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   Table of Contents - Current issue
Coverpage
May-August 2018
Volume 12 | Issue 2
Page Nos. 17-34

Online since Thursday, October 25, 2018

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ORIGINAL ARTICLE  

Is it time to rethink about protocols for managing intraoperative serum potassium and blood glucose levels during off-pump coronary artery bypass surgery? p. 17
Kapil Gupta, Pankaj Devi Dayal, Shyam Bhandari, Amitabh Kumar, Carla Todaro, Anoop R Gogia, Poonam Malhotra
DOI:10.4103/ejca.ejca_10_18  
Background A low perioperative serum potassium level (<4 mEq/l) and high blood glucose level (>200 mg/dl) during cardiac surgery is a preventable cause of high morbidity and mortality. In this study, we measured the changes in intraoperative levels of serum potassium and blood glucose in adult patients undergoing elective off-pump coronary artery bypass (OPCAB) surgery, while administering insulin intraoperatively as per the present guidelines. Patients and methods Thirty-six adults, aged 18–65 years, undergoing elective OPCAB surgery were enrolled in this study. Arterial blood gas analysis was performed at predetermined intraoperative time points to measure serum potassium and blood glucose levels as primary variables. Base excess, pH, and HCO3 were recorded as secondary variables. Insulin infusion was started according to the sliding scale, whenever blood glucose was more than 180 mg/dl. Intravenous potassium was supplemented, when serum potassium was less than 4 mEq/l. Quantitative variables were compared with baseline using paired t test and repeated measure analysis of variance was used for comparison across follow up. Results Potassium chloride had to be continuously administered intravenous to maintain serum potassium levels more than 4 mEq/l throughout OPCAB surgery. There was a highly significant (P<0.001) increase in the intraoperative blood glucose level compared with the baseline throughout the OPCAB surgery. Conclusion Patients are prone to hypokalemia and hyperglycemia during OPCAB surgery, despite following the current guidelines. More studies are needed to formulate a better insulin infusion protocol for maintaining normoglycemia and guidelines need to be formulated for continuous intraoperative potassium infusion during OPCAB surgery.
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CASE REPORTS Top

Perioperative management of a patient with an autosomal dominant hypercoagulation disorder scheduled for off-pump coronary artery bypass surgery p. 27
Kumar Parag, Nishith Govil
DOI:10.4103/ejca.ejca_25_17  
Factor V Leiden (FVL) is the most common known inherited cause of thrombophilia; it is present in ∼5% of the Caucasian population. This results from mutation of the factor V protein, which is found to have normal procoagulant function in vitro but is resistant to inactivation by activated protein C. We describe the case of a 61-year-old male heterozygote for FVL with diagnosed coronary artery disease scheduled for off-pump coronary artery bypass grafting. Avoidance of antifibrinolytics completely, early administration of antiplatelet agents, heparin infusion 6 h after surgery or starting low molecular weight heparin, early extubation, active limb physiotherapy, use of pneumatic compression pumps, and most important of all early mobilization holds the key for successful outcomes of these patients. A comprehensive care team comprising an anesthesiologist, surgeons, and a hematologist should manage individuals with FVL.
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Anaesthetic management of a patient with pentalogy of Fallot: a case report p. 31
Indu Verma, Anisha Dara, C. K. Vyas, Anjum Saiyed, Reema Meena
DOI:10.4103/ejca.ejca_26_17  
Pentalogy of Fallot (POF) is a form of congenital heart disease having tetralogy of Fallot with an atrial septal defect. It is characterised by right to left intracardiac shunt with a decrease in pulmonary blood flow and the development of arterial hypoxaemia. Arterial hypoxaemia depends on the magnitude of shunting and leads to erythrocytosis which in turn poses a risk of thromboembolism. We report on the anaesthetic management of a rare case of a 4-year-old male child with pentalogy of Fallot for total correction.
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