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Protocols in cardiac surgery

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https://www.readbyqxmd.com/read/29336385/prophylaxis-of-postoperative-nausea-and-vomiting-after-cardiac-surgery-in-high-risk-patients-a-randomized-controlled-study
#1
Sébastien Champion, Laëtitia Zieger, Caroline Hemery
CONTEXT: The role of prophylaxis for postoperative nausea and vomiting (PONV) in cardiac surgery is under debate. AIMS: To study the risk factors for PONV after cardiac surgery and the role of betamethasone with or without droperidol for its prevention. SETTING AND DESIGN: Randomized open-label controlled study comparing standard care with PONV prophylaxis from February to November 2016. METHODS: Five hundred and two patients with planned nonemergent cardiac surgery were included...
January 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29326843/risk-of-acute-kidney-injury-in-patients-randomized-to-a-restrictive-versus-liberal-approach-to-red-blood-cell-transfusion-in-cardiac-surgery-a-substudy-protocol-of-the-transfusion-requirements-in-cardiac-surgery-iii-noninferiority-trial
#2
Amit X Garg, Nadine Shehata, Shay McGuinness, Richard Whitlock, Dean Fergusson, Ron Wald, Chirag Parikh, Sean M Bagshaw, Boris Khanykin, Alex Gregory, Summer Syed, Gregory M T Hare, Meaghan S Cuerden, Kevin E Thorpe, Judith Hall, Subodh Verma, Pavel S Roshanov, Jessica M Sontrop, C David Mazer
Background: When safe to do so, avoiding blood transfusions in cardiac surgery can avoid the risk of transfusion-related infections and other complications while protecting a scarce resource and reducing costs. This protocol describes a kidney substudy of the Transfusion Requirements in Cardiac Surgery III (TRICS-III) trial, a multinational noninferiority randomized controlled trial to determine whether the risk of major clinical outcomes in patients undergoing planned cardiac surgery with cardiopulmonary bypass is no greater with a restrictive versus liberal approach to red blood cell transfusion...
2018: Canadian Journal of Kidney Health and Disease
https://www.readbyqxmd.com/read/29321066/perioperative-management-of-antiplatelet-therapy-in-patients-undergoing-non-cardiac-surgery-following-coronary-stent-placement-a-systematic-review
#3
Christopher P Childers, Melinda Maggard-Gibbons, Jesus G Ulloa, Ian T MacQueen, Isomi M Miake-Lye, Roberta Shanman, Selene Mak, Jessica M Beroes, Paul G Shekelle
BACKGROUND: The correct perioperative management of antiplatelet therapy (APT) in patients undergoing non-cardiac surgery (NCS) is often debated by clinicians. American College of Cardiology (ACC) and American Heart Association (AHA) guidelines recommend postponing elective NCS at least 3 months after stent implantation. Regardless of the timing of surgery, ACC/AHA guidelines recommend continuing at least ASA throughout the perioperative period and ideally continuing dual APT (DAPT) therapy "unless surgery demands discontinuation...
January 10, 2018: Systematic Reviews
https://www.readbyqxmd.com/read/29318612/transplanted-human-thymus-slices-induce-and-support-t-cell-development-in-mice-after-cryopreservation
#4
Susan Ross, Melissa Cheung, Ching-In Lau, Neil Sebire, Michael Burch, Peter Kilbride, Barry Fuller, G John Morris, E Graham Davies, Tessa Crompton
Here we show that slices of human thymus tissue that have been frozen and thawed can induce and support T-cell development when transplanted into nude mice. Babies born without a thymus require urgent treatment to reconstitute T-cell immunity. Thymus tissue is removed from infants during cardiac surgery, to allow access to the heart. This discarded thymus tissue can be transplanted into athymic infants to reconstitute T-cell immunity. Slices of thymus tissue are transplanted into the thigh, after a two-three week culture period to deplete thymocytes...
January 10, 2018: European Journal of Immunology
https://www.readbyqxmd.com/read/29302123/bloodless-repair-for-a-3-6-kilogram-transposition-of-the-great-arteries-with-jehovah-s-witness-faith
#5
Jeffery L Burnside, Todd M Ratliff, Ashley B Hodge, Daniel Gomez, Mark Galantowicz, Aymen Naguib
Achieving pediatric cardiac surgery using cardiopulmonary bypass (CPB) without allogeneic blood transfusion is challenging. There are many clinical and economic factors that point to the importance of avoiding blood transfusions. In some instances, honoring patients or parents beliefs may be the reason for avoiding blood transfusions. For example, patients or parents of the Jehovah's Witness faith refuse blood transfusion based on their religious beliefs. Over the last decade, our institution has seen a steady increase in our pediatric Jehovah's Witness patient population...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29296063/atrial-fibrillation-after-cardiac-surgery-prevention-and-management-the-australasian-experience
#6
REVIEW
Mohammed Alawami, Andrew Chatfield, Rajaie Ghashi, Laurence Walker
Background: Atrial fibrillation (AF) after cardiac surgery is a major health problem that is associated with a significant financial burden. This paper aims to highlight this problem and review the current guidelines in the prevention and management of AF after cardiac surgery, providing our experience in the Australasian centers. Methods: We conducted a literature review using mainly PubMed to compare the current practice with the available evidence. EMBASE and Cochrane library were also searched...
January 2018: Journal of the Saudi Heart Association
https://www.readbyqxmd.com/read/29289938/pharmacological-interventions-for-preventing-post-operative-atrial-fibrillation-in-patients-undergoing-cardiac-surgery-a-network-meta-analysis-protocol
#7
Xiaoqin Wang, Liang Yao, Long Ge, Lun Li, Fuxiang Liang, Qi Zhou, Yaolong Chen, Yongfeng Wang, Kehu Yang
INTRODUCTION: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery, and randomised clinical trials (RCTs) and systematic reviews have been conducted to compare and evaluate different pharmacological interventions for preventing POAF. This study aimed to explore the effect of different pharmacological interventions for prophylaxis against POAF after cardiac surgery using network meta-analysis (NMA). METHODS AND ANALYSIS: A systematic search will be performed in PubMed, EMBASE and the Cochrane Library to identify RCTs, systematic reviews, meta-analyses or NMA of different pharmacological interventions for POAF...
December 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/29287123/interventions-to-improve-the-outcomes-of-frail-people-having-surgery-a-systematic-review
#8
Daniel I McIsaac, Tim Jen, Nikhile Mookerji, Abhilasha Patel, Manoj M Lalu
BACKGROUND: Frailty is an important prognostic factor for adverse outcomes and increased resource use in the growing population of older surgical patients. We identified and appraised studies that tested interventions in populations of frail surgical patients to improve perioperative outcomes. METHODS: We systematically searched Cochrane, CINAHL, EMBASE and Medline to identify studies that tested interventions in populations of frail patients having surgery. All phases of study selection, data extraction, and risk of bias assessment were done in duplicate...
2017: PloS One
https://www.readbyqxmd.com/read/29282098/the-impact-of-maintaining-serum-potassium-%C3%A2-3-6-meq-l-vs-%C3%A2-4-5-meq-l-on-the-incidence-of-new-onset-atrial-fibrillation-in-the-first-120-hours-after-isolated-elective-coronary-artery-bypass-grafting-study-protocol-for-a-randomised-feasibility-trial-for-the-proposed
#9
Niall G Campbell, Elizabeth Allen, Julie Sanders, Rebecca Swinson, Sophie Birch, Joanna Sturgess, Nawaf Al-Subaie, Diana Elbourne, Hugh Montgomery, Ben O'Brien
BACKGROUND: Atrial fibrillation (AF) occurs in approximately one in three patients after cardiac surgery, and is associated with increased short-term and long-term mortality, intensive care unit (ICU) and hospital stay, and increased cost of care. In an attempt to reduce AF incidence in these patients, serum potassium (K+) levels are commonly maintained at the high end of normal (4.5-5.5 mEq/L). However, such potassium supplementation is without proven benefit, and is not without negative consequences...
December 28, 2017: Trials
https://www.readbyqxmd.com/read/29273477/transfusion-requirements-in-cardiac-surgery-iii-trics-iii-study-design-of-a-randomized-controlled-trial
#10
Nadine Shehata, Richard Whitlock, Dean A Fergusson, Kevin E Thorpe, Charlie MacAdams, Hilary P Grocott, Fraser Rubens, Stephen Fremes, Francois Lellouche, Sean Bagshaw, Alistair Royse, Peter M Rosseel, Greg Hare, Etienne De Medicis, Christopher Hudson, Emilie Belley-Cote, Daniel Bainbridge, Blaine Kent, Andrew Shaw, Kelly Byrne, Summer Syed, Colin F Royse, Shay McGuiness, Judith Hall, C David Mazer
OBJECTIVES: To determine if a restrictive transfusion threshold is noninferior to a higher threshold as measured by a composite outcome of mortality and serious morbidity. DESIGN: Transfusion Requirements in Cardiac Surgery (TRICS) III was a multicenter, international, open-label randomized controlled trial of two commonly used transfusion strategies in patients having cardiac surgery using a noninferiority trial design (ClinicalTrials.gov number, NCT02042898). SETTING: Eligible patients were randomized prior to surgery in a 1:1 ratio...
November 3, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29249300/incidence-and-etiological-mechanism-of-stroke-in-cardiac-surgery
#11
J M Arribas, E Garcia, R Jara, F Gutierrez, L Albert, D Bixquert, J García-Puente, C Albacete, S Canovas, A Morales
OBJECTIVE: We studied patients who had experienced a stroke in the postoperative period of cardiac surgery, aiming to analyse their progression and determine the factors that may influence prognosis and treatment. METHODS: We established a protocol for early detection of stroke after cardiac surgery and collected data on stroke onset and a number of clinical, surgical, and prognostic variables in order to perform a descriptive analysis. RESULTS: Over the 15-month study period we recorded 16 strokes, which represent 2...
December 14, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/29246546/surgical-unroofing-of-intramural-anomalous-aortic-origin-of-a-coronary-artery-in-pediatric-patients-single-center-perspective
#12
Shagun Sachdeva, Michele A Frommelt, Michael E Mitchell, James S Tweddell, Peter C Frommelt
BACKGROUND: Intramural anomalous aortic origin of a coronary artery (AAOCA) is associated with an increased risk of sudden cardiac death. This is amenable to surgical coronary unroofing, but outcomes studies are lacking. OBJECTIVE: To perform a comprehensive review of our institutional experience with pediatric patients with AAOCA who underwent surgical repair with unroofing of the intramural segment, focusing on preoperative and postoperative course and testing as well as intraoperative findings...
November 10, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29242018/current-practice-in-cytoreductive-surgery-and-hipec-for-metastatic-peritoneal-disease-spanish-multicentric-survey
#13
Rafael Morales-Soriano, Neus Esteve-Pérez, Juan José Segura-Sampedro, Pedro Cascales-Campos, Pedro Barrios
INTRODUCTION: Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers. AIM OF THE STUDY: To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC...
December 6, 2017: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29239149/agreement-between-ccnexfin-co-trek-cardiac-output-and-intermittent-cold-bolus-pulmonary-thermodilution-in-a-prospective-multi-centre-study
#14
Nicolaas H Sperna Weiland, Jim W de Wever, Yoni van Duivenvoorde, Christa Boer, Ludmil Mitrev, Muhammad Muntazar, Kinjal Patel, Markus W Hollmann, Benedikt Preckel
BACKGROUND: The ccNexfin system uses the CO-trek algorithm to analyse a non-invasively obtained arterial pressure waveform and calculate cardiac output (NEXCO). It remains matter of debate whether NEXCO can replace invasive, pulmonary artery catheter derived, cold-bolus pulmonary thermodilution cardiac output measurement (PACCO). This study aimed at testing NEXCO-PACCO agreement in a large sample size, multi-centre study. We hypothesized that agreement between NEXCO and PACCO would be demonstrated by a mean accuracy (bias) < 0...
December 13, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29237510/posterior-left-pericardiotomy-for-the-prevention-of-postoperative-atrial-fibrillation-after-cardiac-surgery-palacs-study-protocol-for-a-randomized-controlled-trial
#15
Ahmed A Abouarab, Jeremy R Leonard, Lucas B Ohmes, Christopher Lau, Lisa Q Rong, Natalia S Ivascu, Kane O Pryor, Monica Munjal, Filippo Crea, Massimo Massetti, Tommaso Sanna, Leonard N Girardi, Mario Gaudino
BACKGROUND: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. POAF is associated with increased morbidity and hospital costs. We herein describe the protocol for a randomized controlled trial to determine if performing a posterior left pericardiotomy prevents POAF after cardiac surgery. METHODS/DESIGN: All patients submitted to cardiac surgery at our institution will be screened for inclusion into the study. The study will consist of two parallel arms with random allocation between groups to either receive a posterior left pericardiotomy or serve as a control...
December 13, 2017: Trials
https://www.readbyqxmd.com/read/29237016/evaluation-of-cefazolin-antimicrobial-prophylaxis-during-cardiac-surgery-with-cardiopulmonary-bypass
#16
Divna Calic, Robert E Ariano, Rakesh C Arora, Hilary P Grocott, Ted M Lakowski, Ryan Lillico, Sheryl A Zelenitsky
Objectives: Although clinical practice guidelines recommend standard cefazolin antimicrobial prophylaxis (AP) dosing for cardiac surgery, limited data exist as to whether adequate concentrations are achieved in this patient population. The goal of our study was to characterize intraoperative cefazolin concentrations particularly at wound closure with regards to maintaining target cefazolin closure concentrations ≥40 mg/L. Methods: Adults undergoing cardiac surgery with cardiopulmonary bypass (CPB) and receiving cefazolin AP according to protocol were studied...
December 8, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29235056/separating-arterial-pressure-increases-and-decreases-in-assessing-cardiac-baroreflex-sensitivity-via-sequence-and-bivariate-phase-rectified-signal-averaging-techniques
#17
Beatrice De Maria, Vlasta Bari, Marco Ranucci, Valeria Pistuddi, Giovanni Ranuzzi, Anielle C M Takahashi, Aparecida M Catai, Laura Dalla Vecchia, Sergio Cerutti, Alberto Porta
Cardiac baroreflex (cBR) is activated by both arterial pressure (AP) increases and decreases. Sequence method, a widely utilized tool assessing cBR sensitivity (cBRS) from spontaneous heart period (HP) and systolic AP (SAP) variations, allows the separated computation of cBRS from positive and negative SAP variations. The recently proposed phase-rectified signal averaging (PRSA) method has the same feature but it has been applied so far solely to positive SAP variations. We adapted the PRSA method to compute cBRS over negative SAP variations and we compared the results with those derived from sequence method over two protocols: (i) graded head-up tilt (HUT) at 15, 30, 45, 60, and 75° in 19 healthy subjects and (ii) general anesthesia induction in 118 patients undergoing coronary artery bypass graft surgery...
December 13, 2017: Medical & Biological Engineering & Computing
https://www.readbyqxmd.com/read/29233022/reduced-inflammatory-response-by-transcatheter-as-compared-to-surgical-aortic-valve-replacement
#18
Karoline K H Fiane, Gry Dahle, Bjørn Bendz, Per Steinar Halvorsen, Michael Abdelnoor, Tom Eirik Mollnes, Erik Fosse
OBJECTIVES: The inflammatory response to on-pump cardiac surgery is well known. Systemic inflammatory response syndrome after transcatheter valve implantation (TAVI) has been reported. The objective of this study was to study the inflammatory response during TAVI, and compare with the response during surgical aortic valve replacement. METHODS: Eighteen patients undergoing transcatheter implantation, either by a transfemoral (n = 9) or transaortal (n = 9) approach were compared with eighteen patients admitted for surgical replacement...
December 12, 2017: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/29232194/persistent-ventricular-bigeminy-during-anesthesia-in-pediatric-patients-a-case-report-of-an-11-year-old-child
#19
Sheetal Dalal, Vikas Chaudhari
An 11-year-old male child with fractures in both bones in his left forearm presented for open reduction and internal fixation. The pre-anesthetic check-up and investigations did not reveal any pre-existing underlying cardio-respiratory disease. The patient had an uneventful peri-operative period during the operation and was comfortable without any anxiety or restlessness. After an uneventful induction and intubation as per routine protocol, the patient received 600 mg of amoxicillin+clavunate intravenously as an antibiotic...
December 12, 2017: Journal of Basic and Clinical Physiology and Pharmacology
https://www.readbyqxmd.com/read/29229252/implementation-of-an-early-extubation-protocol-in-cardiac-surgical-patients-decreased-ventilator-time-but-not-intensive-care-unit-or-hospital-length-of-stay
#20
Matthew Richey, Ashley Mann, Jianghua He, Emmanuel Daon, Katy Wirtz, Allegra Dalton, Brigid C Flynn
OBJECTIVE: The optimal timing of extubation following cardiac surgery is currently unknown. Protocols implemented in order to achieve a rapid extubation may achieve this goal, but not prove beneficial in terms of outcomes. DESIGN: A prospective clinical trial. SETTING: Tertiary care cardiac surgical intensive care unit. PARTICIPANTS: Adult cardiac surgical patients. INTERVENTIONS: Implementation of an 8-tier multidisciplinary rapid weaning protocol...
November 8, 2017: Journal of Cardiothoracic and Vascular Anesthesia
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