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Background:ProSeal laryngeal mask airways (PLMAs) are routinely used after failed tracheal intubation as airway rescue, facilitating tracheal intubation by acting as a conduit and to secure airway during emergencies. In long duration surgeries, use of endotracheal tube (ETT) is associated with various hemodynamic complications, which are minimally affected during PLMA use. However, except for few studies, there are no significant data available that promote the use of laryngeal mask during cardiac surgery. This prospective study was conducted with the objective of demonstrating the advantages of PLMA over ETT in the patients undergoing beating-heart coronary artery bypass graft (CABG).Methodology:This prospective, interventional study was carried out in 200 patients who underwent beating-heart CABG. Patients were randomized in equal numbers to either ETT group or PLMA group, and various hemodynamic and respiratory parameters were observed at different time points.Results:Patients in PLMA group had mean systolic blood pressure 126.10 ± 5.31 mmHg compared to the patients of ETT group 143.75 ± 6.02 mmHg. Pulse rate in the PLMA group was less (74.52 ± 10.79 per min) (P < 0.05) compared to ETT group (81.72 ± 9.8). Thus, hemodynamic changes were significantly lower (P < 0.05) in PLMA than in ETT group. Respiratory parameters such as oxygen saturation, pressure CO2 (pCO2), peak airway pressure, and lung compliance were similar to ETT group at all evaluation times. The incidence of adverse events was also lower in PLMA group.Conclusion:In experience hand, PLMA offers advantages over the ETT in airway management in the patients undergoing beating-heart CABG.

Background Neuromuscular blocking drugs are necessary in cardiac surgery to facilitate smooth intubation and ventilation conditions, avoid patient movement, reduce oxygen consumption, and prevent shivering. Hemodynamic stability is very essential in cardiac surgery because the coronary reserve is below normal in such patients. Aims This study was conducted with the objective of comparing rocuronium, the “near-ideal” muscle relaxant with vecuronium, an already established neuromuscular blocking agent in patients undergoing elective ultrafast-track off-pump coronary artery bypass surgery (CABG). Settings and Design This prospective, randomized comparative study included 60 patients scheduled for elective off-pump CABG procedures under general anesthesia in the period between May 2015 and March 2016. Materials and Methods Patients were randomized in equal numbers to either the rocuronium group or the vecuronium group, and intubating conditions and various hemodynamic parameters were observed at different time points. Statistical Analysis Used Categorical variables were evaluated using the chi-square test, whereas the Student t-test or Mann–Whitney test were used for continuous variables. Results Pulse rate in the rocuronium group was lesser (79.97 ± 7.42) (p < 0.05) at the time of intubation as compared with the vecuronium group (92.33 ± 8.93). Systolic blood pressure was higher in the vecuronium group (150.70 ± 14.05) at the time of intubation as compared with the rocuronium group (130.27 ± 9.95) (p < 0.05). Intubating conditions, mean arterial pressure, and diastolic blood pressure changes were similar in both groups. Conclusions Rocuronium provides good-to-excellent intubating conditions and is devoid of any significant cardiovascular changes causing hemodynamic instability when compared with vecuronium in patients undergoing elective ultrafast-track off-pump CABG.

Postoperative deep vein thrombosis (DVT) of lower limbs is often asymptomatic. In many patients, fatal pulmonary embolism (PE) is the first clinical manifestation of postoperative venous thromboembolism (VTE). Routine screening for asymptomatic DVT of the lower limbs has a low sensitivity and is quite impractical. For these reasons, routine and systematic prophylaxis in patients at risk, is the strategy of choice to reduce the burden of VTE after surgery. If used appropriately such prophylaxis is cost effective since it reduces the incidence of symptomatic thromboembolic events, which require costly diagnostic procedures and prolonged anticoagulation therapy. Here we report the post-operative course of a spine surgery patient, presenting with DVT in calf veins, which lodged into pulmonary artery and was managed successfully with low molecular weight heparin (LMWH), embolectomy, inferior vena cava (IVC) filter, and dabigatran.

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