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Table of Contents
LETTER TO THE EDITOR
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 123-124

Technological Advances in Cardiac Anesthesia: We Live in Exciting Times Ensuring Better Patient Safety and Care


Department of Anesthesia and Critical Care (Cardiac Anaesthesia), Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India

Date of Submission16-Feb-2022
Date of Decision16-Mar-2022
Date of Acceptance23-Mar-2022
Date of Web Publication09-May-2022

Correspondence Address:
Kunal Sarin
Department of Anesthesia and Critical Care (Cardiac Anaesthesia), Army Hospital (Research and Referral), Delhi Cantt, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjoa.bjoa_58_22

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How to cite this article:
Sarin K, Chandra A, Garg A. Technological Advances in Cardiac Anesthesia: We Live in Exciting Times Ensuring Better Patient Safety and Care. Bali J Anaesthesiol 2022;6:123-4

How to cite this URL:
Sarin K, Chandra A, Garg A. Technological Advances in Cardiac Anesthesia: We Live in Exciting Times Ensuring Better Patient Safety and Care. Bali J Anaesthesiol [serial online] 2022 [cited 2022 May 27];6:123-4. Available from: https://www.bjoaonline.com/text.asp?2022/6/2/123/344889



From working with limited facilities, the practice of cardiac anesthesia has evolved into a highly specialized and advanced field due to major progress in skills, technology, teaching, and academic spheres. These have majorly taken place in the last 50 years. From the era of the apprehension and uncertainty, that a patient and his family had to undergo, we have migrated to times when the present practice of cardiac anesthesia allows millions of patients around the world to safely undergo cardiac surgery. Singh and Nath in their recent review article have comprehensibly reviewed the evolution of Artificial Intelligence across the world and its clinical application in perioperative care. They have brought out the immense potential of this advancement in the field of anesthesia care and contributed toward awareness among the anesthesiologists with respect to this technological advancement.[1]

Diagnosis of cardiac problems and their subsequent assessment, for example, in cases of complex congenital diseases, aortic aneurysms, dissections, etc. have undergone a major technological revolution with the advent of imaging modalities such as cardiac computed tomography, cardiac magnetic resonance imaging, and contrast-enhanced magnetic resonance angiography. The advancements in stress echocardiography and myocardial nuclear scintigraphy have made it possible to evaluate and monitor the progress of cardiac diseases without subjecting the patient to a more invasive coronary angiography.

Pioneering of transesophageal echocardiography (TEE) ushered in the Echo Era in the field of cardiac anesthesia. The ever so gold standard “pulmonary artery catheters” have now been superseded with TEE in clinical practice to monitor perioperative cardiac function and cardiac output. TEE has been used effectively to diagnose the complex cardiac and aortic problems in emergency cases in which other imaging modalities could not be used either due to paucity of time or unstable condition of the patient. The software itself has been undergoing major upgradation and with the introduction of 3D imaging in adult as well as pediatric probes, the quality of images and accuracy have been enhanced.[2] Major surgical decisions on table are being based on TEE findings, which have led to better care and improved surgical outcomes in this vulnerable group of patients.

Cardiac output determination based on accurate measurement of stroke volume and heart rate forms the crux of major decisions in the perioperative period for a critical cardiac patient. Major advancements in computer technology, sensors, and refinements in data interpretation since then have resulted in change in preference from using an invasive monitoring system (pulmonary artery catheter monitors) to a less-invasive method employing arterial pulse contour and waveform analysis to the latest non-invasive monitors based on electrical impedance cardiography. The latest technology is still under development to address the issues of accuracy and reliability.

Blood transfusions are an integral part of cardiac surgeries. The associated mortality risk with allogenic blood transfusions increases with the number of units of red blood cells transfused. Moreover, indiscriminate use of the blood products has put a strain on the availability of these precious resources. There are many studies which have compared viscoelastic point-of-care tests of coagulation (VE POCTs), such as rotational thromboelastometry, thromboelastogram, and Sonoclot, with conventional coagulation tests in terms of their utility and cost-effectiveness in different surgical settings and have recommended definite role of VE POCTs in selected high-risk cases.[3]

Perhaps, the advent of newer, safer, and more accurate technological advances has impacted the field of pediatric cardiac anesthesia: the most in terms of better outcomes. Changes in cardiopulmonary bypass circuits, ultrafiltration techniques, cuffed endotracheal tubes, better neurological monitoring using monitors such as near infrared spectroscopy, better understanding of deep hypothermic circulatory arrest pathophysiology, and blood conservation techniques, are few of the concepts which have improved over time and have resulted in marked improvement in patient safety and outcome.[4]

Introduction of drugs like levosimendan, milrinone, i.v. sildenafil, etc. have brought a major change in outlook and treatment modalities of very sick cardiac patients. The improved inhalational nitric oxide delivery systems have been a new ray of hope in managing patients with severe right ventricular dysfunction with increased pulmonary artery pressures.[5] The role of new drugs, especially α-2 agonists and judicious use of neuraxial techniques in pediatric cardiac anesthetic practice, for fast tracking and effective postoperative pain cannot be overemphasized.

To conclude, changing practices in cardiac anesthesia based on revolutionary technological advances has brought us much closer to achieving our goal of better patient safety and care. The future is here and it beacons us to adapt, engage, and innovate which will ultimately help the field of cardiac anesthesia to prosper and benefit the society.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh M, Nath G. Artificial intelligence and anesthesia: A narrative review. Saudi J Anaesth 2022;16:86-93.  Back to cited text no. 1
  [Full text]  
2.
Nagueh SF, Quiñones MA. Important advances in technology: Echocardiography. Methodist Debakey Cardiovasc J 2014;10:146-51.  Back to cited text no. 2
    
3.
Nath SS, Pandey CK, Kumar S. Clinical application of viscoelastic point-of-care tests of coagulation-shifting paradigms. Ann Card Anaesth 2022;25:1-10.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Vakamudi M, Ravulapalli H, Karthikeyan R. Recent advances in paediatric cardiac anaesthesia. Indian J Anaesth 2012;56:485-90.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Eljezi V, Rochette L, Dualé C, Pereira B, Boby H, Constantin JM. Inhaled nitric oxide before induction of anesthesia in patients with pulmonary hypertension. Ann Card Anaesth 2021;24:452-7.  Back to cited text no. 5
[PUBMED]  [Full text]  




 

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