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Noncardiac surgery

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https://www.readbyqxmd.com/read/28742706/reply-to-the-letter-to-the-editor-aspirin-therapy-on-blood-transfusion-in-noncardiac-surgery-evidence-from-quality-effect-model
#1
Jesse A Columbo, Natalie B V Riblet, David H Stone
No abstract text is available yet for this article.
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28728711/cardiac-screening-in-the-noncardiac-surgery-patient
#2
REVIEW
Waseem Chaudhry, Mylan C Cohen
This article will address common cardiac conditions that require evaluation prior to noncardiac surgery, characterization of urgency and the risk associated with surgical procedures, calculation of preoperative risk assessment, indications for diagnostic testing to quantify cardiac risk, and perioperative strategies to minimize the risk of cardiac complications.
August 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28727581/perioperative-gabapentin-does-not-reduce-postoperative-delirium-in-older-surgical-patients-a-randomized-clinical-trial
#3
Jacqueline M Leung, Laura P Sands, Ningning Chen, Christopher Ames, Sigurd Berven, Kevin Bozic, Shane Burch, Dean Chou, Kenneth Covinsky, Vedat Deviren, Sakura Kinjo, Joel H Kramer, Michael Ries, Bobby Tay, Thomas Vail, Philip Weinstein, Stacey Chang, Gabriela Meckler, Stacey Newman, Tiffany Tsai, Vanessa Voss, Emily Youngblom
BACKGROUND: Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. METHODS: Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days...
July 20, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28719430/high-sensitivity-cardiac-troponin-t-improves-the-diagnosis-of-perioperative-mi
#4
Jamie C Brown, Eslam Samaha, Srikar Rao, Mohammad A Helwani, Andreas Duma, Frank Brown, Brian F Gage, J Philip Miller, Allan S Jaffe, Fred S Apple, Mitchell G Scott, Peter Nagele
BACKGROUND: The diagnosis of myocardial infarction (MI) after noncardiac surgery has traditionally relied on using relatively insensitive contemporary cardiac troponin (cTn) assays. We hypothesized that using a recently introduced novel high-sensitivity cTnT (hscTnT) assay would increase the detection rate of perioperative MI. METHODS: In this ancillary study of the Vitamins in Nitrous Oxide trial, readjudicated incidence rates of myocardial injury (new isolated cTn elevation) and MI were compared when diagnosed by contemporary cTnI versus hscTnT...
July 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28709664/current-results-of-single-ventricle-palliation-of-patients-with-double-inlet-left-ventricle
#5
Bahaaldin Alsoufi, Courtney McCracken, Kirk Kanter, Subhadra Shashidharan, Brian Kogon
BACKGROUND: Double inlet left ventricle (DILV) is a heterogeneous single ventricle anomaly in which initial presentation, and consequently, timing and palliation mode vary based on morphology and degree of pulmonary or systemic outflow obstruction. Very few reports, mostly old, focused on palliation outcomes of DILV. We report current-era results and examine whether morphologic and subsequently surgical factors influence survival. METHODS: Fifty-eight infants with DILV underwent single ventricle palliation...
July 11, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28701611/the-utility-of-targeted-perioperative-transthoracic-echocardiography-in-managing-an-adult-patient-with-anomalous-origin-of-the-left-coronary-artery-pulmonary-artery-for-noncardiac-surgery
#6
Anudeep Jafra, Suman Arora, Aveek Jayant
Congenital coronary artery anomalies as a whole are uncommon. Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is probably the most common congenital coronary defect. An overwhelming majority of the patients with untreated ALCAPA do not survive to adulthood. As yet, there is no consensus on the management of adults with ALCAPA. We describe a patient with breast malignancy and incidentally detected ALCAPA; primacy was given to treatment of the oncologic condition as a first step...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28696876/experience-using-kaolin-impregnated-sponge-to-minimize-perioperative-bleeding-in-norwood-operation
#7
Takeshi Shinkawa, Jessica Holloway, Xinyu Tang, Jeffrey M Gossett, Michiaki Imamura
PURPOSE: A kaolin-impregnated hemostatic sponge (QuikClot) is reported to reduce intraoperative blood loss in trauma and noncardiac surgery. The purpose of this study was to assess if this sponge was effective for hemostasis during Norwood operation. DESCRIPTION: We conducted a retrospective review of patients undergoing Norwood operation in infancy between 2011 and 2016 at our institution. EVALUATION: Of 31 identified Norwood operations, a kaolin-impregnated sponge was used intraoperatively in 15 (48%) patients...
July 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28694308/association-of-delay-of-urgent-or-emergency-surgery-with-mortality-and-use-of-health-care-resources-a-propensity-score-matched-observational-cohort-study
#8
Daniel I McIsaac, Karim Abdulla, Homer Yang, Sudhir Sundaresan, Paula Doering, Sandeep Green Vaswani, Kednapa Thavorn, Alan J Forster
BACKGROUND: Delay of surgery for hip fracture is associated with increased risk of morbidity and mortality, but the effects of surgical delays on mortality and resource use in the context of other emergency surgeries is poorly described. Our objective was to measure the independent association between delay of emergency surgery and in-hospital mortality, length of stay and costs. METHODS: We identified all adult patients who underwent emergency noncardiac surgery between January 2012 and October 2014 at a single tertiary care centre...
July 10, 2017: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/28671407/perioperative-cardiovascular-medication-management-in-noncardiac-surgery-common-questions
#9
Michael A Mikhail, Arya B Mohabbat, Amit K Ghosh
Several medications have been used perioperatively in patients undergoing noncardiac surgery in an attempt to improve outcomes. Antiplatelet therapy for primary prevention of cardiovascular events should generally be discontinued seven to 10 days before surgery to avoid increasing the risk of bleeding, unless the risk of a major adverse cardiac event exceeds the risk of bleeding. Antiplatelet therapy for secondary prevention should be continued perioperatively, except before procedures with very high bleeding risk, such as intracranial procedures...
May 15, 2017: American Family Physician
https://www.readbyqxmd.com/read/28662926/defining-the-burden-scope-and-future-of-vascular-acute-care-surgery
#10
Donald G Harris, Anthony Herrera, Charles B Drucker, Richa Kalsi, Nandakumar Menon, Shahab Toursavadkohi, Jose J Diaz, Robert S Crawford
OBJECTIVE: The paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland. METHODS: A retrospective analysis of a statewide inpatient database was performed to identify patients undergoing noncardiac vascular procedures in Maryland from 2009 to 2013...
June 26, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28641862/perioperative-beta-blockers-and-statins-for-noncardiac-surgery-patients-with-coronary-stents
#11
Joshua S Richman, Laura A Graham, Aerin DeRussy, Thomas M Maddox, Kamal M F Itani, Mary T Hawn
IMPORTANCE: Recent publications report that perioperative initiation of statin therapy is associated with improved outcomes particularly among patients with increased cardiac risk. However, findings on associations with beta blocker (BB) initiation are mixed. OBJECTIVE: This study examines associations between perioperative statin and BB use in a national sample of patients with cardiac stents. DESIGN: Retrospective cohort study. SETTING: VA Medical Centers nationwide...
May 31, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28640783/the-implementation-of-a-preoperative-transthoracic-echocardiography-consult-service-by-anesthesiologists
#12
Sasha K Shillcutt, Daniel P Walsh, Walker R Thomas, Elizabeth Lyden, Tara R Brakke, Sheila J Ellis, Steven J Lisco, Nicholas W Markin
We describe a preoperative transthoracic echocardiography consult service led by anesthesiologists. The implementation process and the patient cohort are described. Preoperative transthoracic echocardiographic examinations were mostly performed in patients undergoing intermediate- or high-risk noncardiac surgery and in patients with a higher calculated mortality risk. All transthoracic echocardiographic examinations were interpreted by anesthesiologists.
June 20, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28628711/antiplatelet-therapy-in-patients-with-coronary-stents-undergoing-elective-noncardiac-surgery-continue-stop-or-something-in-between
#13
Christopher P Childers, Melinda Maggard-Gibbons, Paul G Shekelle
No abstract text is available yet for this article.
July 11, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28628568/irregular-outcomes-predictors-of-new-atrial-fibrillation-after-noncardiac-surgery
#14
Naveen Nathan
No abstract text is available yet for this article.
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28622175/predictors-prognosis-and-management-of-new-clinically-important-atrial-fibrillation-after-noncardiac-surgery-a-prospective-cohort-study
#15
Pablo Alonso-Coello, Deborah Cook, Shou Chun Xu, Alben Sigamani, Otavio Berwanger, Soori Sivakumaran, Homer Yang, Denis Xavier, Luz Ximena Martinez, Pedro Ibarra, Purnima Rao-Melacini, Janice Pogue, Kelly Zarnke, Pilar Paniagua, Jack Ostrander, Salim Yusuf, P J Devereaux
BACKGROUND: Despite the frequency of new clinically important atrial fibrillation (AF) after noncardiac surgery and its increased association with the risk of stroke at 30 days, there are limited data informing their prediction, association with outcomes, and management. METHODS: We used the data from the PeriOperative ISchemic Evaluation trial to determine, in patients undergoing noncardiac surgery, the association of new clinically important AF with 30-day outcomes, and to assess management of these patients...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28616213/postoperative-goal-directed-therapy-and-development-of-acute-kidney-injury-following-major-elective-noncardiac-surgery-post-hoc-analysis-of-pom-o-randomized-controlled-trial
#16
Amour Patel, John R Prowle, Gareth L Ackland
Background: The role of goal-directed therapy (GDT) in preventing creatinine rise following noncardiac surgery is unclear. We performed a post-hoc analysis of a randomized controlled trial to assess the relationship between postoperative optimization of oxygen delivery and development of acute kidney injury (AKI)/creatinine rise following noncardiac surgery. Methods: Patients were randomly assigned immediately postoperatively to receive either fluid and/or dobutamine therapy to maintain/restore their preoperative oxygen delivery, or protocolized standard care (oxygen delivery only recorded)...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28593326/intraoperative-infusion-of-dexmedetomidine-for-prevention-of-postoperative-delirium-and-cognitive-dysfunction-in-elderly-patients-undergoing-major-elective-noncardiac-surgery-a-randomized-clinical-trial
#17
Stacie Deiner, Xiaodong Luo, Hung-Mo Lin, Daniel I Sessler, Leif Saager, Frederick E Sieber, Hochang B Lee, Mary Sano, Christopher Jankowski, Sergio D Bergese, Keith Candiotti, Joseph H Flaherty, Harendra Arora, Aryeh Shander, Peter Rock
Importance: Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. Objective: To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium...
June 7, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28588090/associations-between-cardiac-troponin-mechanism-of-myocardial-injury-and-long-term-mortality-after-noncardiac-vascular-surgery
#18
Grant W Reed, Samuel Horr, Laura Young, Joshua Clevenger, Umair Malik, Stephen G Ellis, A Michael Lincoff, Steven E Nissen, Venu Menon
BACKGROUND: The time-sensitive hazard of perioperative cardiac troponin T (cTnT) elevation and whether long-term mortality differs by mechanism of myocardial injury are poorly understood. METHODS AND RESULTS: In this observational study of 12 882 patients who underwent noncardiac vascular surgery, patients were assessed for cTnT sampling within 96 hours postoperatively. Mortality out to 5-years was stratified by cTnT level and mechanism of myocardial injury. During a median follow-up of 26...
June 6, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28555781/high-c-reactive-protein-predicts-delirium-incidence-duration-and-feature-severity-after-major-noncardiac-surgery
#19
Sarinnapha M Vasunilashorn, Simon T Dillon, Sharon K Inouye, Long H Ngo, Tamara G Fong, Richard N Jones, Thomas G Travison, Eva M Schmitt, David C Alsop, Steven D Freedman, Steven E Arnold, Eran D Metzger, Towia A Libermann, Edward R Marcantonio
OBJECTIVES: To examine associations between the inflammatory marker C-reactive protein (CRP) measured preoperatively and on postoperative day 2 (POD2) and delirium incidence, duration, and feature severity. DESIGN: Prospective cohort study. SETTING: Two academic medical centers. PARTICIPANTS: Adults aged 70 and older undergoing major noncardiac surgery (N = 560). MEASUREMENTS: Plasma CRP was measured using enzyme-linked immunosorbent assay...
May 26, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28537983/comparison-of-the-mallampati-classification-in-sitting-and-supine-position-to-predict-difficult-tracheal-intubation-a-prospective-observational-cohort-study
#20
Jean-Luc Hanouz, Vincent Bonnet, Clément Buléon, Thérèse Simonet, Dorothée Radenac, Guillaume Zamparini, Marc Olivier Fischer, Jean-Louis Gérard
BACKGROUND: The Mallampati classification (MLPT) is normally evaluated in the sitting position. However, many patients cannot be evaluated in the sitting position for medical reasons. Thus, we compared the MLPT in sitting and supine positions in predicting difficult tracheal intubation (DTI). We hypothesized that the diagnostic accuracy of the MLPT performed in sitting and supine positions would differ. METHODS: We performed a single-center prospective observational study in adult patients who received general anesthesia and orotracheal intubation for noncardiac surgery...
May 19, 2017: Anesthesia and Analgesia
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