Unilateral pulmonary edema after minimally invasive mitral valve surgery

Unilateral pulmonary edema after minimally invasive mitral valve surgery

S142 34TH EACTA ANNUAL CONGRESS ABSTRACTS / Journal of Cardiothoracic and Vascular Anesthesia 33 (2019) S140 S168 priming fluid was replaced with al...

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S142

34TH EACTA ANNUAL CONGRESS ABSTRACTS / Journal of Cardiothoracic and Vascular Anesthesia 33 (2019) S140 S168

priming fluid was replaced with albumin 5% and the patients received 250mL albumin 5% before initiation and 250mL after separation from CBP. Crystalloid boli were administered in the intensie care unit (ICU) for clinical signs of hypovolemia, increasing pressor requirements or worsening metabolic acidosis. The standard care group was treated per preexisting institutional guidelines. AKI was defined using modified KDIGO (Kidney Disease Improving Global Outcomes) criteria, patients with pre-existing renal injury were excluded. Data were compared using univariate analysis: parametric and non-parametric data were analyzed with Student’s t-test and Wilcoxon rank-sum test, respectively. A p-value of less than 0.05 was considered statistically significant. Results: The mean (SD) creatinine pre-operatively, at discharge, and the peak creatinine were not different between the ERACS and the standard care group (table). Less fluid was administered in the ERACS group, but the total fluid balance was not different. No significant difference exists between the occurrence of AKI between those groups; no patient developed AKI worse than KDIGO stage 1 (modified). Discussion: Although the ERACS patients received less fluid than the standard care group during the hospital stay, the incidence of AKI did not differ, nor did the serum creatinine at discharge between both groups. A restrictive fluid management with intraoperative albumin administration does not increase the incidence of acute kidney injury for patients in the ERACS pathway. REFERENCE: 1. Fuhrman et al, Epidemiology and pathophysiology of cardiac surgery-associated acute kidney injury, Curr Opin Anaesthesiol, 2017.

Methods: That is a prospective observational study including adult patients undergoing cardiac surgery. Patients were recruited on the first post-operative day (POD1). Assessment of patient reported outcomes (assessed in a questionnaire consisting of 13 questions, addressing severity of pain; its interference with activities; effect on affect; adverse effects; degree of satisfaction, whether the patient wished for more treatment for pain) and clinical variables were performed on the POD1. Results: There were 130 patients (105 men), average age of 64.3§8.2 years. 44.8% of patients had worst pain higher than 6. 58.8% of patients were more than 20% of time in severe pain. High level of drowsiness was registered in 43.9% patients. Only 4% of patients have been out of bed on the POD1. 44.8% of patients wished more treatment. 73% of patients received morphine and 31.5% of patients received acetaminophen during the first 24 h after surgery for pain relief. Discussion: It was suggested that incorrect assessment of pain, the use of protocols and inappropriate drug use, patients’ inability or unwillingness to communicate, and the hypothesis that patients should wake early from anesthesia and their blood pressure be stable, pain control is very often postponed to the next step. Several issues may be important for effective pain management, including providing the information about pain management options, systematic evaluation and the use of a multimodal approach. REFERENCES: 1. Cogan J. Pain management after cardiac surgery Seminars in Cardioth Vasc Anesth 2010; 14(3): 201204. 2. Unic-Stojanovic D. Cardiac surgery and postoperative pain. Proceedings of the 13th Belgrade International Symposium on Pain; 2018 18-19 May; Belgrade, Serbia. Belgrade: Serbian Pain Society; 2018: 96-100. PP.02.06 Unilateral pulmonary edema after minimally invasive mitral valve surgery

PP.02.05 Postoperative pain management in cardiac surgery patients

D. Unic-Stojanovic1, S. Samardzic2, L. Rankovic Nicic2 1

Cardiovascular Institute Dedinje, Medical school University of Belgrade, Belgrade, SERBIA 2 Cardiovascular Institute Dedinje, Belgrade, SERBIA Introduction: Pain after cardiac surgery can be caused by the incisions, cutting, heating, intraoperative tissue retraction and dissection, multiple intravascular cannulation, and chest tubes. Achieving optimal pain relief after cardiac surgery can be challenging. Most surgeons, anesthesiologist and nurses believe that cardiac surgery is not very painful, and related to that, pain levels after cardiac surgery are often severe and undertreated. The aim of this study is to evaluate perioperative pain management practices in patients undergoing cardiac surgery in the University hospital.

D. Unic-Stojanovic1, P. Vukovic1, I. Stojanovic1, L. Rankovic2, S. Samardzic2, M. Lukic2, M. Jovic1 1

Institute for Cardiovascular Diseases Dedinje, Medical school University of Belgrade, Belgrade, SERBIA 2 Institute for Cardiovascular Diseases Dedinje, Belgrade, SERBIA Introduction: Unilateral right-sided pulmonary edema (UPE) is a rare but potentially life-threatening complication after minimally invasive mitral valve surgery (MICS). Methods: We will present a case of severe unilateral pulmonary edema with cardiopulmonary instability after mitral valve repair with right minithoracotomy. Results: A 45-year-old man (182 cm, 82 kg) was referred to the authors’ hospital for surgical treatment of mitral regurgitation. His medical history included hypertension and chronic obstructive

34TH EACTA ANNUAL CONGRESS ABSTRACTS / Journal of Cardiothoracic and Vascular Anesthesia 33 (2019) S140 S168

pulmonary disease. Mitral valve repair was performed with plication of prolapsed part of the posterior leaflet and annuloplasty, under general anesthesia. The right lung was decompressed with differential lung ventilation by a double-lumen tracheal tube. Cross-clamp time was 128 min, and CPB time was long (193 min). Three hours after the surgery, oxygen saturation suddenly dropped to approximately 90 %, and frothy pink sputum was blast out from the tracheal tube. Chest radiograph showed unilateral right-sided massive infiltrate. No evidence of residual mitral insufficiency was detected by trans-thoracic echocardiography. Arterial pressure was maintained with high dose norepinephrine. Cardiac output was maintained with epinephrine and dobutamine, which were gradually attenuated within the first postoperative day. Mechanical ventilation was performed with high PEEP and high FiO2 (12 mmHg, 100 %, respiratory rate 16/min, tidal volume 5 ml/kg) by assist/control mode to maintain oxygenation. Pulse steroid therapy was applied for 3 days. Urine output was maintained at least 50 ml/h through the perioperative period. Patient was extubated 21 h after surgery. On the postoperative day 2, chest radiography showed reduced right-sided infiltration. Patient was discharged home on the 8th postoperative day. Discussion: The reasons of unilateral right-sided pulmonary edema are multifactorial, including complete lung collapse and ischemic reperfusion injury, systemic inflammatory reaction and extracorporeal circulation, level of mean pulmonary arterial pressure, chronic obstructive pulmonary disease, and increasing CPB time. Perioperative medical team should be aware of the heightened perioperative risk of UPE during MICS.

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NSAID and paracetamol. Postoperative pain was questioned at 1st, 4th, 12th, 24th, 36th, and 48th hours (at rest and cough) using visual analog scale (VAS). Morphine consumption, additional analgesic (tramadol 0.5 mg/kg) requirement were enrolled as well as complications, mobilization and feeding times. Results: This case series consisted of 3 female and 10 male patients with a mean age of 57§7. Four of them underwent lobectomy and resting 9 segmentectomy. VAS values (at rest and cough) are summarized in table 1. Mean morphine consumption for 12th and 24th hours were respectively 27.7§ 5.5mg and 48.2§13.6mg. Eleven of study patients needed once additional analgesic at 5§2.4 hours. Mobilization time was postoperatively at 4.7§0.98 hours and feeding at 5.11§ 0.92 hours. There was no complication among patients. Discussion: ESPB is a simple and safe block with USG and systemic complications are rare. We think that ESPB is a suitable and reliable option at rest; meanwhile multimodal analgesia is still essential to ensure adequate analgesia for dynamic pain control after VATS. REFERENCE: 1. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. Reg Anesth Pain Med. 2016; 41: 621-7. Table 1 Postoperative VAS values (mean§standard deviation)

REFERENCE: Renner J, et al. Unilateral pulmonary oedema after minimally invasive mitral valve surgery: a single-centre experience. European Journal of Cardio-Thoracic Surgery 2018; 53: 764-770. PP.02.07 Analgesic efficacy of erector spinae plane block in thorascoscopic lung surgery: case series

O. Turhan, Z. Sungur, N. Sivrikoz, N.M. Senturk PP.02.08 Istanbul University, Istanbul Faculty of Medicine-Anesthesiology and Reanimation Department, Istanbul, TURKEY Introduction: Video assisted thoracoscopic surgeries (VATS) as well as thoracotomies require multimodal analgesia. Erector spinae plane block (ESPB) is newly introduced and showed adequate analgesia after VATS (1). In this report, we aimed to investigate the analgesic efficacy of the ESPB in thoracoscopic surgeries. Methods: Written informed consent was obtained from all patients (for use of images and information) in this report. Patients (ASA I to III) above 18 years undergoing VATS were enrolled. Prior to anesthesia induction, we performed unilateral, single-injection ESPB at the level of T5 with USG guidance (figure 1). We used 20mL of 0.5% bupivakain. Multimodal analgesia comprised morphine via patient controlled analgesia,

Association between acute kidney injury and atrial fibrillation in patients undergoing cardiac surgery

S. Tosif, O. Cole, M. Shaw, G.Y.H. Lip Liverpool Heart and Chest Hospital, Liverpool, UNITED KINGDOM Introduction: Atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery, affecting up to 50% of patients in the immediate postoperative period. Postoperative AF is associated with increased morbidity, mortality and prolonged ITU stay. Recent guidelines (1) have identified age >75, history of AF, renal failure, mitral valve surgery/pathology, heart failure and chronic obstructive pulmonary disease as preoperative risk