to October 2020 at our hospital were included in the study. Histopathologic studies of pericardium tissue from every patient were performed. All survivors were followed up. Results: Ninety-two consecutive patients underdoing pericardiectomy were included in the study. The incidence of postoperative low cardiac output syndrome was 10.7% (10/92). There were five operative deaths. Mortality and incidence of LCOS in the group with pericardial effusion were significantly higher than those in the group without pericardial effusion. Tuberculosis of the pericardium (60/92, 65.2%) was the most common histopathologic finding in this study. Both univariate and multivariate analyses showed that preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Eighty-five survivors were in NYHA class I (85/87, 97.7%), and two were in class II (2/87, 2.3%) at the latest follow up. Conclusions: Preoperative pericardial effusion is associated with low cardiac output syndrome after pericardiectomy. Tuberculosis of the pericardium was the most common histopathologic finding in this study. For constrictive pericarditis caused by tuberculous bacteria, systematic antituberculosis drugs should be given. Preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Perfect preoperative preparation is very important to reduce the incidence of postoperative low cardiac output syndrome and mortality. It is very important to use a large dose of diuretics with cardiotonic or vasopressor in a short time after the operation.

scholarly journals Patient’s perspective regarding the elective surgical procedure during Covid 19 pandemic.

2020 ◽  
Author(s):  
Mayank Badkur ◽  
Ashok Puranik ◽  
Naveen Sharma ◽  
Suruthi Baskaran
Keyword(s):  
Surgical Procedure ◽  
Elective Surgery ◽  
Medical Profession ◽  
Female Ratio ◽  
Patient’S Perspective ◽  
The Status ◽  
Choice Of Treatment ◽  
Progression Of Disease ◽  
Elective Surgical Procedure ◽  
Almost All

Abstract Introduction: The ongoing Covid-19 pandemic and the subsequent nationwide lockdown, has impacted all aspects of society including medical profession. In hospitals, the focus has mainly shifted to prevention and treatment of Covid-19 infection. Owing to this, all elective surgeries were postponed and only emergent surgeries were performed. This has affected the patients differently depending on the progression of disease and development of complications.Materials and Methods: A well-structured telephonic scripted questionnaire was administered to all patients who were given appointment for any elective surgery. Data was collected regarding the status of disease including complications and the patient’s perspective on method of treatment. Patients who developed complications or underwent emergency surgery or surgery elsewhere were excluded.Results: The male to female ratio was 2.3:1. Mean age of patients was 41.16 years. A total of 86 patients were included in the study. Almost all (98.8%) were aware that the lockdown and withholding of elective surgeries was to prevent spread of coronavirus infection. Among 34 patients with complications, 88.2% were willing to undergo surgical procedure and 73.5% were willing to visit hospital within a week or two. Among patients without complications, 71.2% were willing to continue treatment on wait and watch policy, for a period of 2 months or more (45.7%). 93.5% of patients avoided visit to hospital due to risk of infection.Discussion: Patient’s attitude towards the choice of treatment (wait and watch Vs surgery) mainly depended on the progression of disease. It is critical, during these tough times of Covid-19 pandemic, that risks are weighed against benefits to decide the line of management for patients waiting for elective surgeries.

scholarly journals Patient’s perspective regarding the elective surgical procedure during Covid 19 pandemic.

2021 ◽  
Author(s):  
Mayank Badkur ◽  
Ashok Puranik ◽  
Naveen Sharma ◽  
Suruthi Baskaran
Keyword(s):  
Surgical Procedure ◽  
Elective Surgery ◽  
Medical Profession ◽  
Patient’S Perspective ◽  
The Status ◽  
Choice Of Treatment ◽  
Progression Of Disease ◽  
Elective Surgical Procedure ◽  
Coronavirus Infection ◽  
Almost All

Abstract Context: The ongoing Covid-19 pandemic and the subsequent nationwide lockdown, has impacted all aspects of society including the medical profession. In hospitals, the focus has mainly shifted to prevention and treatment of Covid-19 infection. Owing to this, all elective surgeries are being postponed and only emergent surgeries are being performed. This has affected the patients differently depending on the progression of disease and development of complications.Methods and Material: A well-structured telephonic scripted questionnaire was administered to all patients who were given an appointment for any elective surgery. Data was collected regarding the status of disease including complications and the patient’s perspective on the method of treatment. Patients who developed complications or underwent emergency surgery or surgery elsewhere were excluded.Statistical analysis used: Collected data was entered in MS Office Excel spreadsheet and analysis was done using SPSS software.Results: The man to women ratio was 2.3:1. The mean age of patients was 41.16 years. A total of 86 patients were included in the study. Almost all (98.8%) were aware that the lockdown and withholding of elective surgeries were directed to prevent the spread of coronavirus infection. Among 34 patients with progressive disease, 88.2% were willing to undergo the surgical procedure and 73.5% were willing to visit hospital within a week or two. Among 46 patients, who were Willing to continue the treatment on wait and watch policy, 45.7% patients wanted to wait for more than 2 months for their treatment, and 93.5% patients were avoiding hospital visit because of infection.Conclusions: Patient’s attitude towards the choice of treatment (wait and watch Vs surgery) mainly depended on the progression of disease. It is critical, during these tough times of Covid-19 pandemic, that risks are weighed against benefits to decide the line of management for patients waiting for elective surgeries.

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