Sambhunath Das

Abstract

Background: Pleiotropic effects of Vitamin D (Vit D) on various cell types and causative association in the epidemiology of cardiovascular diseases is known for ages. Observational studies have successfully linked Vit D deficient states to critical illness and increased ICU morbidity and mortality. The role of preoperative Vit D deficiency on postoperative outcome in cardiac surgery patients is a new horizon for research. Methodology: A prospective observational cohort study was planned to assess impact of pre-operative Vit D deficiency on post-operative cardiac outcomes in adult patients undergoing cardiac surgery, Vit D level was assessed in the preoperative period and divided into group I Vit D deficient (20ng/ml). Primary outcome was to study the occurrence of myocardial infarction, arrhythmia, low cardiac output syndrome (LCOS) and inotropic requirement. Secondary outcomes were duration of mechanical ventilation, ICU length of stay, hospital stay and mortality. Result: Vit D deficiency was associated with increased incidence of arrhythmia (p=0.019), LCOS (0.003) and high inotropic requirements (p=0.001) with no relation to occurrence of MI (p=0.422) and mechanical support (p= 0.114) as compared to the sufficient group. Vit D deficiency was also associated with increased duration of mechanical ventilation (p=0.008), ICU (p=0.001) and hospital stay (p=0.00) as compared to other group. Conclusions: Vitamin D deficiency was associated with increased occurrence of arrhythmia, LCOS and high inotropic requirements. ICU morbidity in the form of increased duration of mechanical ventilation, ICU and hospital stay was increased in patients with Vit D deficiency.   Keywords: Vitamin D deficiency, Vitamin D sufficient, Post-operative cardiac Outcomes, Adult cardiac surgery, 25(OH) Vitamin D.

Open full article page

Abstract

Extracorporeal membrane oxygenation (ECMO) has emerged as a mechanical circulatory support system with rapid advancements in its technology. It has become an essential tool in the care of adults and children with severe cardiac and pulmonary dysfunction refractory to conventional therapy. The ease of implementation and cost effectiveness makes it highly desirable alternative for bridge to recovery or decision especially in developing countries like India. However complications and challenges related to ECMO, require more rigorously designed studies towards redefining management of patients. Anaesthesiologist being the perioperative physician has an impotant role in managing patients with ECMO. This review focuses on fundamental principles, technology, indications, management, weaning, transport protocols, complications, future directions as well as Indian scenario with ECMO utilization. Keywords: Extracorporeal membrane oxygenation, ECPR, Indian overview, Integrated ECMO, Perioperative clinical practices Venoarterial ECMO, Venovenous ECMO.

Open full article page

Abstract

Presence of malignant pheochromocytoma tumor and coronary artery disease is extremely rare and carry high perioperative risk. The postoperative morbidity and mortality are increased by many folds. In the reference case, adrenal tumor had infiltrated to inferior vena cava (IVC), liver and right kidney. He had associated coronary artery disease. We describe the management of a patient with malignant tumor of adrenal gland undergoing surgical removal with all arrangements for coronary artery bypass grafting and intrathoracic extraction of tumor from IVC. It is a rare example of cardiac patient for non-cardiac surgery. Keywords: Cardiac patient for non-cardiac surgery, Coronary artery disease, Malignant pheochromocytoma, Pheochromocytoma.

Open full article page