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   2019| May-August  | Volume 13 | Issue 2  
    Online since November 15, 2019

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Transthoracic echocardiography: a surrogate tool for predicting pulmonary hypertension using pulmonary artery to aorta ratio
Amita Sharma, Minati Choudhury, Sandeep Chauhan, Milind P Hote, Pradeep Ramakrishnan
May-August 2019, 13(2):30-34
Background Owing to the nonspecific and subtle nature of physical signs and symptoms of pulmonary hypertension (PH) in early stages, treatment is usually delayed despite advancement over the past decade. Use of transthoracic echocardiography (TTE) as the initial noninvasive modality in the screening and evaluation of PH can provide key information about the etiology and the prognosis of PH, thereby avoiding the complications associated with the invasive methods. The aim of this study was to determine the usefulness of main pulmonary artery (mPA) and ascending aorta (AscAo) ratio using TTE. Patients and methods In this prospective observational study, 30 adult patients undergoing elective coronary artery bypass grafting surgery were enrolled. Postanesthetic induction mPA and AscAo transverse diameters were measured using TTE. The mean pulmonary arterial pressures (mPAPs) were recorded using a direct pulmonary artery puncture after sternotomy. Correlations were established using the Pearson correlation coefficient. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results mPA : AscAo ratio demonstrated significant linear correlation with mPAP (i.e. r=0.553, P=0.00152). Sensitivity, specificity, positive predictive value, negative predictive value were 80, 100, 80, and 100%, respectively, for an mPAP of up to 25 mmHg. Conclusion TTE-guided measurement of mPA : AscAo ratio can be used as a simple and easily reproducible noninvasive method in predicting PH not only in cardiac but also in other noncardiac settings.
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Eisenmenger syndrome and emergency laparotomy: a case report
Neeraj Kumar, Amarjeet Kumar, Kumari Sneha, Mukta Agarwal, Sanjeev Kumar
May-August 2019, 13(2):35-37
The ES (Eisenmenger syndrome) consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrio-ventricular or aorto-pulmonary level. Anaesthetic management for these patients is always challenging. So careful circulatory and respiratory managements is required to avoid various factors related to surgery and anesthesia that can potentially increase right to left shunt. So primary goal is to maintain cardiac output to prevent a decrease in systemic vascular resistance and an increase in pulmonary vascular resistance. Here we describe an anaesthetic management of a 15-year-old lady,diagnosed with ES posted for emergency removal of left adnexal mass. In this case we have used general anaesthesia with patient controlled epidural analgesia for abolishing postoperative pain.
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Comparative effects of human albumin versus modern hydroxyethyl starch in living-donor renal transplant
Nazmy E Seif, Ahmed K Mohammed
May-August 2019, 13(2):23-29
Background Living-donor renal transplantation is considered the best therapy for renal failure patients. The outcome and graft function are affected by various perioperative variables. Fluid management remains a controversy whether to use crystalloids or colloids with the effect of either type of solution on graft function and overall morbidity. Patients and methods We studied 120 patients with end-stage renal disease, who were on regular hemodialysis scheduled for living-related kidney transplantation. The patients were assigned to receive either 6% hydroxylethyl starch (HES) 130/0.4 (Voluven) (HES group: n=60) or albumin 5% (ALB group: n=60) for intraoperative use. In both groups, normal saline was administered at 10 ml/kg/h. In addition, patients received 250 ml boluses of either Voluven (HES group) with a maximum of 50 ml/kg/day or ALB 5% (ALB group) to maintain their central venous pressure between 12 and 15 mmHg. Blood transfusion was given based on the hemoglobin level (<7 g/dl). Hemodynamic variables (mean arterial pressure and central venous pressure) were recorded. We recorded the cold and warm ischemia times, the operative time and the time of start of graft diuresis. Urine output, serum creatinine, blood urea nitrogen (BUN), and International Normalized Ratio (INR) were recorded by the end of surgery, then every 24 h during the first 3 postoperative days and once again on day 7. Creatinine clearance was calculated on post-transplant days 1, 2, 3, and 7. The need for postoperative dialysis within the first week and the incidence of early graft rejection were noted. Results There were no statistically significant differences between the two groups regarding hemodynamic variables, onset of diuresis, or need for postoperative dialysis. Perioperative laboratory workup (BUN, creatinine, creatinine clearance, and INR) were similar in both study groups. Conclusion There are no statistically significant differences between the use of HES solutions and ALB 5% on the outcome of living-donor renal transplant recipients. Using either solutions is comparable to the other with no special side effects.
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