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Perioperative cardiovascular evaluation

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https://www.readbyqxmd.com/read/27906721/preoperative-evaluation-and-preparation-of-the-morbidly-obese-patient
#1
Andreas B Böhmer, Frank Wappler
PURPOSE OF REVIEW: This review aims to familiarize with the most current findings regarding preoperative evaluation and preparation of morbidly obese patients prior to elective, noncardiac surgery. In the light of the increasing number of surgical patients being morbidly obese, the knowledge of evidence-based preoperative evaluation strategies is profound for a rational approach. RECENT FINDINGS: Preoperative evaluation should be carried out with sufficient time before the day of surgery to allow modification of the perioperative management...
November 30, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27902607/perioperative-complications-following-preoperative-cessation-of-antithrombotic-agents-for-total-knee-arthroplasty-a-retrospective-study
#2
Jin-Young Hwang, Sohee Oh, Chong-Soo Kim, Jee-Eun Chang, Seong-Won Min
The number of elderly patients undergoing total knee arthroplasty (TKA) has steadily increased. Elderly patients undergoing TKA usually have underlying diseases, and some of them take antithrombotic agents for the prevention or treatment of these co-morbidities, including cardiovascular, cerebrovascular, or thromboembolic diseases. When these patients are scheduled to undergo TKA, preoperative cessation of antithrombotic agents is considered on the basis of its risks and benefits. This study was aimed to evaluate the impact of discontinuing antithrombotic agents for primary total knee arthroplasty (TKA) on perioperative complications...
November 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27871236/the-timing-of-administration-of-intravenous-dexmedetomidine-during-lower-limb-surgery-a-randomized-controlled-trial
#3
Eunsu Kang, Ki Hwa Lee, Sang Yoon Jeon, Kyu Won Lee, Myoung Jin Ko, Hyojoong Kim, Yong Han Kim, Jae-Wook Jung
BACKGROUND: Dexmedetomidine, a selective alpha-2 agonist, has sedative, analgesic, and anxiolytic effects without respiratory depression. Dexmedetomidine can cause a biphasic cardiovascular response, and induce transient hypertension. Hypotension is a common complication of spinal anesthesia. Decreasing anxiety of patients before procedure is important for high quality of procedure. This study aimed to compare the incidence of hypotension and patients' anxiety and comfort levels when dexmedetomidine was intravenously administered before and after spinal anesthesia...
November 21, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27865641/canadian-cardiovascular-society-guidelines-on-perioperative-cardiac-risk-assessment-and-management-for-patients-who-undergo-noncardiac-surgery
#4
Emmanuelle Duceppe, Joel Parlow, Paul MacDonald, Kristin Lyons, Michael McMullen, Sadeesh Srinathan, Michelle Graham, Vikas Tandon, Kim Styles, Amal Bessissow, Daniel I Sessler, Gregory Bryson, P J Devereaux
The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery...
October 4, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27865637/increased-risk-of-mortality-after-lower-extremity-bypass-in-individuals-with-acute-kidney-injury-in-the-vascular-quality-initiative
#5
Erica Flores, Juan Pablo Lewinger, Vincent L Rowe, Karen Woo, Fred A Weaver, David Shavelle, Leonardo Clavijo, Parveen K Garg
OBJECTIVE: The development of acute kidney injury (AKI) and its effect on prognosis after lower extremity bypass (LEB) surgery have not been well described. We determined risk factors associated with AKI in patients undergoing infrainguinal LEB surgery and whether individuals with AKI are at increased risk for cardiovascular events and mortality. METHODS: Data for 12,907 operations entered in the Vascular Quality Initiative (VQI) registry from January 2012 through April 2015 were retrospectively reviewed...
November 16, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27854111/the-risk-of-hypotension-and-seizures-in-patients-receiving-prophylactic-anti-epileptic-drugs-for-supratentorial-craniotomy
#6
Julius Höhne, Karl M Schebesch, Christian Ott, Alexander Brawanski, Max Lange
BACKGROUND: Perioperative seizure prophylaxis with antiepileptic drugs (AED) has been advocated in patients undergoing supratentorial craniotomy. The practice remains controversial. The reasoning presupposes that the possibility of an adverse drug reaction from the AED is lower than the probability of harm from a seizure. Even short periods of hypotension during the operation can lead to acute kidney and myocardial injury. We retrospectively evaluated cardiovascular effects and tolerability of Levetiracetam (LEV) alone, LEV and Lacosamid (LCM) as compared to Phenytoin (PHT)...
November 17, 2016: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/27830409/perioperative-cardiovascular-evaluation-for-orthotopic-liver-transplantation
#7
REVIEW
Robert J Donovan, Calvin Choi, Asghar Ali, Douglas M Heuman, Michael Fuchs, Anthony A Bavry, Ion S Jovin
Patients with advanced liver disease have a high prevalence of cardiovascular risk factors, but many of them are asymptomatic. Cardiovascular risk stratification prior to liver transplant can be done by dobutamine stress echocardiography, stress myocardial perfusion imaging, cardiac computer tomography, and coronary angiography, but there are no clear recommendations regarding what method should be used and who should be screened. Because of this and because of inherent risk profile in this population, the variations in practice are significant...
November 9, 2016: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/27810456/considerations-in-spinal-fusion-surgery-for-chronic-lumbar-pain-psychosocial-factors-rating-scales-and-perioperative-patient-education-a-review-of-the-literature
#8
REVIEW
Daniel Gaudin, Brianna M Krafcik, Tarek R Mansour, Ahmed Alnemari
OBJECTIVE: This literature review was conducted to better understand the factors associated with optimal post-operative results following lumbar spinal fusion for chronic back pain, and the current tools used for evaluation. BACKGROUND: Despite widespread use of lumbar spinal fusion as a treatment for back pain, outcomes remain variable. Optimizing patient selection can help to reduce adverse outcomes. METHODS: The PubMed database was searched for clinical trials related to psychosocial determinants of outcome following lumbar spinal fusion surgery, evaluation of commonly used patient subjective outcome measures, and perioperative cognitive, behavioral, and educational therapies...
October 31, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27806350/enteral-docosahexaenoic-acid-reduces-analgesic-administration-in-neonates-undergoing-cardiovascular-surgery
#9
Mariela Bernabe-Garcia, Mardia López-Alarcon, Alfredo Salgado-Sosa, Raul Villegas-Silva, Jorge Maldonado-Hernandez, Maricela Rodríguez-Cruz, Rodolfo Rivas-Ruiz, Luis Chavez-Sanchez, Francisco A Blanco-Favela, Javier Mancilla-Ramirez, Virginia Gordillo-Alvarez, Olivia Madrigal-Muñiz
BACKGROUND: Neonates undergoing surgery require analgesic medication to ameliorate acute pain. These medications produce negative side effects. Docosahexaenoic acid (DHA) has an antinociceptive effect in animals, but this has not been evaluated in human neonates. We evaluated the DHA effect on cumulative dose and duration of analgesics administered to neonates undergoing cardiovascular surgery. METHODS: A secondary analysis was performed with data from a clinical trial, in which enteral DHA was administered perioperatively compared with sunflower oil (SO)...
2016: Annals of Nutrition & Metabolism
https://www.readbyqxmd.com/read/27759648/mechanism-and-early-intervention-research-on-ali-during-emergence-surgery-of-stanford-type-a-aad-study-protocol-for-a-prospective-double-blind-clinical-trial
#10
Yi Cheng, Mu Jin, Xiuhua Dong, Lizhong Sun, Jing Liu, Rong Wang, Yanwei Yang, Peirong Lin, Siyu Hou, Yuehua Ma, Yuefeng Wang, Xudong Pan, Jiakai Lu, Weiping Cheng
BACKGROUND: Stanford type-A acute aortic dissection (AAD) is a severe cardiovascular disease demonstrating the characteristics of acute onset and rapid development, with high morbidity and mortality. The available evidence shows that preoperative acute lung injury (ALI) induced by Stanford type-A AAD is a frequent and important cause for a number of untoward consequences. However, there is no study assessing the incidence of preoperative ALI and its independent determinants before Standford type-A AAD surgery in Chinese adult patients...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27726856/prediction-of-transfusions-after-isolated-coronary-artery-bypass-grafting-surgical%C3%A2-procedures
#11
Donald S Likosky, Theron A Paugh, Steven D Harrington, Xiaoting Wu, Mary A M Rogers, Timothy A Dickinson, Alphonse DeLucia, Barbara R Benedetti, Richard L Prager, Min Zhang, Gaetano Paone
BACKGROUND: Although blood transfusions are common and have been associated with adverse sequelae after cardiac surgical procedures, few contemporaneous models exist to support clinical decision making. This study developed a preoperative clinical decision support tool to predict perioperative red blood cell transfusions in the setting of isolated coronary artery bypass grafting. METHODS: We performed a multicenter, observational study of 20,377 patients undergoing isolated coronary artery bypass grafting among patients at 39 hospitals participating in the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative's PERFusion measures and outcomes (PERForm) registry between 2011 and 2015...
October 7, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27716695/variations-of-transesophageal-echocardiography-practices-in-india-a-survey-by-indian-college-of-cardiac-anaesthesia
#12
Deepak Prakash Borde, Antony George, Shreedhar Joshi, Suresh Nair, Thomas Koshy, Uday Gandhe, Murali Chakravarthy
CONTEXT: Use of perioperative transesophageal echocardiography (TEE) has expanded in India. Despite attempts to standardize the practice of TEE in cardiac surgical procedures, variation in practice and application exists. This is the first online survey by Indian College of Cardiac Anaesthesia, research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists (IACTA). AIMS: We hypothesized that variations in practice of intraoperative TEE exist among centers and this survey aimed at analyzing them...
October 2016: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/27671998/-platelet-aggregation-inhibitors-and-anticoagulants-during-ophthalmic-interventions
#13
N Feltgen, H Hoerauf, W Noske, A Hager, J Koscielny
In ophthalmology many patients undergo surgical treatment who need to take anticoagulant medication due to cardiovascular diseases. The proper handling of these drugs requires both correct assessment of the risk of thromboembolism as well as the rating of the risk of surgery-related hemorrhages. While there are established recommendations for estimation of the risk of thromboembolism based on a large body of prospective randomized trials, data regarding the evaluation of the related complications secondary to ophthalmic surgery are limited...
September 26, 2016: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
https://www.readbyqxmd.com/read/27636228/the-impact-of-preoperative-evaluation-on-perioperative-events-in-patients-undergoing-cataract-surgery-a-cohort-study
#14
C Alboim, R B Kliemann, L E Soares, M M Ferreira, C A Polanczyk, A Biolo
PurposeAmbulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery.MethodsThis was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records...
September 16, 2016: Eye
https://www.readbyqxmd.com/read/27614827/evaluating-blood-loss-and-the-effect-of-antiplatelet-treatment-in%C3%A2-foot%C3%A2-and-ankle-amputations
#15
David Schweer, Jonathon J Carmouche, Daniel Jupiter, Timothy Ball, J Randolph Clements
The interrelationship between diabetes mellitus and cardiovascular disease is well-documented, and, secondary to the latter, is the use of antiplatelet therapy. Although diabetes and the associated vascular manifestations are driving forces behind lower extremity amputations, few data are available on the risks of perioperative antiplatelet therapy with foot and ankle amputations. The goal of the present study was to address the surgical effect of continuing or discontinuing antiplatelet therapy before foot and/or ankle amputation...
September 7, 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/27609430/2016-focused-update-of-the-canadian-cardiovascular-society-guidelines-for-the-management-of-atrial-fibrillation
#16
Laurent Macle, John Cairns, Kori Leblanc, Teresa Tsang, Allan Skanes, Jafna L Cox, Jeff S Healey, Alan Bell, Louise Pilote, Jason G Andrade, L Brent Mitchell, Clare Atzema, David Gladstone, Mike Sharma, Subodh Verma, Stuart Connolly, Paul Dorian, Ratika Parkash, Mario Talajic, Stanley Nattel, Atul Verma
The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery...
October 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27607474/baseline-pulse-pressure-acute-kidney-injury-and-mortality-after-noncardiac-surgery
#17
Adriana D Oprea, Frederick W Lombard, Wen-Wei Liu, William D White, Jörn A Karhausen, Yi-Ju Li, Timothy E Miller, Solomon Aronson, Tong J Gan, Manuel L Fontes, Miklos D Kertai
BACKGROUND: Increased pulse pressure (PP) is an important independent predictor of cardiovascular outcome and acute kidney injury (AKI) after cardiac surgery. The objective of this study was to determine whether elevated baseline PP is associated with postoperative AKI and 30-day mortality after noncardiac surgery. METHODS: We evaluated 9125 adult patients who underwent noncardiac surgery at Duke University Medical Center between January 2006 and December 2009. Baseline arterial blood pressure was defined as the mean of the first 5 measurements recorded by the automated record keeping system before inducing anesthesia...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27574546/cholesterol-metabolism-in-cholestatic-liver-disease-and-liver-transplantation-from-molecular-mechanisms-to-clinical-implications
#19
REVIEW
Katriina Nemes, Fredrik Åberg, Helena Gylling, Helena Isoniemi
The aim of this review is to enlighten the critical roles that the liver plays in cholesterol metabolism. Liver transplantation can serve as gene therapy or a source of gene transmission in certain conditions that affect cholesterol metabolism, such as low-density-lipoprotein (LDL) receptor gene mutations that are associated with familial hypercholesterolemia. On the other hand, cholestatic liver disease often alters cholesterol metabolism. Cholestasis can lead to formation of lipoprotein X (Lp-X), which is frequently mistaken for LDL on routine clinical tests...
August 8, 2016: World Journal of Hepatology
https://www.readbyqxmd.com/read/27554331/anaesthetic-management-of-breast-surgery-in-a-patient-with-eisenmenger-syndrome
#20
J C Galán Gutiérrez, F E Fernández Suárez, P Miranda García, L A Sopena Zubiria
Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks...
August 20, 2016: Revista Española de Anestesiología y Reanimación
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