Browsing by Author "Sethuraman, Manikandan"

Now showing 1 - 8 of 8
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    Entropy score, patent ductus arteriosus (PDA), and cardiopulmonary bypass (CPB): ligation of PDA on CPB can compromise cerebral blood flow.
    (Annals of cardiac anaesthesia, 2011)
    A patent ductus arteriosus (PDA) is often present in patients undergoing correction of congenital heart disease. It is well appreciated that during cardiopulmonary bypass (CPB), a PDA steals arterial inflow into pulmonary circulation, and may lead to systemic hypoperfusion, excessive pulmonary blood flow (PBF) and distention of the left heart. Therefore, PDA is preferably ligated before initiation of CPB. We describe acute decreases of arterial blood pressure and entropy score with the initiation of CPB and immediate increase in entropy score following the PDA ligation in a child undergoing intracardiac repair of ventricular septal defect and right ventricular infundibular stenosis. The observation strongly indicates that a PDA steals arterial inflow into pulmonary circulation and if the PDA is dissected and ligated on CPB or its ligation on CPB is delayed the cerebral perfusion is potentially compromised.
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    Left atrial pressure waveform: Does it show mitral insufficiency?
    (JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2008)
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    Mainstream time-capnography: an aid to select an appropriate uncuffed endotracheal tube in small children.
    (Journal of clinical monitoring and computing, 2008)
    Uncuffed endotracheal tubes are commonly used in children in an attempt to decrease the potential for pressure induced tracheal injury. However, uncuffed endotracheal tube may increase the risk of aspiration and lead to erratic delivery of preset tidal volume during mechanical ventilation. Therefore, it is desirable to intubate trachea with an appropriate but not an oversized endotracheal tube. In children, for selecting an endotracheal tube, a variety of formulas and techniques are used to find the endotracheal tube size that minimizes both pressure induced tracheal injury and aspiration potential or variable ventilation. Air-leak following tracheal intubation can be recognized by the presence of audible leak, by auscultation over the trachea, by palpation over the trachea and by observing effects of positive end-expiratory pressure on inspiratory expiratory tidal volume difference during mechanical ventilation. We describe mainstream time-capnograph as an aid to recognize leak around the endotracheal tube and its utility to determine appropriate endotracheal tube size in small children.
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    Pericardial tamponade after left posterolateral thoracotomy for left upper lobectomy for pulmonary aspergilloma.
    (Annals of cardiac anaesthesia, 2011)
    Pericardial tamponade limits diastolic filling of the heart; therefore, a high venous pressure is required to fill the ventricle. In presence of cardiac tamponade, therapeutic agents and manoeuvres that results in venodilation or vasodilation can severely compromise diastolic filling of the heart and might result in rapid cardiac decompensation. Equalization of central venous pressure and pulmonary artery diastolic pressure or equalization of pressures in all four chambers during diastole confirms cardiac tamponade. Transthoracic echocardiography can detect the site of tamponade and assist in pericardiocentesis. We describe acute pericardial tamponade in a young man who underwent left posterolateral thoracotomy for left upper lobectomy. Intraoperatively, mobilization of the left upper lobe was frequently associated with hypotension. Postoperatively, the patient suffered two more episodes of hypotension. The episodes of hypotension were attributed to surgical manipulation and epidural blockade. Hemodynamics normalized after discontinuing epidural infusion, volume resuscitation and lobectomy. On third postoperative day, the patient developed cardiovascular collapse; arterial blood pressure and central venous pressure were 70/50 and 12 mmHg. Investigations showed haziness of left lung, and severe respiratory acidosis. On opening of the left thoracotomy wound, pericardial tamponade was diagnosed. A pericardial window was created and tamponade was released with that the hemodynamics normalized. Episodes of unexplained hypotension after left upper lobectomy suggest a cardiac etiology and acute pericardial tamponade is a possibility which should be released immediately otherwise it can result in fatal outcome.
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    Severe hypotension and overflowing of venous reservoir at the initiation of cardiopulmonary bypass in a patient undergoing repair of ruptured sinus of Valsalva aneurysm: management issues.
    (Interactive cardiovascular and thoracic surgery, 2006)
    Aneurysm of sinus of Valsalva is a rare cardiac lesion that may be acquired or congenital. The presentations of RSOV range from incidental detection to frank heart failure. Right sinus of Valsalva aneurysm usually ruptures into the right ventricle. If non-coronary sinus is involved, most aneurysms erode into the right atrium. The problems described with surgical repair of RSOV include--distension of the communicating chamber at initiation of cardiopulmonary bypass (CPB), limited ability to achieve cardiac arrest if RSOV is misdiagnosed as ventricular septal defect, and air entrainment in venous drainage line on opening of the aorta, if tricuspid valve is regurgitant and total CPB is not established. We report severe hypotension and overflowing of the venous reservoir at initiation of CPB in a patient having RSOV with significant tricuspid regurgitation and discuss its optimal management.
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    Superior vena cava syndrome after pulsatile bidirectional Glenn shunt procedure: perioperative implications.
    (Annals of cardiac anaesthesia, 2009)
    Bidirectional superior cavopulmonary shunt (bidirectional Glenn shunt) is generally performed in many congenital cardiac anomalies where complete two ventricle circulations cannot be easily achieved. The advantages of BDG shunt are achieved by partially separating the pulmonary and systemic venous circuits, and include reduced ventricular preload and long-term preservation of myocardium. The benefits of additional pulsatile pulmonary blood flow include the potential growth of pulmonary arteries, possible improvement in arterial oxygen saturation, and possible prevention of development of pulmonary arteriovenous malformations. However, increase in the systemic venous pressure after BDG with additional pulsatile blood flow is known. We describe the peri-operative implications of severe flow reversal in the superior vena cava after pulsatile BDG shunt construction in a child who presented for surgical interruption of the main pulmonary artery.