Early outcome of surgical treatment of 20 cases of postinfartion ventricular septal rupture by extended sandwich patch technique via right ventricle approach

Objective: Different techniques have been described to repair post myocardial infarction ventricular septal rupture (VSR), each method may result in residual shunting, bleeding, and post-operative mortality. The aim of this report is to describe early results of extended sandwich technique through right ventricle in 20 consecutive patients. Patients and Methods: A retrospective, cross-sectional and descriptive study on 20 patients underwent surgery for myocardial infarction VSR by extended sandwich technique through right ventricle from 12/2018 to 3/2021 in Hanoi Heart Hospital. Result: 20 consecutive patients (10 women and 10 men) with postinfarction ventricular septal rupture (mean age 72 years, range 48-84) underwent surgical repair for by extended sandwich technique performed through right ventricle from December 2018 to August 2021 in our institute. Reconstruction of the septum was performed by two patches according to the method described by Asai et al. The mean aortic clamp time was 101. The mean extracorporeal circulation time was 143 min. Postoperative intensive care unit (ICU) stay averaged 4 days (range, 1-10 days). There was 30% hospital mortality. 10% postoperative residual shunting was detected, and no patient needed reoperation for bleeding. Conclusion: This method of extended sandwich technique through right ventricle was safe, simple, and it could be performed in acute phase of myocardial infarction.

Italian survey on non-intubated thoracic surgery: results from INFINITY group

Background Non-Intubated Thoracic Surgery (NITS) is becoming increasingly adopted all over the world. Although it is mainly used for pleural operations,, non-intubated parenchymal lung surgery has been less frequently reported. Recently, NITS utilization seems to be increased also in Italy, albeit there are no multi-center studies confirming this finding. The objective of this survey is to assess quantitatively and qualitatively the performance of NITS in Italy. Methods In 2018 a web-based national survey on Non-Intubated management including both thoracic surgeons and anesthesiologists was carried out. Reference centers have been asked to answer 32 questions. Replies were collected from June 26 to November 31, 2019. Results We raised feedbacks from 95% (55/58) of Italian centers. Seventy-eight percent of the respondents perform NITS but only 38% of them used this strategy for parenchymal surgery. These procedures are more frequently carried out in patients with severe comorbidities and/or with poor lung function. Several issues as obesity, previous non-invasive ventilation and/or oxygen therapy are considered contraindications to NITS. The regional anesthesia technique most used to provide intra- and postoperative analgesia was the paravertebral block (37%). Conversion to general anesthesia is not anecdotal (31% of answerers). More than half of the centers believed that NITS may reduce postoperative intensive care unit admissions. Approximately a quarter of the centers are conducting trials on NITS and, three quarters of the respondent suppose that the number of these procedures will increase in the future. Conclusions There is a growing interest in Italy for NITS and this survey provides a clear view of the national management framework of these procedures.

Pain Monitoring Using Heart Rate Variability and Photoplethysmograph-Derived Parameters by Binary Logistic Regression

Purpose To construct a pain classification model using binary logistic regression to calculate pain probability and monitor pain based on heart rate variability (HRV) and photoplethysmography (PPG) parameters. Methods Heat stimulation was used to simulate pain for modeling the pain generation process, and electrocardiography and PPG signals were recorded simultaneously. After signal analysis, statistical analysis was performed using SPSS to determine the parameters that were significant for pain. Thereafter, a pain classification model with HRV and PPG parameters was established using binary logistic regression. Results The sensitivity and specificity of the pain classification model were 60.0% and 72.0%, respectively. When pain occurred, the probability calculated using the pain classification model increased from < 50% to > 50%. When the pain was relieved, the probability decreased to < 50%. The probability of pain was consistent with the numeric rating scale value, which indicated that the model can correctly determine the presence of pain. Conclusion This pain classification model has sufficient robustness and adaptability to be applied to different healthy people for classification and monitoring. This model is helpful in establishing a real-time pain monitoring system to improve pain management for patients in the postoperative intensive care unit and patient-controlled analgesia and provide a reference for doctors regarding medication.

Intraoperative haemodynamics and postoperative intensive care unit admission in older patients with cancer

Purpose Research on the impact of various intraoperative haemodynamic variables on the incidence of postoperative ICU admission among older patients with cancer is limited. In this study, the relationship between intraoperative haemodynamic status and postoperative intensive care unit admission among older patients with cancer is explored. Methods Patients aged ≥75 who underwent elective oncologic surgery lasting ≥120min were analysed. Chi-squared and t-tests were used to assess the associations between intraoperative variables with postoperative intensive care unit admission. Multivariable regressions were used to analyse potential predict risk factors for postoperative intensive care unit admission. Results Out of 994 patients, 48 (4.8%) were admitted to the intensive care unit within 30 days following surgery. Intensive care unit admission was associated with the presence of ≥4 comorbid conditions, intraoperative blood loss ≥100mL, and intraoperative tachycardia and hypertensive urgency. On multivariable analysis, operation time ≥240min (Odds Ratio [OR] = 2.29, p = 0.01), and each minute spent with intraoperative hypertensive urgency (OR = 1.06, p = 0.01) or tachycardia (OR = 1.01, p = 0.002) were associated with postoperative intensive care unit admission. Conclusion Intraoperative hypertensive urgency and tachycardia were associated with postoperative intensive care unit admission in older patients undergoing cancer surgery.