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Neuroaxial Anesthesia Methods Combined with General Anesthesia for Beating Heart Surgery References

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Neuroaxial Anesthesia Methods Combined with General Anesthesia for Beating Heart Surgery References British Journal of Anaesthesia 102 (S2): ii266–ii343 (2012) doi:10.1093/bja/aer485 OTHER (The names of the authors presenting each paper are shown in bold type) Paper No: 1.00 Results: The total doses of sistemic fentanyl were smaller in the multimodal groups (2793 micrograms +2915.94 vs 1300 +2 392.79 vs 998 +229.10; p,0.001) The time of extubation (7.83 hours +25.24 vs 4.57 + Neuroaxial anesthesia methods combined 2 2.87 vs 1.72+2 1.07; p, 0.001) and the intensive care with general anesthesia for beating heart un it stay (CG¼2.83+22.42 days, GMOI¼1.92+21.23, surgery GMET¼1.41+20.75, p¼0.005) were smaller too, in both multimodal groups, wihtout differents beetwen then, but Aguero Martinez, Maria Oslaida, this methods didn’t influence in the hospital stay. A neuro- Rosa Jimenez Paneque, Idoris Cordero Escobar, logical complication associated to neuraxial blockade was Raul Cruz Bouza and Antonio Cabrera Pratts not observed. Hermanos Ameijeiras Hospital. Havana. Cuba Conclusions: The multimodal anesthetic methods are more effectives, with they a superior perioperative patients evolu- Introduction: In Cuba more than 50% of the coronary tion were obtained. Key words: Coronary surgery without surgery is carried out with the beating heart modality. extracorporeal circulation, intrathecal opioids, high epidural Endotracheal general anesthesia has been the technique blockade, spinal anesthesia, epidural anesthesia, multimod- used in our service. Neuraxial Anesthesia combined ality anesthesia. with the general anesthesia method, in this last decade, has prevailed in a certain number of the cardio- vascular centers of the world, due to their undeniable References advantages. 1 Lena P, Balarac N, Lena D, De la Chapelle A, Arnulf JJ, Mihoubi A, Objectives: To evaluate the effects of the general anesthe- Bonnet F. Fast-track anesthesia with remifentanil and spinal anal- sia combined with high thoracic epidural blockade or intra- gesia for cardiac surgery: The effect on pain control and quality of thecal administration of morphine/ fentanyl on the recovery. J of cardiothorac and vasc anesthesia 2008; 22(4): intraoperative analgesia, time of extubation, intensive 536–42. care unit and hospital stay. To identify the frequency of 2 Yapici D, Ozer ZO, Atici S, Bilgin E, Doruk N, Cinel I, et al. Post- operative effect of low-dose intratecal morphine in appearance of adverse effects related with the spinal ad- coronary artery bypass surgery. J Card Surg 2008; 23: ministration of opioides and the frequency of appearance 140–45. of complications related with regional anesthetic’s 3 Tenenbein PK, Derouwere R, Maguire D, Duke PC, Muirhead B, method. Enns J, et al. Thoracic epidural analgesia improves pulmonary Methods: A controlled randomized trial was conducted in function in patients undergoing cardiac surgery. Can J Anesth patients with diagnosis of coronary heart disease, pro- 2008; 55(6): 344–50. grammed for off pump coronary artery bypass graft 4 Caputo M, Alwair H, Roger CA, Ginty M, Monk C, Tomkins S, et al. surgery. This patients were assigned to one of the following Myocardial, Inflamtory, and Stress Responses in off-pump coron- three groups: Control group (n¼30): Endotracheal general ary artery bypass surgery with thoracic epidural Anesthesia. Ann Thorac Surg 2009; 87: 1119–26. anesthetic method. Multimodal group (n¼29) with thoracic 5 Moraes L, Canavi V, Canavi S, Sa Malbouissan LM, Carvalo CJ. epidural anesthesia: bupivaca¨ ana 0,5% (50 mg) 10 ml/single Intrathecal morphine plus general anesthesia in cardiac surgery: dose and 5 mg of morphine. Multimodal group with intra- Effect on pulmonary funtion, post operative analgesia and thecal administration of opioides (n¼29): fentanil 1,5 mcg/ plasma morphine concentration. Clinics (Sao Paulo) 2009; 64(4): kg and morphine 8mcg/kg. 279–85. & The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected] Abstracts presented at WFSA BJA Paper No: 57.00 Paper No: 63.00 Perioperative Anaesthesiological Candedemia in intensive care unit Management Obesity Patients Undergoing 1 1 2 Bariatric Surgery Prof. Chandralekha , I. Xess and Fahmi Hasan 1 Dept. of Anesthesiology and 2 Deptt of Microbiology Alisher Agzamov, Abdul Raheem, Al Qattan and Mohammad Behzad Introduction: There is a need to understand the epidemi- Department of Anaesthesiology& ICU, Al Sabah & Zain Hospitals, ology and risk factors associated with candidemia in critically Kuwait City, Kuwait ill patients. The rise in incidence of non¨Calbicans candidemia and emergence of antifungal resistance have made such a Introduction: In the long run, surgical treatment proves to study necessary. Candidemia in Intensive Care Units (ICUs) the most effective measure for the treatment of both setting are of special concern due to high mortality rate. morbid adipositas and concomitant morbidity. Patients Objective: The aim of this study was to evaluate epidemi- undergoing bariatric surgical procedures are a challenge to ology of Candidemia, associated risk factors and outcome the anaesthesiologist: Obesity-associated morbidity, the of the disease and antifungal resistance among ICU patients. poten-tially difficult airway and intravenous accesses as Methods: The study was carried out at an Indian tertiary- well as the demand for effective pain and anti-emetic care teaching hospital, New Delhi, India from a period of therapy. Interrestingly, only sparse and conflicting data three years. January 2005 to December 2008. Prospective exist about the perioperative anaesthesiological manage- analysis of 85 cases of Candida blood stream infection ment of these patients. (BSI) done from January 2005 to December 2008. Out of 85 Objectives: This study retrospectively reviewed the previous patients, 38 patients were getting repetitive BSI infection perioperative anaesthesiological management and and 47 patients got Candida infection only once during appraised critically the situation in the follow-ing analysis. their hospital stay. Follow up study was done till discharge A potential for improvement should be identified and or death of the patients and data were analyzed. Isolates included into a new SOP via the PDCA cycle of the quality were characterized and antifungal susceptibility test was management system. done against fluconazole and amphotericin B. Methods: Retrospectively, peri-operative charts of all Results: Non- C. albicans species accounted for majority of patients undergoing gastric banding or gastric bypass pro- episodes of candidemia as reported by our previous study. cedures within the last five years at our obesity Patients in ventilators and foleys catheter along with old treatment centre were analysed. Anesthesiological treat- age were significantly associated with persistence of infec- ment be-fore, during and after the bariatric surgery as tion (P ¡U¨ 0.05). Overall mortality was (65.8%) 56 of 85 in can- well as the pain therapy were documented. Ad-herence didemia patients. The time and the choice of antifungals for to the standard operating procedures, processing -times the treatment of candidemia were significantly associated and qualification of the anaesthesiologist were further spe- with the clearance of the infection (P¼0.01) but not with cific benchmarks. mortality (P¼0.23). 30% of the isolates showed decreased Results: Overall, 224 patient charts were available for this susceptibility to fluconazole. survey (n¼103 gastric banding and n¼121 gastric bypass). Conclusion: There is a shift in the epidemiology of candide- Most of the patients (64 %) had anaesthesiologically relevant mia and the timely institution of antifungals and combin- co-morbidites. Significant differences between the bypass ation therapy suggest the better outcome of the patients. and the banding groups were found for the median process- Presence of azole resistances is a matter of concern in our ing times. The need for postoperative opiods differs signifi- isolates. cantly as well (90 vs. 120 mg Pethidine). No severe anaesthesiological complications occurred. The overall rate of PONV was impressive with 32 %. Based on a pre-existing SOP, even a large number of different anaesthesiologists of References various qualification levels was able to conduct anaethesia 1 Behera B, Singh RI, Xess I, Mathur P, Hasan F, Mishra MC, Candida in a very homogeneous way. rugosa: a possible emerging cause of candidemia in trauma patients Infections 2010; 38: 387–393 Conclusions: Bariatric patients are a high risk patient group. 2 Singh RI, Xess I, Mathur P, Behera B, Gupta B, Mishra MC, Epidemi- Present-day anaesthesiological practice as well as the pro- ology of candidemia in critically ill trauma patients: experiences of found implementation of a SOP could permit safe anaesthe- a level I trauma centre in North India . J Med Microbiol 2011; 60: sia and a minimised risk for complications. Due to the high 342–348 PONV rate, a routine perioperative PONV prophylaxis should 3 Barton RC, Candida rugosa : a new fungal pathogen emerging, but be implemented. from where? J Med Microbiol 2011; Editorial 265 ii267 BJA Abstracts presented at WFSA Paper No: 68.00 3 Nisson, Rawal N, Unosson M, A comparison of intra-operative or postoperative exposure to music–a controlled trial of the effects on postoperative pain. Anaesthesia. 2003 Jul; Effect of Indian Classical Music (Raga 58(7):699–703. 4 Yale University School of medicine 2003 Effects of music therapy. Therapy) on Fentanyl, Vecuronium, Propofol 5 Sairam TV, (2004a) Medicinal Music. Chennai: Nada Centre for requirement and cortisol levels in Music Therapy Cardiopulmonary Bypass 6 Sairam TV, (2004b) Raga Therapy. Chennai: Nada Centre for Music Therapy 1 2 Sandeep Kumar Kar , Chaitali Sen and 7 Sairam TV, (2004c) What is Music? Chennai: Nada Centre for Music Anupam Goswami3 Therapy 1 Institute of Post Graduate Medical Education & Research 8 Lewis. Anesth Analg 2004; 98:533–6 KOLKATA INDIA 2 I.P.G.M& R Kolkata INDIA and 3 I.P.G.M.E&R 9 Yapici N, Tarhan IA, Kehlibar T, Coruh T, Arslan Y, Yilmaz M, Yapici F, Ozler A, Aykac Z, Blood Cortisol Levels On Cardiopulmon- ary Bypass After Methylene Blue Administration .
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