Future of Awake Cardiac Surgery

Comparing Conscious Sedation With Regional Anesthesia Versus General Anesthesia in Minimally Invasive Mitral Valve Surgery With Right-Sided Minithoracotomy: A Retrospective Study

OBJECTIVES

The aims of the present study were to evaluate and compare the safety and feasibility, including hospitalization, intensive care unit (ICU) stay, frequency of conversion to general anesthesia (GA), pH, PaCO₂, and PaO₂, of selected patients who underwent minimally invasive mitral valve surgery (MIMVS) via a right minithoracotomy under conscious sedation (CS) to avoid GA. The authors also aimed to evaluate the perioperative management of spontaneous breathing.

DESIGN

A retrospective, observational study.

SETTING

Single-center.

PARTICIPANTS

This study enrolled 101 patients who underwent MIMVS under CS or GA.

INTERVENTIONS

The patients who underwent MIMVS were managed under CS or GA according to indication criteria.

MEASUREMENTS AND MAIN RESULTS

ICU stay (p = 0.010), postoperative time until first fluid intake (p < 0.0001), and duration of mechanical ventilation (p = 0.004) were shorter in the CS group than in the GA group. No patients converted to GA from CS. PaCO₂ during cardiopulmonary bypass (CPB) in the CS group was significantly lower than that in the GA group. However, PaCO₂ at the termination of CPB in the CS group was significantly higher than that in the GA group.

CONCLUSIONS

In the CS group, advanced-age patients with comorbidities underwent mitral surgery without postoperative complications. The authors' findings suggested that MIMVS under CS could be a potentially less-invasive method, providing a quicker recovery than MIMVS under GA.

Pectointercostal Fascial Block (PIFB) as a Novel Technique for Postoperative Pain Management in Patients Undergoing Cardiac Surgery

OBJECTIVE

To determine the efficacy of pectointercostal fascial block in relieving postoperative pain in patients undergoing cardiac surgery.

DESIGN

Single-blinded, prospective, randomized controlled trial.

SETTING

Single-center tertiary care teaching hospital.

PARTICIPANTS

A total 40 participants undergoing cardiac surgery aged 18 to 80 years.

INTERVENTIONS

Subjects were categorized into 2 groups of 20 each. In group 2 participants (interventional group), bilateral pectointercostal fascial block was given using ropivacaine injection 0.25% after completion of surgery, before shifting to the intensive care unit.

MEASUREMENTS AND MAIN RESULTS

Postoperative pain was measured after extubation at 0, 3, 6, and 12 hours, using a numeric rating scale. Pain in group 2 was significantly less and lasted for a longer duration than in group 1. Fentanyl requirement was significantly higher in group 1 (1.06 ± 0.12 µ/kg) than in group 2 (0.82 ± 0.19 µ/kg).

CONCLUSIONS

Pectointercostal fascial block is an easy and efficient technique to reduce postoperative pain after cardiac surgery.

The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Despite improvements in surgical techniques and perioperative care, cardiac surgery still is burdened by relatively high mortality and frequent major postoperative complications, including myocardial dysfunction, pulmonary complications, neurologic injury, and acute kidney injury. Although the surgeon's skills and volume and patient- and procedure-related risk factors play a major role in the success of cardiac surgery, there is growing evidence that also optimizing perioperative care may improve outcomes significantly. The present review focuses on the aspects of perioperative care that are strictly related to the anesthesia regimen, with special reference to volatile anesthetics and neuraxial anesthesia, whose effect on outcome in adult cardiac surgery has been investigated extensively.