Amiodarone in the Management of Cardiac Arrhythmia Following Open Heart Surgery

2021 ◽  
Vol 14 (1) ◽  
pp. 20-23
Author(s):  
Nazmul Hosain ◽  
Md Rajibul Islam ◽  
Muhammad Abdul Quaium Chowdhury ◽  
Mohammad Fazle Maruf ◽  
Ahsan Uddin Mahmud ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Arrhythmia ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Ventricular Rate ◽  
Hemodynamic Stability ◽  
Postoperative Arrhythmia ◽  
Life Threatening ◽  
The Mean

Background: Postoperative cardiac arrhythmias may present as life threatening complications like- cerebrovascular strokes, thrombo-embolic manifestations, inadequate ventricular filling and compromised hemodynamic stability. Amiodarone is an effective drug for various postoperative arrhythmias. Objective of this study is to evaluate the efficacy of Amiodarone in controlling postoperative arrhythmia in our settings at the department of cardiac surgery. Methods: This retrospective observational study involved random selection of 20 patients, who developed potentially life-threatening arrhythmia following cardiac surgical procedures under cardiopulmonary bypass (CPB) at Chittagong Medical College Hospital (CMCH) between January 2018 and December 2020. Amiodarone was used in controlling postoperative cardiac arrhythmia by loading 1000 mg in first 24 hours, followed by 800 mg orally in daily divided doses. Results: Among 20 patients under study, five had valvular replacement, three had ASD closure, one VSD closure, one patient had excision of LA myxoma and in ten patients had undergone CABG. The Mean ± SD of the age of the patients was 50.2 ± 14.7 years. Eleven patients (55%) were female. Atrial fibrillation with rapid ventricular rate occurred in 15 patients, supraventricular tachycardia in two and ventricular tachycardia three patients. Targets were achieved in all 20 of these patients. Among them 13 (65%) reverted to sinus rhythm, in other 7 AF persisted but ventricular rates became below 100/m with hemodynamic stability. The Mean ± SD of the time required for target achievement was 8.9 ± 7.4 hours. There was no perioperative death in these patients. Conclusion: Amiodarone is an effective medication in combating both atrial and ventricular arrhythmia following cardiac surgery employing cardiopulmonary bypass. Cardiovasc j 2021; 14(1): 20-23

Delayed Development of Malignant Hyperthermia Following Cardiopulmonary Bypass

2017 ◽  
Vol 22 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Stephen Hall Sams ◽  
Stephen Revilla ◽  
David Lawrence Stahl
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Malignant Hyperthermia ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Signs And Symptoms ◽  
Life Threatening ◽  
Cardiac Intensive Care ◽  
High Index Of Suspicion ◽  
Post Cardiac Surgery

Malignant hyperthermia (MH) is a rare but potentially life-threatening disorder encountered during general anesthesia. The use of cardiopulmonary bypass during cardiac surgery can obscure many of the cardinal signs and symptoms of MH. The development of postoperative MH following cardiac surgery is rare, but anesthesiologists and intensivists must maintain a high index of suspicion in order to make a prompt diagnosis. Initiation and tailored maintenance of MH therapy must also consider the complex physiologic changes of patients in the immediate post–cardiac surgery period. In this article, we present a case of the development of postoperative MH in the cardiac intensive care unit after elective open heart surgery with cardiopulmonary bypass.

scholarly journals Analysis of Dynamic Changes in Cognitive Workload During Cardiac Surgery Perfusionists′ Interactions With the Cardiopulmonary Bypass Pump

2020 ◽  
pp. 001872082097629
Author(s):  
Lauren R. Kennedy-Metz ◽  
Roger D. Dias ◽  
Rithy Srey ◽  
Geoffrey C. Rance ◽  
Heather M. Conboy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Time Windows ◽  
Open Heart Surgery ◽  
Real Life ◽  
Skin Incision ◽  
Cognitive Workload ◽  
Dynamic Changes ◽  
Pump Operation

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient’s homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. Method HRV and self-reported cognitive workload were collected from three Board-certified cardiac perfusionists ( N = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. Results Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. Conclusion We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. Application These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement.

scholarly journals Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

2019 ◽  
Vol 6 (3) ◽  
pp. 756
Author(s):  
Praveen Dhaulta ◽  
Vikas Panwar
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Ejection Fraction ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Clinical Variable ◽  
Open Heart ◽  
Multiple Variables

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

Intraoperative CARTO Mapping for Atrial Fibrillation Ablation in Patients Undergoing Cardiac Surgery

2021 ◽  
Author(s):  
Sara Rita Vacirca
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Pulmonary Veins ◽  
Open Heart Surgery ◽  
Atrial Fibrillation Ablation ◽  
Surgical Ablation ◽  
Before And After ◽  
The Mean ◽  
Exit Block

Objective: Intraoperative CARTO Mapping for Atrial Fibrillation ablation in cardiac surgery. Background: Surgical ablation of Atrial Fibrillation is usually performed without mapping. The study aims to determine if intraoperative CARTO can be useful to guide the ablating procedure. Methods and Findings: Fourteen patients with symptomatic and drug-refractory concomitant AF were operated on in 2003 and 2004. CARTO mapping was performed before and after surgical bipolar radio-frequency ablation. Application of energy was repeated when residual electrical activity was detected at the pulmonary veins-atrial junction. Pacing wires were applied on right and left pulmonary veins distally to the ablation line to confirm the exit block. The mapping protocol was completed in 12 patients. Acute left atrium-pulmonary vein isolation was achieved after single or double energy application in 2/12 (16.6%) and 9/12 (75%) patients, respectively. The mean duration of the mapping and ablation procedure was 67 minutes. At discharge, PV isolation persisted in 10 patients: exit block was confirmed by the absence of pacing through the pulmonary veins electrodes. After a mean follows up of 181 months, no further recurrent AF events were registered in 9/12 (69.2%) patients. Conclusions: CARTO system is useful during open-heart surgery to guide the ablating strategy.

The systemic inflammatory response syndrome following cardiac surgery: different expression of proinflammatory cytokines and procalcitonin in patients with and without multiorgan dysfunctions

Perfusion ◽  
2002 ◽  
Vol 17 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Armin Sablotzki ◽  
Ivar Friedrich ◽  
Jörg Mühling ◽  
Marius G Dehne ◽  
Jan Spillner ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Multiple Organ ◽  
Systemic Inflammatory Response ◽  
Apache Ii Score ◽  
Organ Dysfunctions

Cardiopulmonary bypass is associated with an injury that may cause pathophysiological changes in the form of systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS). In the present study, we investigated the inflammatory response of patients with multiple organ dysfunctions following open-heart surgery. Plasma levels of cytokines (IL-1β, IL-6, IL-8, IL-18) and procalcitonin (PCT) were measured on the first four postoperative days in 12 adult male patients with SIRS and two or more organ dysfunctions after myocar-dial revascularization (MODS group), and 15 patients without organ dysfunctions (SIRS group). All cytokines (except IL-1β) and PCT were significantly elevated in MODS patients, with peak values at the first two postoperative days. The results of our study show a different expression of members of the IL-1 family following extracorporeal circulation. For the first time, we can document that IL-18 is involved in the inflammatory response and the initiation of the MODS following cardiopulmonary bypass. In addition to APACHE-II score, PCT, IL-8, and IL-18 may be used as parameters for the prognosis of patients with organ dysfunctions after cardiac surgery. Furthermore, it must be noted that the duration of the surgical procedure is one of the most important factors for the initiation of the inflammatory response.

scholarly journals Impact of some intraoperative factors on wound infection in cardiac surgery

2021 ◽  
Vol 20 (1) ◽  
pp. 36-43
Author(s):  
A. V. Stepin
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Wound Infection ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Wound Infections ◽  
Open Heart ◽  
Postoperative Wound ◽  
Sternal Infection ◽  
Mammary Arteries

Relevanc. Surgical Site Infection (SSI) after open heart surgery is a significant problem in clinical, social, and economic aspect which causes the need to identification of the preferred procedures for successful prevention of the SSI.Objectives. To determine risk of the SSI in cardiac surgery depending on complexity of intervention, using of cardiopulmonary bypass (CBP) and use of both internal mammary arteries (IMA).Methods. Prospective observations study from 2010 to 2019 in cardiac surgery department of the Ural Institute of Cardiology, where in total 4993 open heart surgery procedures were consecutively performed. All SSI cases were recorded up to 90 days after surgery. The analysis was performed to identify risk of cardiopulmonary bypass (CPB), bilateral IMA grafting and combined procedures on the risk of the postoperative wound infection.Results. During the investigation period, total 220 cases of the SSI (4,5%) have been registered of the 4993 patients undergoing open heart surgery. It included 42 cases of deep sternal infection (0,9%) and 178 cases of superficial infection (3,6%). The main pathogen identified was Staphylococcus epidermidis (56,4%). During the hospital period, 151 cases (66,5%) of SSI have been detected, with the median time to detection of the complication 6 days. The relative mortality risk in deep sternal infection group was 4,4 times higher than in the group without SSI (HR 4,6, 95 % CI 1,5-13,9, p=0,003624). CABG increases the relative risk of SSI in compare with non-CABG procedures (OR 3,086169; 95%CI 1,281 – 7,437), while the complexity of the operation (combined versus isolated interventions) does not significantly increase the risk (OR 0.972283; 95% CI: 0.696 - 1.359). The incidence of SSI in the group of in situ BIMA grafting was 8.8%, significantly increasing the likelihood of the SSI in compare to those with SIMA (OR 2.167983, 95% CI 1.463 - 3.212; p =0,000057). CBP significantly increases the risk of postoperative wound infections (OR 1.523890, 95% CI 1.149 - 2.022, p = 0.001742).Conclusions. Refusal of cardiopulmonary bypass, simultaneous procedures and bilateral coronary artery bypass does not allow completely to avoid postoperative wound infections. Nevertheless, the technical features of the preparations and use of grafts, including skeletonization, prevention of coagulation and the preference for sequential composite CABG, can reduce the risk associated with the type of the open heart surgery.

Postbypass plasma surface tension and its role in bubble filtration

Perfusion ◽  
1986 ◽  
Vol 1 (3) ◽  
pp. 187-191 ◽  
Author(s):  
BD Butler ◽  
M. Kurusz ◽  
VR Conti
Keyword(s):  
Surface Tension ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Statistical Correlation ◽  
Plasma Samples ◽  
Plasma Surface ◽  
Arterial Blood ◽  
The Mean ◽  
Tension Analysis

Plasma samples from patients undergoing open-heart surgery were obtained at the end of cardiopulmonary bypass for surface tension analysis. The samples were measured with a Du Nouy tensiometer for true static surface tension. The surface tension values from 40 patients were analysed and correlated with plasma free haemoglobin levels, cardiopulmonary bypass time and oxygenator type. The mean surface tension value for the plasma samples was 49·96 ± 2·98 dynes/cm. No statistical correlation was found between the surface tension and the three variables. Surface tension phenomena have important implications in the removal of gaseous microemboli by screen filtration of arterial blood as it is applied to the bubble point concept. Another aspect of surface tension involves the concept of capillarity which considers the forces tending to push a bubble through a blood vessel thus preventing the obstruction of blood flow. The results of this study provide actual values of plasma surface tension from patients undergoing cardiopulmonary bypass.

Carbon dioxide field flooding techniques for open heart surgery: monitoring and minimizing potential adverse effects

Perfusion ◽  
2000 ◽  
Vol 15 (2) ◽  
pp. 151-153 ◽  
Author(s):  
Edward M Nadolny ◽  
Lars G Svensson
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Adverse Effects ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Blood Gas

The use of carbon dioxide for displacement of air in cardiac surgery can have potential adverse effects on blood gas strategies. Presented is a method of monitoring carbon dioxide in the cardiopulmonary bypass circuit and limiting the potential for severe hypercarbia during cardiopulmonary bypass.

Clinical response to arginine vasopressin therapy after paediatric cardiac surgery

2012 ◽  
Vol 23 (3) ◽  
pp. 387-393 ◽  
Author(s):  
Christopher W. Mastropietro ◽  
Maria C. Davalos ◽  
Shivaprakash Seshadri ◽  
Henry L. Walters ◽  
Ralph E. Delius
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Arginine Vasopressin ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
P Value ◽  
Haemodynamic Instability ◽  
Post Operation ◽  
The Mean ◽  
Haemodynamic Improvement

AbstractObjectiveTo describe the haemodynamic response of children who receive arginine vasopressin for haemodynamic instability after cardiac surgery and to identify clinical variables associated with a favourable response.Materials and MethodsWe reviewed patients less than or equal to 6 years undergoing open heart surgery in our institution between January, 2009 and July, 2010 who received arginine vasopressin during the first 7 days post operation. Favourable responders were defined as those in whom blood pressure was increased or maintained and catecholamine score was decreased, or blood pressure was increased by greater than or equal to 10% of baseline and catecholamine score was unchanged at 6 hours following arginine vasopressin initiation.ResultsOf the 34 patients identified, 17 (50%) patients responded favourably to arginine vasopressin. At 6 hours, the mean blood pressure was increased by 32.2% in responders as compared with 4.6% in non-responders, with a p-value less than 0.001. The mean catecholamine score decreased by 30.1% in responders and increased by 7.6% in non-responders, with a p-value less than 0.001. Anthropometric, demographic, and intra-operative variables were similar in both groups, as was maximum dose of arginine vasopressin. The median time after arrival to the intensive care unit at which arginine vasopressin was initiated, however, was later in those who responded, 20 hours as compared with those who did not, 6 hours, with a p-value equal to 0.032.ConclusionsArginine vasopressin therapy led to haemodynamic improvement in only half of the children in this study, and improvement was more likely to occur if arginine vasopressin was initiated after the post-operative night.

Establishing Cardiac Surgery in Eastern Nepal: Early Results

2018 ◽  
Vol 16 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Lokesh Shekher Jaiswal ◽  
Jagat Narayan Prasad ◽  
Prashant Shah ◽  
Narendra Pandit
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Nyha Class ◽  
Open Heart Surgery ◽  
Left Atrial Myxoma ◽  
Early Results ◽  
The Mean

Background: Only few dedicated cardiac centres provide cardiac surgery service in Nepal. We are the only government affiliated centre outside the capital providing this service. In this study, we aim to present our early results of cardiac surgery.Methods: This retrospective study was conducted at B P Koirala Institute of Health Sciences with objective of analysing the early results of cardiac surgery in the patients operated from July 2016 to March 2017.The data were analysed for patient demographics, type of surgery and cardiac disease, mortality, hospital and intensive care unit stay, valve related complications.Results: Total 51 major cardiac surgeries (42 on pump and nine off pump) were performed. There were 27 (53%) males and 24 (47%) females with median age of 36 years (range: 1 to 70 years). The cardiac diseases consisted of 28 rheumatic heart disease, 12 congenital heart diseases, five coronary artery disease, five chronic constrictive pericarditis and one left atrial myxoma. The mean cardiopulmonary bypass and cross clamp times were 106 ±35 and 80±26 minutes respectively. The mean intensive care unit and hospital stay was 4±2 and 8±3 days respectively. Two (4%) patients required re-exploration for mediastinal bleeding. There was no prosthetic valve thrombosis or infection.Two patients (4%) had superficial wound infections.There were four (7.8%) in hospital mortalities. Remaining 47 patients (91.8%) are in NYHA class I aftermean follow up duration of five months.Conclusions: Our early result of cardiac surgery is encouraging and has established the safety and feasibility of starting open heart surgery in other parts of Nepal.

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