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Steroids in cardiac surgery

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https://www.readbyqxmd.com/read/29793761/steroids-and-survival-in-critically-ill-adult-patients-a-meta-analysis-of-135-randomized-trials
#1
Enrico A Martino, Martina Baiardo Redaelli, Salvatore Sardo, Rosalba Lembo, Vito F Giordano, Dario Winterton, Laura Ruggeri, Ludhmilla A Hajjar, Alberto Zangrillo, Giovanni Landoni
OBJECTIVE: Corticosteroids have important effects on intermediate outcomes in critically ill patients, but their effect on survival is unknown. The objective of this meta-analysis was to analyze the effect on mortality of corticosteroids in critical and perioperative settings. DESIGN: A meta-analysis of randomized trials. SETTING: PubMed, Embase, BioMed Central, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched to February 1, 2018, for randomized trials comparing corticosteroids with placebo or standard care...
April 6, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29732365/corticosteroids-in-pediatric-heart-surgery-myth-or-reality
#2
REVIEW
Daniel P Fudulu, Ben Gibbison, Thomas Upton, Serban C Stoica, Massimo Caputo, Stafford Lightman, Gianni D Angelini
Background: Corticosteroids have been administered prophylactically for more than 60 years in pediatric heart surgery, however, their use remains a matter of debate. There are three main indications for corticosteroid use in pediatric heart surgery with the use of cardiopulmonary bypass (CPB): (1) to blunt the systemic inflammatory response (SIRS) induced by the extracorporeal circuit; (2) to provide perioperative supplementation for presumed relative adrenal insufficiency; (3) for the presumed neuroprotective effect during deep hypothermic circulatory arrest operations...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29692229/corticosteroids-and-other-anti-inflammatory-strategies-in-pediatric-heart-surgery-a-national-survey-of-practice
#3
Daniel P Fudulu, Alvin Schadenberg, Ben Gibbison, Ian Jenkins, Stafford Lightman, Gianni D Angelini, Serban Stoica
BACKGROUND: The role of steroids to mitigate the deleterious effects of pediatric cardiopulmonary bypass (CPB) remains a matter of debate; therefore, we aimed to assess preferences in administering corticosteroids (CSs) and the use of other anti-inflammatory strategies in pediatric cardiac surgery. METHODS: A 19-question survey was distributed to consultants in pediatric cardiac anesthesia from 12 centers across the United Kingdom and Ireland. RESULTS: Of the 37 respondents (37/60, 62%), 24 (65%) use CSs, while 13 (35%) do not use steroids at all...
May 2018: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29677033/characterization-of-the-glucocorticoid-receptor-in-children-undergoing-cardiac-surgery
#4
Saul Flores, David S Cooper, Amy M Opoka, Ilias Iliopoulos, Sarah Pluckebaum, Matthew N Alder, Kelli A Krallman, Rashmi D Sahay, Lin Fei, Hector R Wong
OBJECTIVES: Postoperative administration of corticosteroids is common practice for managing catecholamine refractory low cardiac output syndrome. Since corticosteroid activity is dependent on the glucocorticoid receptor, we sought to characterize glucocorticoid receptor levels in children undergoing cardiac surgery and examined the association between glucocorticoid receptor levels and cardiovascular dysfunction. DESIGN: Prospective observational cohort study. SETTING: Large, tertiary pediatric cardiac center...
April 19, 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29662808/critical-illness-related-corticosteroid-insufficiency-in-patients-with-low-cardiac-output-syndrome-after-cardiac-surgery
#5
You Jung Ok, Ju Yong Lim, Sung-Ho Jung
Background: Low cardiac output syndrome (LCOS) after cardiac surgery usually requires inotropes. In this setting, critical illness-related corticosteroid insufficiency (CIRCI) may develop. We aimed to investigate the clinical features of CIRCI in the presence of LCOS and to assess the efficacy of steroid treatment. Methods: We reviewed 28 patients who underwent a rapid adrenocorticotropic hormone (ACTH) test due to the suspicion of CIRCI between February 2010 and September 2014...
April 2018: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29656776/purulenta-pericarditis-and-pasteurella-multocida-an-extremely-rare-entity
#6
Raquel Ferreira, José Martins, Tiago Adrega, Sara Pinto, Sofia Nunes, Rita Pancas, Anabela Gonzaga, José Santos
Purulent pericarditis is a rare entity, defined as the presence of neutrophilic pericardial effusion which is infected by a bacterial, fungus or parasite agent. The diagnosis can be challenging, especially if patients have taken previous antibiotic therapy; on the other hand the recognition of this pathology is often made late, with the onset of severe symptoms or signs of cardiac tamponade or even only at the autopsy. The authors describe the case of a 82-year-old woman with history of extensive laceration of the right lower limb from a dog bite in July 2016, admitted to the Cardiology Department one month later for Acute Pericarditis...
April 2018: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29576107/steroids-in-cardiac-surgery-a-systematic-review-and-meta-analysis
#7
REVIEW
N Dvirnik, E P Belley-Cote, H Hanif, P J Devereaux, A Lamy, J M Dieleman, J Vincent, R P Whitlock
BACKGROUND: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction that may contribute to postoperative complications. Preventing this reaction with steroids may improve outcomes. We performed a systematic review to evaluate the impact of prophylactic steroids on clinical outcomes in patients undergoing on-pump cardiac surgery. METHODS: We searched MEDLINE, EMBASE, and Cochrane CENTRAL for randomised controlled trials (RCTs) comparing perioperative corticosteroid administration with a control group in adults undergoing CPB...
April 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29534229/ceramide-1-phosphate-has-protective-properties-against-cyclophosphamide-induced-ovarian-damage-in-a-mice-model-of-premature-ovarian-failure
#8
Natalia Pascuali, Leopoldina Scotti, Mariana Di Pietro, Gonzalo Oubiña, Diana Bas, María May, Antonio Gómez Muñoz, Patricia S Cuasnicú, Débora J Cohen, Marta Tesone, Dalhia Abramovich, Fernanda Parborell
STUDY QUESTION: Is ceramide-1-phosphate (C1P) an ovarian protective agent during alkylating chemotherapy? SUMMARY ANSWER: Local administration of C1P drastically reduces ovarian damage induced by cyclophosphamide (Cy) via protection of follicular reserve, restoration of hormone levels, inhibition of apoptosis and improvement of stromal vasculature, while protecting fertility, oocyte quality and uterine morphology. WHAT IS KNOWN ALREADY: Cancer-directed therapies cause accelerated loss of ovarian reserve and lead to premature ovarian failure (POF)...
May 1, 2018: Human Reproduction
https://www.readbyqxmd.com/read/29505006/clinically-suspected-anaphylaxis-induced-by-sugammadex-in-a-patient-with-weaver-syndrome-undergoing-restrictive-mammoplasty-surgery-a-case-report-with-the-literature-review
#9
REVIEW
Nurdan Bedirli, Berrin Işık, Mehrnoosh Bashiri, Kutluk Pampal, Ömer Kurtipek
RATIONALE: Sugammadex is a cylodextrin derivate that encapsulates steroidal neuromuscular blocker agents and is reported as a safe and well-tolerated drug. In this case report, we present a patient who developed grade 3 anaphylaxis just after sugammadex administration. PATIENT CONCERNS: A 22-year-old woman with diagnosis of Weaver syndrome was scheduled for bilateral mammoplasty and resection of unilateral accessory breast tissue resection. Anesthesia was induced and maintained by propofol, rocuronium, and remifentanil...
January 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29452806/steroid-administration-after-anaesthetic-induction-with-etomidate-does-not-reduce-in-hospital-mortality-or-cardiovascular-morbidity-after-non-cardiac-surgery
#10
R Komatsu, J You, S Rajan, Y Kasuya, D I Sessler, A Turan
BACKGROUND: We tested the primary hypothesis that corticosteroid administration after etomidate exposure reduces a composite of in-hospital mortality and cardiovascular morbidity after non-cardiac surgery. METHODS: We evaluated ASA physical status III and IV patients who had non-cardiac surgery with general anaesthesia at the Cleveland Clinic. Amongst 4275 patients in whom anaesthesia was induced with etomidate, 804 were also given steroid intraoperatively, mostly dexamethasone at a median dose of 6 mg...
March 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29452285/risk-factors-for-perioperative-morbidity-in-spine-surgeries-of-different-complexities-a-multivariate-analysis-of-1-009-consecutive-patients
#11
Mazda Farshad, David E Bauer, Cyrill Wechsler, Christian Gerber, Alexander Aichmair
BACKGROUND CONTEXT: There is a broad spectrum of complications during or after surgical procedures, with differing incidences reported in the published literature. Heterogeneity can be explained by the lack of an established evidence-based classification system for documentation and classification of complications in a standardized manner. PURPOSE: The objective of this study was to identify predictive risk factors for perioperative and early postoperative morbidities in spine surgeries of different complexities in a large cohort of consecutive patients...
February 13, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29392429/minimally-invasive-surgery-mis-in-children-and-adolescents-with-pheochromocytomas-and-retroperitoneal-paragangliomas-experiences-in-42-patients
#12
Martin K Walz, Laura D Iova, Judith Deimel, Hartmut P H Neumann, Birke Bausch, Stefan Zschiedrich, Harald Groeben, Pier F Alesina
BACKGROUND: Pheochromocytomas (PH) and paragangliomas (PGL) are rare tumours in children accounting for about 1% of the paediatric hypertension. While minimally invasive surgical techniques are well established in adult patients with PH, the experience in children is extremely limited. To the best of our knowledge, we herewith present the largest series of young patients operated on chromaffin tumours by minimally invasive access. MATERIALS: In the setting of a prospective study (1/2001-12/2016), 42 consecutive children and adolescents (33 m, 9 f) were operated on...
April 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29389252/risk-factors-and-predictive-model-development-of-thirty-day-post-operative-surgical-site-infection-in-the-veterans-administration-surgical-population
#13
Xinli Li, William Nylander, Tracy Smith, Soonhee Han, William Gunnar
BACKGROUND: Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population...
April 2018: Surgical Infections
https://www.readbyqxmd.com/read/29310552/prevention-of-acute-kidney-injury-in-children-undergoing-cardiac-surgery-a-narrative-review
#14
Esther Huimin Leow, Yoke Hwee Chan, Yong Hong Ng, Joel Kian Boon Lim, Masakazu Nakao, Jan Hau Lee
Children undergoing cardiac surgery are at risk of developing acute kidney injury (AKI). Preventing cardiac surgery-associated AKI (CS-AKI) is important as it is associated with increased early- and long-term mortality and morbidity. Targeting modifiable risk factors (eg, avoiding poor renal perfusion, nephrotoxic drugs, and fluid overload) reduces the risk of CS-AKI. There is currently no strong evidence for the routine use of pharmacological approaches (eg, aminophylline, dexmedetomidine, fenoldopam, and steroids) to prevent CS-AKI...
January 2018: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29240563/impact-of-methylprednisolone-on-postoperative-quality-of-recovery-and-delirium-in-the-steroids-in-cardiac-surgery-trial-a-randomized-double-blind-placebo-controlled-substudy-erratum
#15
https://www.readbyqxmd.com/read/29155116/the-effect-of-steroids-on-complications-readmission-and-reoperation-after-posterior-lumbar-fusion
#16
Michael B Cloney, Roxanna M Garcia, Zachary A Smith, Nader S Dahdaleh
BACKGROUND: The effects of chronic corticosteroid therapy on complications, readmission, and reoperation after posterior lumbar fusion (PLF) remain underinvestigated, and were examined to determine differences in outcomes. METHODS: We analyzed patients undergoing PLF between 2006 and 2013 using the National Surgery Quality Improvement Program database (NSQIP). Patients taking steroids for a chronic condition were compared with those not taking steroids. Multivariable regression identified factors independently associated with complications, readmission, and reoperation...
February 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29119086/can-acute-phase-response-biomarkers-differentiate-infection-from-inflammation-postpediatric-cardiac-surgery
#17
Bana Agha Nasser, Abdu Rahman Mesned, Mohamad Tageldein, Mohamed S Kabbani, Nada Siddig Sayed
Background: Infection is a common serious complication postpediatric cardiac surgery. Diagnosis of infection after cardiopulmonary bypass (CPB) is difficult in the presence of surgical stress, hemodynamic instability, and inflammatory reaction. Aim: The purpose of this study is to investigate the value of available inflammatory biomarkers and its validity to differentiate infection from inflammation postpediatric cardiac surgery and to find the trend and the change in the level of these biomarkers shortly after cardiac surgery...
October 2017: Avicenna Journal of Medicine
https://www.readbyqxmd.com/read/29092664/the-perspective-of-the-intensivist-on-inotropes-and-postoperative-care-following-pediatric-heart-surgery-an-international-survey-and-systematic-review-of-the-literature
#18
Peter P Roeleveld, J C A de Klerk
INTRODUCTION: Inotropes are frequently being used in children undergoing heart surgery to prevent or treat low cardiac output syndrome (LCOS). There is only limited evidence that inotropes actually positively influence postoperative outcome. Our aim was to describe the current international practice variation in the use of inotropes following congenital heart surgery. METHODS: We developed an online survey regarding the postoperative use of inotropes. We sent an invitation to all 197 registered members of the Pediatric Cardiac Intensive Care Society (PCICS) to participate in the survey...
January 2018: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29049838/predicting-long-term-survival-after-coronary-artery-bypass-graft-surgery
#19
Md N Karim, Christopher M Reid, Molla Huq, Samuel L Brilleman, Andrew Cochrane, Lavinia Tran, Baki Billah
OBJECTIVES: To develop a model for predicting long-term survival following coronary artery bypass graft surgery. METHODS: This study included 46 573 patients from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZCTS) registry, who underwent isolated coronary artery bypass graft surgery between 2001 and 2014. Data were randomly split into development (23 282) and validation (23 291) samples. Cox regression models were fitted separately, using the important preoperative variables, for 4 'time intervals' (31-90 days, 91-365 days, 1-3 years and >3 years), with optimal predictors selected using the bootstrap bagging technique...
February 1, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29016439/examining-the-ability-of-artificial-neural-networks-machine-learning-models-to-accurately-predict-complications-following-posterior-lumbar-spine-fusion
#20
Jun S Kim, Robert K Merrill, Varun Arvind, Deepak Kaji, Sara D Pasik, Chuma C Nwachukwu, Luilly Vargas, Nebiyu S Osman, Eric K Oermann, John M Caridi, Samuel K Cho
STUDY DESIGN: Cross-sectional database study. OBJECTIVE: To train and validate machine learning models to identify risk factors for complications following posterior lumbar spine fusion. SUMMARY OF BACKGROUND DATA: Machine learning models such as artificial neural networks (ANNs) are valuable tools for analyzing and interpreting large and complex datasets. ANNs have yet to be used for risk factor analysis in orthopedic surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for patients who underwent posterior lumbar spine fusion...
October 9, 2017: Spine
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