Papers by Muralidhar Kanchi
Annals of Cardiac Anaesthesia, 2023
Annals of Cardiac Anaesthesia, 2013
Transoesophageal Echocardiography (TEE) is now an integral part of practice of cardiac anaesthesi... more Transoesophageal Echocardiography (TEE) is now an integral part of practice of cardiac anaesthesiology. Advances in instrumentation and the information that can be obtained from the TEE examination has proceeded at a breath-taking pace since the introduction of this technology in the early 1980s. Recognizing the importance of TEE in the management of surgical patients, the American Societies of Anesthesiologists (ASA) and the Society of Cardiac Anesthesiologists, USA (SCA) published practice guidelines for the clinical application of perioperative TEE in 1996. On a similar pattern, Indian Association of Cardiac Anaesthesiologists (IACTA) has taken the task of putting forth guidelines for transesophageal echocardiography (TEE) to standardize practice across the country. This review assesses the risks and benefits of TEE for several indications or clinical scenarios. The indications for this review were drawn from common applications or anticipated uses as well as current clinical practice guidelines published by various society practicing Cardiac Anaesthesia and cardiology . Based on the input received, it was determined that the most important parts of the TEE examination could be displayed in a set of 20 cross sectional imaging planes. These 20 cross sections would provide also the format for digital acquisition and storage of a comprehensive TEE examination. Because variability exists in the precise anatomic orientation between the heart and the esophagus in individual patients, an attempt was made to provide specific criteria based on identifiable anatomic landmarks to improve the reproducibility and consistency of image acquisition for each of the standard cross sections.
Circulation, Nov 16, 2021
Introduction: In this study, we evaluated the genetic predisposition to AKI using genome-wide ass... more Introduction: In this study, we evaluated the genetic predisposition to AKI using genome-wide association study (GWAS) in patients undergoing elective off-pump-CABG (OP-CABG). Methods: Patients of South Asian ancestry were categorized into four cohorts as follows: (A) patients with normal renal function undergoing OP-CABG (eGFR>60ml/min/m2) (n=754; AKI - 81, Non-AKI-673); (B) patients with renal dysfunction (eGFR<60ml/min/m2; not needing dialysis) undergoing OP-CABG (n=263; AKI-169, non-AKI-89); (C) patients with renal dysfunction with no symptomatic/known heart disease (n=92); (D) age-matched healthy control population (with normal kidney function, without symptomatic/known heart disease) (n=826). Renal function was considered to be normal, if the serum creatinine was less than 1.3mg% and/or estimated glomerular filtration rate was greater than 60ml/min/1.7 m 2 . Genotyping was performed using Infinium Global Screening Array-24 v3.0 BeadChip from Illumina, which included 6,54,027 markers. GWAS analysis was performed using age, genders and top10 principal components as covariates using logistic regression using PLINK 2.0. Postoperative AKI was defined based on Kidney Disease Improving Global Outcomes guidelines. Results: There were 754 participants with good renal function undergoing OP-CABG; among them, 81 subjects developed AKI postoperatively. The GWAS analysis revealed 607 markers with a suggestive significance p-value threshold of 1e-4. A modest signal was observed on chromosome 11 region, covering genes such as COX8A, NAA40, RCOR. The gene-based test in FUMA annotation revealed genes, MARCOD2, CNTN4, MAGI2 etc. as top hits. However, none of the markers remained significant after multiple testing corrections using Bonferroni and Benjamini-Hochberg. Conclusions: The GWAS revealed an association signal on chromosome 11, which is suggestive and needs to be pursued further in a larger sample set.
The journal of extra-corporeal technology, 2011
Cerebral dysfunction after CPB represents deficits ranging from neurocognitive deficits occurring... more Cerebral dysfunction after CPB represents deficits ranging from neurocognitive deficits occurring in approximately 25 % to 80% of patients stroke to overt occurring in 1% to 5% of patients. Neurological injury ranges from incapacitating stroke lethal encephalopathy coma to delirium term neurocognitive decline. Although stroke after cardiac surgery is an important concern for both short disability long-term effects more subtle neurological encephalopathy such as dysfunction neurocognitive costs are associated with increased medical review decreased quality of life. In this incidence we will discuss the pathogenesis aetio patho-physiology sum up with the safe CPB practices that are necessary to prevent neurological insult during cardiac surgery. (Ind J Extra Corpor Technol 2011;21:0–0)
Journal of Anaesthesiology Clinical Pharmacology, 2012
The Journal of Thoracic and Cardiovascular Surgery, Aug 1, 1997
Journal of Cardiothoracic and Vascular Anesthesia, Dec 1, 2019
Journal of Cardiothoracic and Vascular Anesthesia, Dec 1, 2017
Objectives: To examine patterns of use of pulmonary artery catheters in a large cohort of patient... more Objectives: To examine patterns of use of pulmonary artery catheters in a large cohort of patients undergoing cardiac surgery. Design: A retrospective study with univariate and multivariate logistic regression to identify independent predictors for the utilization of pulmonary artery catheters. Setting: University, small, medium and large community hospitals participating in the National Anesthesia Clinical Outcomes Registry. Participants: A total of 116,333 patients undergoing pulmonary artery catheter placement during cardiac surgery in the National Anesthesia Clinical Outcomes Registry from the Anesthesia Quality Institute. Measurements and Main Results: Age older than 50 years, American Society of Anesthesiologists classification of 3 or higher, case duration of longer than 6 hours, and presence of a resident physician or certified nurse anesthetist were associated with increased likelihood of pulmonary artery catheter (PAC) placement. Age o18 years, or presence of a board-certified anesthesiologist, were associated with a decreased likelihood of catheter placement. The use of PACs has increased from 2010 to 2014. The presence of a PAC did not alter the risk of cardiac arrest intraoperatively. A nonsignificant decrease in mortality was associated with catheter placement. Transfusion was 75% less likely in the PAC cohort than in the control group. Conclusions: Pulmonary artery catheter use remains a mainstay of cardiac anesthesia practice. No significant change in the incidence of intraoperative death was noted, but patients with a PAC were less likely to have blood transfused.
Asian Cardiovascular and Thoracic Annals, Jun 1, 1994
One hundred patients of either sex undergoing elective cardiac operation were divided randomly in... more One hundred patients of either sex undergoing elective cardiac operation were divided randomly into 2 groups. In both groups, the right internal jugular vein was cannulated using the Seldinger technique and multilumen central venous catheters. The length of catheter inserted in Group A was height of the patient in centimeters divided by 10, and Group B height in centimeters divided by 12. Ideal catheter tip position could be obtained in 94% of the patients in Group B, but only 36% in Group A ( p < 0.001).
Annals of Cardiac Anaesthesia, 2005
Annals of Cardiac Anaesthesia, 2004
It is postulated that patients with ischaemic heart disease (IHD) and coronary steal prone anatom... more It is postulated that patients with ischaemic heart disease (IHD) and coronary steal prone anatomy (CSPA) may develop myocardial ischaemia under isoflurane anaesthesia. This study was conducted in 50 patients undergoing coronary artery bypass grafting. Among these 10 patients (20%) had CSPA, as evidenced by coronary angiography. Anaesthesia was induced with fentanyl, midazolam and thiopentone and maintained with isoflurane in oxygen after endotracheal intubation. Patients were continuously monitored with automated ST segment analysis of electrocardiogram (ECG) and transoesophageal echocardiography (TEE). The end-tidal concentration of isoflurane was maintained at 1.2%, which is equal to one minimum alveolar concentration. Haemodynamic parameters were maintained within 20% of baseline values with either the use of phenylephrine or increasing the depth of anaesthesia by using midazolam and fentanyl. ST changes were measured after 80 ms of J-point in ECG and TEE monitored for occurrence of new regional wall motion abnormalities during the study period. ST changes more than +/-1.0 mm were considered as an indication of myocardial ischaemia. Out of 10 patients having CSPA, 50% developed significant ECG changes during isoflurane anaesthesia at an endtidal concentration of 1.2%. In patients not having CSPA new ischaemia was not observed. Our study indicates necessity of close monitoring of patients with IHD and CSPA during isoflurane anaesthesia to identify new ischaemia and institute appropriate measures.
Journal of Cardiothoracic and Vascular Anesthesia, Feb 1, 1995
Journal of Clinical Monitoring and Computing, Apr 17, 2008
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Papers by Muralidhar Kanchi