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Large Anterior Mediastinal Mass: Intraoperative Transesophageal Echocardiography Guided Evaluation and Management

World Journal of Cardiovascular Surgery 2021年第8期11卷 69-74页

作者： kulbhushan saini Sandeep Chauhan Manu saini Department of Anesthesia and Intensive Care Post Graduate Institute of Medical Education and Research Chandigarh India Department of Cardiac Anesthesia All India Institute of Medical Sciences New Delhi India Department of Ophthalmology Advanced Eye Center Post Graduate Institute of Medical Education and Research Chandi-garh India

The authors report a case of Large Anterior mediastinal mass in which Transoesophageal Echocardiography (TEE) revealed a large mass that was compressing the right atrium, SVC, henceforth, TEE helped in guiding aspiration and surgical resection of the cystic mass. Therefore, through this case report, authors emphasize the importance of performing intraoperative real-time TEE in the mediastinal mass. This imaging technique helps in visualizing the external compression of cardio-vascular structure and aid in their management, obviating the possibility of large vascular structures from being injured by the surgeon during intraoperative manipulation.

关键词： Transoesophageal Echocardiography Superior Vena Cava Trans Thoracic Echocardiography Computed Tomography Right Atrium Inferior Vena Cava

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Comparison of Parasternal Intercostal Block Using Ropivacaine or bupivacaine for Postoperative Analgesia in Patients Undergoing Cardiac Surgery

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World Journal of Cardiovascular Surgery 2015年第6期5卷 49-57页

作者： kulbhushan saini Sandeep Chauhan Usha Kiran Akshay Kumar Bisoi Minati Choudhury Suruchi Hasija Department of Cardiothoracic and Vascular Anaesthesia CN Centre All India Institute of Medical Science New Delhi India M.CH Cardiothoracic and Vascular Surgery All India Institute of Medical Science New Delhi India

Objective: The objective of this study was to compare the efficacy of 0.5% ropivacaine and 0.25% bupivacaine for parasternal intercostal block for postoperative analgesia in children undergoing cardiac surgery. Design: A randomized, controlled, prospective, double blind study. Setting: A tertiary care teaching hospital. Participants: One Hundred children scheduled for cardiac surgery through a median sternotomy were divided into 3 groups of at least 33 children each, receiving either ropivacaine, bupivacaine or saline (control). Interventions: A bilateral parasternal block performed either with 0.5% ropivacaine or 0.25% bupiacaine or 0.9% saline with 5 doses of 0.5 mL on each side in the 2nd to 6th parasternal intercostal spaces 1 to 1.5 cm lateral to the sternal edge, before sternal wound closure. Measurements and Main Results: The time to extubation was significantly less in children administered the parasternal blocks with ropivacaine or bupivacaine compared to the saline (control) group. The pain scores were lower and comparable in the ropivacaine and bupivacaine groups compared to the saline group. The cumulative fentanyl dose requirement over a 24-hour period was higher in the saline group than the ropivacaine (p < 0.001) and bupivacaine group. No side effects were observed in any of the children. Conclusions: Parasternal blocks either with ropivacaine or bupivacaine appear to be a simple, safe, and useful technique for supplementation of postoperative analgesia in children undergoing cardiac surgery with a median sternotomy.

关键词： Pediatric Cardiac Patients Parasternal Intercostalblock Sternotomy Ropivacaine Bupivacaine Postoperative Pain

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