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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Sharma, Jai
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Medicine & Pharmacology

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Cerebral Oxygenation Monitoring During Coronary Artery Bypass Grafting and Its Correlation with Hematocrit, Mean arterial pressure, and Partial pressure of Oxygen in Arterial Blood Sharma, Jai; Verma, Indu; Agarwal, Swati; Dagar, Nivedita
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V7I12025.1-11

Abstract

Introduction: Optimal cerebral oxygenation is vital during coronary artery bypass grafting (CABG) to prevent neurological complications like cognitive decline and stroke. Non-invasive monitoring methods include near-infrared spectroscopy (NIRS), electroencephalography (EEG), and transcranial doppler (TCD). It offers real-time rSO2 assessment, detecting critical thresholds and reducing risks during cardiopulmonary bypass (CPB). Objective: This observational study aims to investigates cerebral oxygenation changes during CABG and correlations with hematocrit, mean arterial pressure (MAP), blood oxygen levels, CPB flows, and temperature. Methods: Seventy-two elective CABG patients underwent CPB with parameters including rSO2, hematocrit, MAP, PaO2, temperature, and pump flows assessed at specific time points: T1: Baseline pre-anesthesia; T2: Post-anesthesia induction (FiO2 100%); T3: Post-anesthesia induction (FiO2 50%); T4: CPB initiation; T5: CPB at 35°C; T6: CPB at 32°C; T7: CPB rewarming (36°C); T8: Post-CPB weaning (FiO2 100%); T9: Post-CPB weaning (FiO2 50%). Results: The mean baseline values for rSO2 were 72.14 for the right side and 71.90 for the left side. Upon initiating CPB at 35°C, a significant maximum reduction in rSO2 of 10.5% was observed, which remained below baseline during the hypothermia phase. The rSO2 values began to increase during the rewarming phase, nearly reaching baseline levels after CPB. A post hoc analysis indicated that changes in rSO2 were correlated with variations in hematocrit (correlation coefficient = 0.518), MAP (correlation coefficient = 0.399), and PaO2 (correlation coefficient = 0.001). Conclusion: This study explored the fluctuations in rSO2 during CABG with CPB and examined its correlations with hematocrit, MAP, PaO2, CPB flows, and temperature. The findings highlight significant correlations among these variables, providing insights into factors influencing cerebral oxygenation during cardiac surgery.
Comparing Hemodynamic Responses to Intubation in Hypertensive Patients: Clearvue® Video Laryngoscope Versus Macintosh Direct Laryngoscope Vyas, Ram Kishan; Meena, Sunita; Sharma, Jai; Sompura, Ritesh Kumar
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 2 (2025): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V7I22025.76-84

Abstract

Introduction: The ClearVue® video-laryngoscope (CVL) is believed to alleviate the stress response associated with intubation by providing superior laryngeal views, minimizing oropharyngo-laryngeal stimulation, and potentially reducing the pressor response. Objective: This study aims to assess and compare how effective and safe intubation is when using a CVL versus a Macintosh direct laryngoscope (MDL) in patients with high blood pressure who are having surgery. Methods: This prospective, randomized, interventional study was conducted on 140 hypertensive patients on antihypertensive medication undergoing elective surgery under general anesthesia (GA), who were allocated into two groups, CVL group (n = 70) and MDL group (n = 70). Hemodynamic parameters, including mean arterial pressure (MAP), mean heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP), were monitored at baseline, induction, and at various intervals post-intubation (1, 2, 3, 4, 5, and 10 minutes). Other metrics, such as intubation time, intubation attempts, ease of intubation, and associated complications, were documented. Results: Significant differences in heart rate were observed between the groups, right at intubation and at 1, 2, and 3 minutes post-intubation (p-values: 0.011; 0.028; 0.002; 0.003). SBP showed significant differences at intubation and during the first four minutes post-intubation (p-values < 0.001 except for the fourth minute, p = 0.001). DBP and MBP also showed significant differences at various intervals post-intubation (p-values < 0.001 to 0.025 and < 0.001 to 0.020, respectively). No significant difference in airway complications was noted. Conclusion: The CVL offers advantages over MDL in patients with controlled hypertension, specifically in reducing hemodynamic changes during intubation without increasing airway complications. At the same time, MDL offered less intubation time overall than CVL.
Comparison of Auscultation Method Versus Lung Ultrasound Technique to Evaluate the Accuracy of Positioning of Left Double Lumen Tube in Patients Undergoing Cardiothoracic Surgery Agarwal, Swati; Verma, Indu; Sharma, Jai; Dagar, Nivedita
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 2 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I22024.89-98

Abstract

Introduction: Cardiothoracic surgery is a complex and highly specialized medical field requiring precise surgical techniques and meticulous patient management. One critical aspect of this type of surgery is the accurate placement of the endobronchial double-lumen tube (DLT), which facilitates lung isolation and one-lung ventilation (OLV) during the procedure. Proper positioning of the DLT is essential to ensure adequate oxygenation, prevent complications, and optimize surgical access. Objective: This study aimed to compare the accuracy of positioning of the left DLT by the auscultation method versus the lung ultrasound technique in patients undergoing cardiothoracic surgery in both supine and lateral positions. Methods: A prospective, observational, and cross-sectional study was conducted in a single group of 62 patients based on the eligibility criteria. After general anesthesia, a DLT was inserted and rotated until resistance. Placement was confirmed by auscultation, ultrasound, and fibreoptic bronchoscopy. The evaluation process was done initially in a supine position, followed by a lateral position. Results: After insertion of the left DLT, initially evaluated in the supine position, sensitivity and specificity for auscultation were found to be 65.2% and 37.5%, respectively, sensitivity and specificity for ultrasonography were 82.6% and 75%, respectively. The accuracy of lung ultrasound at 80.7% (69.2%-88.6%) was higher than the accuracy of auscultation at 58.1% (45.7%-69.5%). This was followed by evaluation in lateral position, where sensitivity and specificity for auscultation were found to be 76.1% and 25% respectively, sensitivity and specificity for ultrasonography were 95.7% and 62.5%, respectively. The accuracy of lung ultrasound at 87.1% (76.6%-93.3%) was higher than the accuracy of auscultation at 62.9% (50.5%- 73.8%). Conclusion: Lung ultrasound is a superior method for assessing lung isolation and determining Double Lumen Tube position as compared to auscultation.
Co-Authors Agarwal, Swati Dagar, Nivedita Meena, Sunita Sompura, Ritesh Kumar Verma, Indu Vyas, Ram Kishan