Deep hypothermic circulatory arrest in adults undergoing aortic surgery: local experience

INTRODUCTION

The aim of our study was to evaluate the efficacy and safety of deep hypothermic circulatory arrest (DHCA) as a method of cerebral protection during aortic surgery.

MATERIALS AND METHODS

We carried out a retrospective review of 59 consecutive patients (48 men, 11 women) undergoing elective or emergency aortic surgery requiring DHCA from January 1999 to April 2002 in 2 tertiary care hospitals. Data regarding demographics, clinical characteristics, operation type, duration of circulatory arrest, nasopharyngeal temperatures, use of retrograde cerebral perfusion and central nervous system (CNS) morbidity and perioperative mortality were collected and analysed.

RESULTS

There were 47 (79.7 %) operations for aortic dissections and 12 (20.3 %) for aortic aneurysms. The mean duration of circulatory arrest was 42 +/- 23 minutes. The lowest nasopharyngeal temperature at the time of arrest was 16.5 degrees +/- 1.9 degrees C. Eight (13.6 %) patients had a new irreversible neurologic deficit postoperatively. These patients had a mean circulatory arrest time of 50 +/- 28 minutes. Temporary neurologic dysfunction occurred in 8 (13.6 %) patients. Intra-hospital mortality was 22 %. The mean circulatory arrest time for patients who died was 54 +/- 24 minutes.

CONCLUSION

DHCA is a simple and effective method of CNS protection in aortic surgery with satisfactory outcomes. With increased surgical and anaesthetic experience, as well as selective use of adjuncts of cerebral protection, reductions in mortality and neurological morbidity will likely be achieved in the future.

Patient-controlled epidural analgesia after thoracic and upper abdominal surgery using sufentanil with and without bupivacaine 0.125%

BACKGROUND

Epidural sufentanil can relieve postoperative pain after thoracic and upper abdominal surgery but it has some unwanted side effects. Patient-controlled epidural analgesia (PCEA) allows patients to titrate and reduce their analgesic requirements.

OBJECTIVE

The study aims to assess the use of demand-only PCEA after thoracotomy and upper abdominal surgery using sufentanil with or without bupivacaine in terms of pain control, amount of analgesic required and side effect profile.

METHODS

After the Hospital Ethics Committee approval and written informed consent, 34 ASA I and II patients were enrolled in this prospective, randomised, double-blinded controlled study. Post-operatively, after achieving adequate analgesia in the recovery, the patients were randomised to receive either sufentanil 1 microg/ml in normal saline (Group S) or sufentanil 1 microg/ml with bupivacaine 0.125% (Group SB) in a demand-only PCEA programme. Pain scores, side effects and amount of analgesia used were reviewed every hour.

RESULTS

The demographic profile of both groups was similar. The amount of sufentanil used was higher in Group S than in Group SB but it was not statistically significant. The numbers of patients with high pain scores at rest and during movement were not significantly different between the two groups. The side effect profiles of both groups were similar.

CONCLUSIONS

The PCEA demand-only programme using sufentanil 1 microg/ml with and without bupivacaine 0.125% was satisfactory after thoracotomy and upper abdominal surgery in our patient population. The addition of bupivacaine to sufentanil did not significantly reduce the amount of sufentanil required, the pain scores or the side effects.

Anaesthetic considerations for lung volume reduction surgery--a case report

INTRODUCTION

This case describes some of the unique problems faced by the thoracic anaesthesiologists during anaesthesia for lung volume reduction surgery.

CLINICAL PICTURE

The usual pulmonary function requirements for lobectomy are normally not met in these patients with severe emphysema.

TREATMENT

Maintenance of the functional residual capacity of the lung and normocapnia during anaesthesia are not as important. Instead problems due to barotrauma and dynamic hyperinflation from positive pressure ventilation are.

OUTCOME

Modification of ventilation strategy and providing an anaesthetic tailored towards early extubation is the cornerstone of the anaesthetic plan.

CONCLUSION

A good understanding of the respiratory physiology in patients with severe emphysema is essential.