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Background Healthcare workers (HCWs) are at increased risk of exposure to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Personal protective equipment (PPE) is mandated for HCWs. However, the physiological effects on the HCWs while working in the protective gear remains unexplored. This study aimed to assess the physiological effects of the prolonged use of PPE on HCWs. Materials and methods Seventy-five HCWs, aged 18–50 years were enrolled in this prospective, observational, cohort study. The physiological variables [heart rate, oxygen saturation, and perfusion index (PI)] were recorded at the start of duty, 4 hours after wearing N95 filtering facepiece respirator (FFR), pre-donning, and post-doffing. The rating of perceived exertion (RPE) score and modified Borg scale for dyspnea was evaluated. The physiological variables were represented as the mean ± standard deviation. Wilcoxon signed-rank test was used to show any difference in RPE and modified Borg scale for dyspnea. A p value of

ICU course may be prolonged in patients suffering from Coronavirus associated acute respiratory distress syndrome (CARDS) due to severity of initial disease and presence of opportunistic infections. A structured approach to management may help reduce morbidity and mortality. Case presentation: We present a series of five cases of CARDS with a prolonged ICU course, despite the resolution of viremia. A multipronged therapeutic approach was adopted in the form of self proning, thrombo–prophylaxis, chest physiotherapy, adequate nutrition, psychotherapy and early mobilization. We could transfer two patients on domiciliary oxygen therapy and one on room air. Despite aggressive measures to control infection, one patient developed fungal sepsis, and another developed pseudomonal pneumonia. Both the patients rapidly deteriorated and succumbed to secondary infection, despite having shown initial recovery from CARDS. Conclusion: Prevention of infections is the key to recovery after resolution of viremia. This warrants COVID step down facility and structured rehabilitation program. Key words: COVID–19; ARDS; Sepsis Citation: Talwar V, Mustafi SM, Choudhury A, Jain S, Kumar A. Outcome of COVID–19 associated severe ARDS: A case series. Anaesth. pain intensive care 2021;25(2):199-202. DOI: 10.35975/apic.v25i2.1472 Received: 18 January 2021, Reviewed: 13 February 2021, Accepted: 25 February 2021

Background: Postoperative arrhythmias are a known complication after cardiac surgical repairs for congenital heart disease. Methods: Data were reviewed pertaining to incidence, diagnosis, potential risk factors, and management of postoperative arrhythmias in 369 consecutive patients under 18 years of age, undergoing elective open heart surgery. All children were admitted to the intensive care unit and continuous electrocardiographic monitoring was performed. Patient factors such as Aristotle Basic Complexity Score, total surgical duration, hypotension, tachycardia, serum lactate level, and inotropic score were analyzed. Univariate analysis was done to assess associations between these factors and the occurrence of postoperative arrhythmias. Results: Twenty-five (6.7%) patients developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia occurring in 15 (60%) patients, followed by supraventricular tachycardia in 3 (12%), ventricular premature contractions in 3 (12%), hemodynamically unstable ventricular tachycardia and fibrillation in 3 (12%), and atrial fibrillation in 1 (4%) patient. Different grades of heart block were noted in 13 patients. Aristotle score (P = .014), total surgical duration (P < .01), hypotension (P = .02), heart rate (beats per minute) (P = .001), serum lactate level (P = .04), and inotropic score (P = .02) in the early postoperative period were associated with arrhythmia occurrence. Surgeries for ventricular septal defect alone or in association with other diseases including tetralogy of Fallot (TOF) and transposition of the great arteries (TGA) were found to be associated with higher risk of arrhythmias. Conclusion: This study showed a low incidence of arrhythmias, JET being the commonest, seen more in TOF repair and these could be treated efficiently. Higher Aristotle score, longer surgical time, hypotension, tachycardia, high inotropic score, and high serum lactate levels were associated with the occurrence of arrhythmias postoperatively.

Objective: To compare the haemodynamic effects of the induction agents ketamine, etomidate and sevoflurane using the model of electrical velocimetry based cardiac output monitoring in paediatric cardiac surgical patients. Design: Prospective randomized study. Setting: Tertiary care hospital. Participants: 60 children < 2 years age undergoing cardiac surgery. Interventions: The patients were randomized into 3 equal groups to receive 1.5-2.5 mg/kg iv ketamine (group K), 0.2-0.3 mg/kg iv etomidate (group E) or upto 8% sevoflurane (group S) as the induction agent. Hemodynamic parameters were noted before and after induction of anaesthesia utilizing a noninvasive cardiac monitor based on the model of electrical velocimetry. Measurements and Main Results: The demographic characteristics of the patients were similar in the three groups. The HR decreased in all groups, least in group E (P ≤ 0.01) but the MAP decreased only in group S (P ≤ 0.001). In group S, the stroke volume improved from 9 ± 3.2 ml to 10 ± 3.2 ml (P ≤ 0.05) and the stroke volume variation decreased from 25% ± 6.4% to 13% ± 6.2% (P ≤ 0.001). The stroke index and systemic arterial saturation improved in all groups (P ≤ 0.01). The cardiac index and index of contractility were unchanged. The transthoracic fluid content reduced in groups E and S, but did not change in group K (P ≤ 0.05). Conclusions: Etomidate appeared to provide the most stable conditions for induction of anesthesia in children undergoing cardiac surgery, followed by ketamine and sevoflurane.

Patients with dextro-transposition of the great arteries (d-TGA) with an intact ventricular septum (IVS) beyond 21 days of age may develop left ventricular (LV) regression. Perioperative echocardiography-guided assessment of LV for signs of regression is crucial in decision-making for definitive corrective surgery, namely arterial switch operation (ASO), as a regressed LV may not be capable of sustaining the load of systemic circulation. We hereby present transesophageal echocardiography (TEE) findings in a child with d-TGA and regressed LV where decision to perform a primary ASO with integrated extracorporeal membrane oxygenation (ECMO)- cardiopulmonary bypass (CPB) circuit was made. Use of ECMO was planned as a standby technique in the event of LV failure. ECMO was eventually used as the LV was unable to sustain the load of systemic circulation after ASO. How to cite this article Makhija N, Singh SP, Narula J, Choudhury A, Kiran U. Transesophageal Echocardiography in a Case of Dextro-Transposition of Great Arteries with Regressed Left Ventricle. J Perioper Echocardiogr 2014;2(2):71-74.

Infective endocarditis is a rare occurrence in the main pulmonary artery trunk and even rarer in tetralogy of Fallot.