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Steroids in cardiac surgery

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https://www.readbyqxmd.com/read/27856137/therapeutic-hypothermia-and-inhalation-anesthesia-in-a-patient-with-severe-pneumococcal-meningitis-and-secondary-cardiac-arrest
#1
Nejc Bukovnik, Andrej Markota, Tomaž Velnar, Janez Rebol, Andreja Sinkovič
Therapeutic hypothermia was associated with increased mortality in patients with severe bacterial meningitis in a large randomized trial. It still remains a treatment strategy for comatose survivors of cardiac arrest. There are several potential advantages of inhalational anesthetics as long-term sedation agents compared to intravenous sedation, however, uncontrollable increases of intracranial pressure were observed in neurocritical patients. Here we present a patient with severe bacterial meningitis and secondary cardiac arrest where therapeutic hypothermia and inhalational anesthesia were successfully used...
November 2, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27779350/adrenal-insufficiency-in-neonates-after-cardiac-surgery-with-cardiopulmonary-bypass
#2
Jack H Crawford, Matthew S Hull, Santiago Borasino, Brad L Steenwyk, Kristal M Hock, Kevin Wall, Jeffrey A Alten
BACKGROUND: Cardiopulmonary bypass (CPB) may lead to adrenal insufficiency (AI). Emerging evidence supports association of AI with morbidity after cardiac surgery. AIMS: The aim of this study was to define AI incidence in neonates undergoing complex cardiac surgery with CPB and its association with intraoperative post-CPB outcomes. METHODS: Forty subjects enrolled in a prior randomized control trial who received preoperative methylprednisolone as part of our institutional neonatal bypass protocol were included...
October 25, 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27775998/impact-of-methylprednisolone-on-postoperative-quality-of-recovery-and-delirium-in-the-steroids-in-cardiac-surgery-trial-a-randomized-double-blind-placebo-controlled-substudy
#3
Colin F Royse, Leif Saager, Richard Whitlock, Jared Ou-Young, Alistair Royse, Jessica Vincent, P J Devereaux, Andrea Kurz, Ahmed Awais, Krit Panjasawatwong, Daniel I Sessler
BACKGROUND: Inflammation after cardiopulmonary bypass may contribute to postoperative delirium and cognitive dysfunction. The authors evaluated the effect of high-dose methylprednisolone to suppress inflammation on the incidence of delirium and postoperative quality of recovery after cardiac surgery. METHODS: Five hundred fifty-five adults from three hospitals enrolled in the randomized, double-blind Steroids in Cardiac Surgery trial were randomly allocated to placebo or 250 mg methylprednisolone at induction and 250 mg methylprednisolone before cardiopulmonary bypass...
October 24, 2016: Anesthesiology
https://www.readbyqxmd.com/read/27761786/post-pericardiotomy-syndrome
#4
Balaji K Tamarappoo, Allan L Klein
Post-pericardiotomy syndrome (PPS) occurs in a subgroup of patients who have undergone cardiothoracic surgery and is characterized by fever, pleuritic pain, pleural effusion, and pericardial effusion. It is associated with significant morbidity, and the leading complications include tamponade and constrictive pericarditis. Epidemiologic studies have found that PPS often occurs among younger patients; however, there is a lack of comprehensive risk stratification. It is therefore important to be able to identify patients who are at high risk for developing this disease...
November 2016: Current Cardiology Reports
https://www.readbyqxmd.com/read/27738530/aortic-dissection-in-a-healthy-male-athlete-a-unique-case-with-comprehensive-literature-review
#5
Balraj Singh, Jennifer M Treece, Ghulam Murtaza, Samit Bhatheja, Steven J Lavine, Timir K Paul
A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air...
2016: Case Reports in Cardiology
https://www.readbyqxmd.com/read/27725476/clinical-features-of-acute-and-fulminant-myocarditis-in-children%C3%A3-2nd-nationwide-survey-by-japanese-society-of-pediatric-cardiology-and-cardiac-surgery
#6
Hiroyuki Matsuura, Fukiko Ichida, Tsutomu Saji, Shunichi Ogawa, Kenji Waki, Masahide Kaneko, Masahiro Tahara, Takashi Soga, Yasuo Ono, Satoshi Yasukochi
BACKGROUND: The 1st nationwide survey by the Japanese Society of Pediatric Cardiology and Cardiac Surgery of acute or fulminant myocarditis (AMC/FMC) in children revealed that the survival rate of FMC was only 51.6%. The 2nd nationwide survey was performed to evaluate the recent outcomes of pediatric myocarditis.Methods and Results:Questionnaires regarding patients aged ≤18 years with AMC/FMC during the period from January 2006 to December 2011 were mailed. A total of 221 cases (age 6...
October 4, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/27617783/-2016%C3%A2-review-on-catastrophic-antiphospholipid-syndrome
#7
Nathalie Costedoat-Chalumeau, Laetitia Coutte, Véronique Le Guern, Nathalie Morel, Gaelle Leroux, Romain Paule, Luc Mouthon, Jean-Charles Piette
The catastrophic antiphospholipid syndrome (CAPS) develops in at least 1% of patients with antiphospholipid syndrome, either primary or associated with systemic lupus erythematosus. CAPS reveals the antiphospholipid syndrome in about 50% of cases. The CAPS is characterized by rapidly-progressive widespread thromboses mainly affecting the microvasculature in the presence of antiphospholipid antibodies. In a few days, the patients develop multiorgan failure with renal insufficiency with severe hypertension, pulmonary, cerebral, cardiac, digestive and/or cutaneous involvement...
September 9, 2016: La Presse Médicale
https://www.readbyqxmd.com/read/27544541/whipple-abacus-a-simple-validated-risk-score-for-30-day-mortality-after-pancreaticoduodenectomy-developed-using-the-acs-nsqip-database
#8
Elizabeth M Gleeson, Mohammad F Shaikh, Patricia A Shewokis, John R Clarke, William C Meyers, Henry A Pitt, Wilbur B Bowne
BACKGROUND: Pancreaticoduodenectomy needs simple, validated risk models to better identify 30-day mortality. The goal of this study is to develop a simple risk score to predict 30-day mortality after pancreaticoduodenectomy. METHODS: We reviewed cases of pancreaticoduodenectomy from 2005-2012 in the American College of Surgeons-National Surgical Quality Improvement Program databases. Logistic regression was used to identify preoperative risk factors for morbidity and mortality from a development cohort...
August 17, 2016: Surgery
https://www.readbyqxmd.com/read/27489622/perioperative-use-of-steroids-in-neonatal-heart-surgery-evidence-based-practice-or-tradition
#9
Daniel Fudulu, Alvin Schadenberg, Gianni Angelini, Serban Stoica
A best evidence topic was written according to a structured protocol. The question addressed was: Is the use of prophylactic, perioperative steroids associated with better clinical outcomes following heart surgery in neonates? Altogether, 194 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. One study found improved hospital survival in the group without steroids. Steroids increased infection in one large retrospective study. Incidence of hyperglycaemia was increased in the steroid group in 2 out of 5 studies...
August 2016: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/27403384/investigating-the-impacts-of-preoperative-steroid-treatment-on-tumor-necrosis-factor-alpha-and-duration-of-extubation-time-underwent-ventricular-septal-defect-surgery
#10
H Hakan Poyrazoğlu, Zeynel Duman, Şerafettin Demir, M Kemal Avşar, Atakan Atalay, Bahattin Çiftçi, İhsan Bayraktar, Funda Tor
BACKGROUND: Cardiopulmonary bypass is known to cause inflammatory events. Inflammation occurs due to many known important biological processes. Numerous mechanisms are known to be responsible for the development of inflammatory processes. Currently, there are many defined mediators as a tumor necrosis factor-α (TNF-α) playing an active role in this process. AIMS: This research was to investigate the effects of pre-operative steroid use on inflammatory mediator TNF-α and on time to extubation postoperatively in ventricular septal defect patients undergoing cardiopulmonary bypass surgery...
March 2016: Balkan Medical Journal
https://www.readbyqxmd.com/read/27324403/sugammadex-a-review-of-neuromuscular-blockade-reversal
#11
Gillian M Keating
Sugammadex (Bridion(®)) is a modified γ-cyclodextrin that reverses the effect of the steroidal nondepolarizing neuromuscular blocking agents rocuronium and vecuronium. Intravenous sugammadex resulted in rapid, predictable recovery from moderate and deep neuromuscular blockade in patients undergoing surgery who received rocuronium or vecuronium. Recovery from moderate neuromuscular blockade was significantly faster with sugammadex 2 mg/kg than with neostigmine, and recovery from deep neuromuscular blockade was significantly faster with sugammadex 4 mg/kg than with neostigmine or spontaneous recovery...
July 2016: Drugs
https://www.readbyqxmd.com/read/27309972/postoperative-complications-of-patients-undergoing-cardiac-surgery
#12
Lorenzo Ball, Federico Costantino, Paolo Pelosi
PURPOSE OF REVIEW: Cardiac surgery is at high risk for the development of postoperative complications involving cardiovascular and respiratory system, as well as kidneys and central nervous system. The aim of this review is to provide an overview on the most recent findings concerning the type and incidence of different complications after cardiac surgery and to summarize the current recommendations. RECENT FINDINGS: Despite an improvement of surgical and anaesthesia techniques that resulted in a significant decrease in mortality, postoperative complications play a major role in affecting morbidity, mortality, length of hospital stay and patients' quality of life...
August 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27309152/effect-of-pre-operative-use-of-medications-on-the-risk-of-surgical-site-infections-in-patients-undergoing-cardiac-surgery
#13
Vic Eton, Liliya Sinyavskaya, Yves Langlois, Jean François Morin, Samy Suissa, Paul Brassard
BACKGROUND: Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac surgery on the subsequent risk of SSIs usually focused on antibacterial prophylaxis. The objective of the current study was to evaluate the effect of medications prescribed commonly to cardiac patients on the risk of incident SSIs. METHODS: The study analyzed data on consecutive cardiac surgery patients undergoing median sternotomy at a McGill University teaching hospital between April 1, 2011 and October 31, 2013...
October 2016: Surgical Infections
https://www.readbyqxmd.com/read/27140295/treatment-of-post-cardiopulmonary-bypass-sirs-by-hemoadsorption-a-case-series
#14
Karl Träger, Daniel Fritzler, Guenther Fischer, Janpeter Schröder, Christian Skrabal, Andreas Liebold, Helmut Reinelt
The use of cardiopulmonary bypass (CPB) in cardiothoracic surgery results in a well-known activation of the immunologic response. In some cases, however, this triggered immunologic response may be excessive, leading to a severe systemic inflammatory response syndrome (SIRS) and induced organ dysfunction. For example, patients frequently develop hemodynamic instability with hypotension and low systemic vascular resistance. To date, different therapeutic approaches, such as steroids, have been tried to control this maladaptive postoperative SIRS response, yet definitive proof of clinical efficacy is missing...
May 16, 2016: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/27067028/single-chamber-permanent-epicardial-pacing-for-children-with-congenital-heart-disease-after-surgical-repair
#15
Tao Zhang, Yiwei Liu, Chengwei Zou, Hao Zhang
BACKGROUND: To analyze the 10-year experience of single chamber permanent epicardial pacemaker placement for children with congenital heart diseases (CHD) after surgical repair. METHODS: Between 2002 and 2014, a total of 35 patients with CHD (age: 26.9 ± 23.2 months, weight: 9.7 ± 5.6 kg) received permanent epicardial pacemaker placement following corrective surgery. Echocardiography and programming information of the pacemaker, as well as major adverse cardiac events (MACE) as heart failure or sudden death, were recorded during follow-up (46...
2016: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/26995098/steroids-improve-hemodynamics-in-infants-with-adrenal-insufficiency-after-cardiac-surgery
#16
Takuma Maeda, Muneyuki Takeuchi, Kazuya Tachibana, Tomoyo Nishida, Koji Kagisaki, Hideaki Imanaka
OBJECTIVE: To investigate whether steroid replacement therapy improved hemodynamics in infants after surgery for congenital heart disease only when they develop adrenal insufficiency. The authors retrospectively investigated adrenal function and evaluated hemodynamic responses to steroid replacement therapy in infants after surgery for congenital heart disease. DESIGN: Retrospective, cohort study. SETTING: Intensive care unit in the National Cerebral and Cardiovascular Center Hospital in Japan...
August 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/26948465/acute-pain-and-analgesic-requirements-after-pulmonary-endarterectomy-with-deep-hypothermic-circulatory-arrest
#17
Marc Giménez-Milà, Sebastian Videla, David Jenkins, Andrew A Klein, Caroline Gerrard, Jacinta Nalpon, Kamen Valchanov
OBJECTIVES: To assess postoperative pain intensity and the analgesic requirements in the postoperative period in patients undergoing sternotomy for pulmonary endarterectomy involving deep hypothermic circulatory arrest. DESIGN: Retrospective cohort study. SETTING: Single-center hospital study. PARTICIPANTS: Patients 18 years and older undergoing sternotomy for cardiac surgery between August 2012 and August 2014. INTERVENTIONS: No modification to usual clinical practice...
August 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/26945330/pediatric-cardiac-intensive-care-society-2014-consensus-statement-pharmacotherapies-in-cardiac-critical-care-hormone-replacement-therapy
#18
Carmen L Soto-Rivera, Michael S D Agus, Jaclyn E Sawyer, Duncan J Macrae
OBJECTIVE: To provide an overview of the current literature on the use of hormone replacement therapies in pediatric cardiac critical care. DATA SOURCES: PubMed, EMBASE, and the Cochrane Library were searched using keywords relevant to the hormonal therapy, with no limits on language but restricting the search to children 0-18 years old. STUDY SELECTION: All clinical studies believed to have relevance were considered. Where studies in children were sparse, additional evidence was sought from adult studies...
March 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/26702342/ibuprofen-a-safe-analgesic-during-cardiac-surgery-recovery-a-randomized-controlled-trial
#19
Saddiq Mohammad Qazi, Eske Jesper Sindby, Martin Agge Nørgaard
INTRODUCTION: Postoperative pain-management with non-steroid anti-inflammatory drugs has been controversial, due to related side-effects. We investigated whether there was a significant difference between an oxycodone-based pain-management regimen versus a slow-release ibuprofen based regimen, in a short term post-cardiac surgery setting. Particular attention was given to the rate of myocardial infarction, sternal healing, gastro-intestinal complications, renal failure and all-cause mortality...
2015: Journal of Cardiovascular and Thoracic Research
https://www.readbyqxmd.com/read/26609532/endogenous-ouabain-an-old-cardiotonic-steroid-as-a-new-biomarker-of-heart-failure-and-a-predictor-of-mortality-after-cardiac-surgery
#20
Marco Simonini, Simona Pozzoli, Elena Bignami, Nunzia Casamassima, Elisabetta Messaggio, Chiara Lanzani, Elena Frati, Irene Maria Botticelli, Francesco Rotatori, Ottavio Alfieri, Alberto Zangrillo, Paolo Manunta
Cardiovascular diseases remain the main cause of mortality and morbidity worldwide; primary prevention is a priority for physicians. Biomarkers are useful tools able to identify high-risk individuals, guide treatments, and determine prognosis. Our aim is to investigate Endogenous Ouabain (EO), an adrenal stress hormone with hemodynamic effects, as a valuable biomarker of heart failure. In a population of 845 patients undergoing elective cardiac surgery, we have investigated the relationships between EO and echocardiography parameters/plasmatic biomarker of cardiac function...
2015: BioMed Research International
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