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Protocols in cardiac surgery

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https://www.readbyqxmd.com/read/29782862/evaluation-of-cardiac-arrhythmic-risks-using-a-rabbit-model-of-left-ventricular-systolic-dysfunction
#1
Bianca Hemmeryckx, Yuanbo Feng, Liesbeth Frederix, Marleen Lox, Sander Trenson, Rob Vreeken, Hua Rong Lu, David Gallacher, Yicheng Ni, H Roger Lijnen
Patients with heart disease have a higher risk to develop cardiac arrhythmias, either spontaneously or drug-induced. In this study, we have used a rabbit model of myocardial infarction (MI) with severe left ventricular systolic dysfunction (LVSD) to study potential drug-induced cardiac risks with N-(piperidin-2-ylmethyl)-2,5-bis(2,2,2-trifluoroethoxy)benzamide (flecainide). Upon ligation of the left circumflex arteries, male New Zealand White rabbits developed a large MI and moderate or severe LVSD 7 weeks after surgery, in comparison to SHAM-operated animals...
May 18, 2018: European Journal of Pharmacology
https://www.readbyqxmd.com/read/29772592/-cardiac-anaesthesia-anaesthesiological-management
#2
Jochen Renner, Berthold Bein, Ole Broch
The anaesthesiological management of patients scheduled for cardiac surgery has been refined distinctively over the last decade due to different reasons. The continuing growth of the elderly patient population and the increasing number of combined cardiac surgery procedures in octogenarians on the one hand are one aspect. The rapid development of minimally invasive cardiac surgery and the enhancements in mechanical, artificial heart assist devices on the other hand can be seen as additional decisive factors...
May 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29762314/effectiveness-of-dexmedetomidine-versus-propofol-on-extubation-times-length-of-stay-and-mortality-rates-in-adult-cardiac-surgery-patients-a-systematic-review-and-meta-analysis
#3
John Nguyen, Noel Nacpil
OBJECTIVE: To determine the effects of dexmedetomidine versus propofol on extubation time, intensive care unit (ICU) length of stay, total hospital length of stay and in-hospital mortality rates in cardiac surgery patients. INTRODUCTION: Recovery from cardiovascular surgery involves weaning from mechanical ventilation. Mechanical ventilation decreases the work of breathing for patients by inhaling oxygen and exhaling carbon dioxide via a ventilator or breathing machine...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29762304/effectiveness-and-harms-of-pharmacological-interventions-in-the-treatment-of-delirium-in-adults-in-intensive-care-units-post-cardiac-surgery-a-systematic-review-protocol
#4
Vivienne Leigh, Catalin Tufanaru, Rosalind Elliott
The review objective is to synthesize the best available evidence on the effectiveness and harms of pharmacological interventions in the treatment of delirium in adults in intensive care units (ICU) after cardiac surgery.The specific review question is: What is the effectiveness and what are the harms of pharmacological interventions in relation to the duration and severity of delirium episodes, length of stay in ICU, length of stay in hospital, functional capacity and quality of life and mortality for critically ill adult patients treated in intensive care after cardiac surgery?...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29750694/impact-of-2-distinct-levels-of-mean-arterial-pressure-on-near-infrared-spectroscopy-during-cardiac-surgery-secondary-outcome-from-a-randomized-clinical-trial
#5
Frederik Holmgaard, Anne G Vedel, Theis Lange, Jens C Nilsson, Hanne B Ravn
BACKGROUND: Near-infrared spectroscopy (NIRS) is used worldwide to monitor regional cerebral oxygenation (rScO2) during cardiopulmonary bypass (CPB). Intervention protocols meant to mitigate cerebral desaturation advocate to increase mean arterial pressure (MAP) when cerebral desaturation occurs. However, the isolated effect of MAP on rScO2 is uncertain. The aim of the present study was in a randomized, blinded design to elucidate the effect of 2 distinct levels of MAP on rScO2 values during CPB...
May 9, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29743101/individualized-perioperative-hemodynamic-goal-directed-therapy-in-major-abdominal-surgery-ipegasus-trial-study-protocol-for-a-randomized-controlled-trial
#6
Sandra Funcke, Bernd Saugel, Christian Koch, Dagmar Schulte, Thomas Zajonz, Michael Sander, Angelo Gratarola, Lorenzo Ball, Paolo Pelosi, Savino Spadaro, Riccardo Ragazzi, Carlo Alberto Volta, Thomas Mencke, Amelie Zitzmann, Benedikt Neukirch, Gonzalo Azparren, Marta Giné, Vicky Moral, Hans Otto Pinnschmidt, Oscar Díaz-Cambronero, Maria Jose Alberola Estelles, Marisol Echeverri Velez, Maria Vila Montañes, Javier Belda, Marina Soro, Jaume Puig, Daniel Arnulf Reuter, Sebastian Alois Haas
BACKGROUND: Postoperative morbidity and mortality in patients undergoing surgery is high, especially in patients who are at risk of complications and undergoing major surgery. We hypothesize that perioperative, algorithm-driven, hemodynamic therapy based on individualized fluid status and cardiac output optimization is able to reduce mortality and postoperative moderate and severe complications as a major determinant of the patients' postoperative quality of life, as well as health care costs...
May 9, 2018: Trials
https://www.readbyqxmd.com/read/29730125/triage-and-optimization-a-new-paradigm-in-the-treatment-of-massive-pulmonary-embolism
#7
Chetan Pasrija, Aakash Shah, Praveen George, Anthony Kronfli, Maxwell Raithel, Francesca Boulos, Mehrdad Ghoreishi, Gregory J Bittle, Michael A Mazzeffi, Lewis Rubinson, James S Gammie, Bartley P Griffith, Zachary N Kon
BACKGROUND: Massive pulmonary embolism (PE) remains a highly fatal condition. Although venoarterial extracorporeal membrane oxygenation (VA-ECMO) and surgical pulmonary embolectomy in the management of massive PE have been reported previously, the outcomes remain less than ideal. We hypothesized that the institution of a protocolized approach of triage and optimization using VA-ECMO would result in improved outcomes compared with historical surgical management. METHODS: All patients with a massive PE referred to the cardiac surgery service between 2010 and 2017 were retrospectively reviewed...
April 7, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29716640/tranexamic-acid-versus-placebo-to-prevent-blood-transfusion-during-radical-cystectomy-for-bladder-cancer-tact-study-protocol-for-a-randomized-controlled-trial
#8
Rodney H Breau, Luke T Lavallée, Sonya Cnossen, Kelsey Witiuk, Ilias Cagiannos, Franco Momoli, Gregory Bryson, Salmaan Kanji, Christopher Morash, Alexis Turgeon, Ryan Zarychanski, Ranjeeta Mallick, Greg Knoll, Dean A Fergusson
BACKGROUND: Radical cystectomy for bladder cancer is associated with a high risk of needing red blood cell transfusion. Tranexamic acid reduces blood loss during cardiac and orthopedic surgery, but no study has yet evaluated tranexamic acid use during cystectomy. METHODS: A randomized, double-blind (surgeon-, anesthesiologist-, patient-, data-monitor-blinded), placebo-controlled trial of tranexamic acid during cystectomy was initiated in June 2013. Prior to incision, the intervention arm participants receive a 10 mg/kg loading dose of intravenously administered tranexamic acid, followed by a 5 mg/kg/h maintenance infusion...
May 2, 2018: Trials
https://www.readbyqxmd.com/read/29706371/an-anticoagulation-protocol-for-use-after-congenital-cardiac-surgery
#9
Asha G Nair, Olubunmi O Oladunjoye, Cameron C Trenor, Meena LaRonde, Sarah J van den Bosch, Lynn A Sleeper, Christina VanderPluym, Sitaram M Emani, John N Kheir
BACKGROUND: Patients undergoing surgery for congenital heart disease are at high risk for bleeding as well as thrombosis in the postoperative period. The objective of the study was to describe the design and effects of implementing a standardized unfractionated heparin anticoagulation protocol for children after congenital heart surgery. METHODS: We created a tiered guideline for the postoperative management of bleeding and thrombosis. In patients treated with unfractionated heparin, anti-factor Xa activity level as well as activated partial thromboplastin time were used for dose titration...
April 7, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29705730/paediatric-traumatic-cardiac-arrest-a-delphi-study-to-establish-consensus-on-definition-and-management
#10
Annette C Rickard, James Vassallo, Tim Nutbeam, Mark D Lyttle, Ian K Maconochie, Doyo G Enki, Jason E Smith
AIMS: Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients. METHODS: An online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA...
April 28, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29701386/simplified-technique-for-aortic-arch-replacement-in-patients-at-high-risk-for-frozen-elephant-trunk
#11
Álvaro Laranjeira Santos, António Cruz Tomás, Jorge Pinheiro Santos, Daniela Varela-Afonso, José Fragata
INTRODUCTION: Surgical approach of multisegmental pathology of the thoracic aorta, namely aortic arch / descending aorta is challenging. The Frozen Elephant Trunk (FET) has good results, with acceptable risk. However, in the subgroup of patients (pts) older than 75 years and with important comorbidities, the surgical risk is very high. OBJECTIVES: Review short-term results of this original, simplified and potentially hybrid technique developed in our Department for this subgroup of patients...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29694994/predicting-the-future-delivery-room-planning-of-congenital-heart-disease-diagnosed-by-fetal-echocardiography
#12
Mary T Donofrio
Advances in prenatal imaging have improved the examination of the fetal cardiovascular system. Fetal echocardiography facilitates the prenatal diagnosis of congenital heart disease (CHD) and through sequential examination, allows assessment of fetal cardiac hemodynamics, predicting the evolution of anatomical and functional cardiovascular abnormalities in utero and during the transition to a postnatal circulation at delivery. This approach allows detailed diagnosis with prenatal counseling and enables planning to define perinatal management, selecting the fetuses at a risk of postnatal hemodynamic instability who are likely to require a specialized delivery plan...
May 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29690945/a-protocol-to-decrease-postoperative-chylous-effusion-duration-in-children
#13
Melissa M Winder, Aaron W Eckhauser, Claudia Delgado-Corcoran, Randall J Smout, Jennifer Marietta, David K Bailly
OBJECTIVE: Our primary goal was to decrease time to resolution of postoperative chylothorax as demonstrated by total days of chest tube utilisation through development and implementation of a management protocol. METHODS: A chylothorax management protocol was implemented as a quality improvement project at a tertiary-care paediatric hospital in July, 2015. Retrospective analysis was completed on patients aged 0-17 years diagnosed with chylothorax within 30 days of cardiac surgery in a pre-protocol cohort (February, 2014 to June, 2015, n=20) and a post-protocol cohort (July, 2015 to March, 2016, n=22)...
April 25, 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/29680809/impact-of-dexmedetomidine-infusion-during-general-anaesthesia-on-incidence-of-postoperative-delirium-in-elderly-patients-after-major-non-cardiac-surgery-study-protocol-of-a-randomised-double-blinded-and-placebo-controlled-trial
#14
Bo-Jie Wang, Chun-Jing Li, Jian Hu, Huai-Jin Li, Chao Guo, Zhen-Han Wang, Qiao-Chu Zhang, Dong-Liang Mu, Dong-Xin Wang
INTRODUCTION: Delirium is a common complication in the elderly after surgery and is associated with worse outcomes. Multiple risk factors are related with postoperative delirium, such as exposure to general anaesthetics, pain and postoperative inflammatory response. Preclinical and clinical studies have shown that dexmedetomidine attenuated neurotoxicity induced by general anaesthetics, improved postoperative analgesia and inhibited inflammatory response after surgery. Several studies found that intraoperative use of dexmedetomidine can prevent postoperative delirium, but data were inconsistent...
April 21, 2018: BMJ Open
https://www.readbyqxmd.com/read/29678987/protocol-for-a-phase-iii-non-inferiority-randomised-comparison-of-a-new-fibrinogen-concentrate-versus-cryoprecipitate-for-treating-acquired-hypofibrinogenaemia-in-bleeding-cardiac-surgical-patients-the-fibres-trial
#15
Keyvan Karkouti, Jeannie Callum, Vivek Rao, Nancy Heddle, Michael E Farkouh, Mark A Crowther, Damon C Scales
INTRODUCTION: Coagulopathic bleeding is a serious complication of cardiac surgery to which an important contributor is acquired hypofibrinogenaemia (plasma fibrinogen <1.5-2.0 g/L). The standard intervention for acquired hypofibrinogenaemia is cryoprecipitate, but purified fibrinogen concentrates are also available. There is little comparative data between the two therapies and randomised trials are needed. METHODS AND ANALYSIS: FIBrinogen REplenishment in Surgery (FIBRES) is a multicentre, randomised (1:1), active-control, single-blinded, phase III trial in adult cardiac surgical patients experiencing clinically significant bleeding related to acquired hypofibrinogenaemia...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29678977/minimizing-icu-neurological-dysfunction-with-dexmedetomidine-induced-sleep-mindds-protocol-for-a-randomised-double-blind-parallel-arm-placebo-controlled-trial
#16
Kenneth T Shelton, Jason Qu, Federico Bilotta, Emery N Brown, Gaston Cudemus, David A D'Alessandro, Hao Deng, Alan DiBiasio, Jacob A Gitlin, Eunice Y Hahm, Lauren E Hobbs, Timothy T Houle, Reine Ibala, Marco Loggia, Kara J Pavone, Shahzad Shaefi, George Tolis, M Brandon Westover, Oluwaseun Akeju
INTRODUCTION: Delirium, which is prevalent in postcardiac surgical patients, is an acute brain dysfunction characterised by disturbances in attention, awareness and cognition not explained by a pre-existing neurocognitive disorder. The pathophysiology of delirium remains poorly understood. However, basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for the development of delirium. Dexmedetomidine is a α-2A adrenergic receptor agonist medication that patterns the activity of various arousal nuclei similar to sleep...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29677060/cerebral-small-vessel-but-not-large-vessel-disease-is-associated-with-impaired-cerebral-autoregulation-during-cardiopulmonary-bypass-a-retrospective-cohort-study
#17
Yohei Nomura, Roland Faegle, Daijiro Hori, Abbas Al-Qamari, Alexander J Nemeth, Rebecca Gottesman, Gayane Yenokyan, Charles Brown, Charles W Hogue
BACKGROUND: Impaired cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB) is associated with stroke and other adverse outcomes. Large and small arterial stenosis is prevalent in patients undergoing cardiac surgery. We hypothesize that large and/or small vessel cerebral arterial disease is associated with impaired cerebral autoregulation during CPB. METHODS: A retrospective cohort analysis of data from 346 patients undergoing cardiac surgery with CPB enrolled in an ongoing prospectively randomized clinical trial of autoregulation monitoring were evaluated...
April 17, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29664117/perioperative-hyperoxia-and-post-operative-cardiac-complications-in-adults-undergoing-non-cardiac-surgery-systematic-review-protocol
#18
REVIEW
C Petersen, J Wetterslev, C S Meyhoff
BACKGROUND: Oxygen therapy is used liberally for all patients undergoing anaesthesia. Recent studies have raised concerns that it may not be without complications when arterial oxygen concentrations reach supranormal concentrations (hyperoxia). Studies of oxygen therapy have raised concerns that the risk of myocardial injury and infarction is elevated in patients with hyperoxia due to vasoconstriction and formation of reactive oxygen species. Due to lack of symptoms or silent ischaemia, post-operative myocardial injury may be missed clinically...
April 17, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29660009/critical-care-in-the-military-health-system-a-24-h-point-prevalence-study
#19
Raymond Fisher, Christopher J Colombo, Cristin A Mount, Elizabeth A Mann-Salinas, Adam W Bostick, Konrad Davis, James K Aden, Kevin K Chung, Mary S McCarthy, Jeremy C Pamplin
Background: Healthcare expenditures are a significant economic cost with critical care services constituting one of its largest components. The Military Health System (MHS) is the largest, global healthcare system of its kind. In this project, we sought to describe critical care services and the patients who receive them in the MHS. Methods: We surveyed 26 military treatment facilities (MTFs) representing 38 critical care services or intensive care units (ICUs)...
April 11, 2018: Military Medicine
https://www.readbyqxmd.com/read/29659846/is-administration-of-dual-antiplatelet-therapy-beneficial-for-patients-following-off-pump-coronary-artery-bypass-grafting
#20
Maciej Peksa, Sleiman Sebastian Aboul-Hassan, Jakub Marczak, Romuald Cichon
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether administration of dual-antiplatelet therapy (DAPT) following off-pump coronary artery bypass grafting (OPCAB) would improve postoperative clinical outcomes or minimize the incidence of postoperative graft failure. In total, 101 papers were found using the reported search, 14 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated...
April 5, 2018: Interactive Cardiovascular and Thoracic Surgery
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