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Cardiac anesthesia risk score

Lillian M Lai, Joseph Y Cheng, Marcus T Alley, Tao Zhang, Michael Lustig, Shreyas S Vasanawala
PURPOSE: To assess the feasibility of ferumoxytol-enhanced anesthesia-free cardiac MRI in neonates and young infants for complex congenital heart disease (CHD). MATERIALS AND METHODS: With Institutional Review Board approval, 21 consecutive neonates and young infants (1 day to 11 weeks old; median age of 3 days) who underwent a rapid two-sequence (MR angiography [MRA] and four-dimensional [4D] flow) MRI protocol with intravenous ferumoxytol without sedation (n = 17) or light sedation (n = 4) at 3 Tesla (T) (except one case at 1...
September 28, 2016: Journal of Magnetic Resonance Imaging: JMRI
Adrian Mahlmann, Norbert Weiss
Patients with aortic diseases have a high rate of cardiac, cerebrovascular, or pulmonary comorbidities. Open surgery or endovascular interventions of the aorta are associated with high perioperative cardiac risk. Simple scoring systems for preoperative risk stratification can be used to identify high-risk patients. In these patients, further diagnostic and therapeutic interventions are required to reduce perioperative morbidity and mortality. In contrast, low-risk patients can be identified, who may proceed to intervention without additional cardiopulmonary diagnostic testing...
September 2016: Best Practice & Research. Clinical Anaesthesiology
Anahi Perlas, Vincent W S Chan, Scott Beattie
BACKGROUND: This propensity score-matched cohort study evaluates the effect of anesthetic technique on a 30-day mortality after total hip or knee arthroplasty. METHODS: All patients who had hip or knee arthroplasty between January 1, 2003, and December 31, 2014, were evaluated. The principal exposure was spinal versus general anesthesia. The primary outcome was 30-day mortality. Secondary outcomes were (1) perioperative myocardial infarction; (2) a composite of major adverse cardiac events that includes cardiac arrest, myocardial infarction, or newly diagnosed arrhythmia; (3) pulmonary embolism; (4) major blood loss; (5) hospital length of stay; and (6) operating room procedure time...
October 2016: Anesthesiology
Mette Kehlet, Leif Panduro Jensen, Torben V Schroeder
BACKGROUND: Complications after open vascular surgery is a major health challenge for the health care system and the patients. Infrainguinal vascular surgery is often perceived as less risky than aortic surgery and the aim of this study was to identify which risk factors correlated with postoperative complications after open vascular surgery for infrainguinal occlusive disease in an 8-year cohort using the Danish National Vascular Registry -Karbase, which gathers information on all vascular procedures in Denmark...
June 25, 2016: Annals of Vascular Surgery
S-E Juang, C-E Huang, C-L Chen, C-H Wang, C-J Huang, K-W Cheng, S-C Wu, T-H Shih, S-C Yang, Z-W Wong, B Jawan, Y-E Lee
BACKGROUND: Hyperkalemia, defined as a serum potassium level higher than 5 mEq/L, is common in the liver transplantation setting. Severe hyperkalemia may induce fatal cardiac arrhythmias; therefore, it should be monitored and treated accordingly. The aim of the current retrospective study is to evaluate and indentify the predictive risk factors of hyperkalemia during living-donor liver transplantation (LDLT). METHODS AND PATIENTS: Four hundred eighty-seven adult LDLT patients were included in the study...
May 2016: Transplantation Proceedings
Yong Wang, Jie Zhang, Shuijun Zhang
OBJECTIVE: To discuss over influence of two different anesthetic and analgesic methods on early cognitive function of elderly patients who received non-cardiac surgery. METHODS: Two hundred and six elderly patients who underwent non-cardiac surgery were selected as research subjects. They were randomly divided into observation group (103 cases) and control group (103 cases). Patients in observation group were given combined spinal and epidural anesthesia and epidural analgesia, while patients in control group adopted general anesthesia and intravenous analgesia...
March 2016: Pakistan Journal of Medical Sciences Quarterly
Majid Kiavar, Rasoul Azarfarin, Ziae Totonchi, Fatemeh Tavakoli, Azin Alizadehasl, Mitra Teymouri
BACKGROUND: Critical-care patients are at higher risk of untreated pain, because they are often unable to communicate owing to altered mental status, tracheal intubation and sedation. OBJECTIVES: This study compared two pain assessment tools on tracheal intubated critically ill patients in a cardiac post-anesthesia care unit, who were unable to communicate verbally. The studied tools were "critical-care pain observation tool (CPOT)" and "facial expression (FE)"...
February 2016: Anesthesiology and Pain Medicine
Jeong Jin Min, Gahyun Kim, Jong-Hwan Lee, Kwan Young Hong, Wook Sung Kim, Young-Tak Lee
Despite numerous previous studies, there is little data on the effects of anesthetics on clinical outcome after off-pump coronary arterial bypass grafting (OPCAB). Therefore, we retrospectively compared the effects of anesthetic choice on in-hospital major adverse events (MAEs) and one-year major adverse cardiovascular and cerebral events (MACCEs) in patients undergoing OPCAB. Electronic medical records were reviewed in 192 patients who received propofol-remifenanil total intravenous anesthesia (TIVA) and propensity score-matched 662 patients who received isoflurane anesthesia...
2016: PloS One
Thanh Ngoc Ha, Robert Graham van Renen, Guy L Ludbrook, Peter-John Wormald
BACKGROUND: A clear surgical field is critical during endoscopic sinus surgery (ESS). Hypotensive anesthesia and cardiac output (CO) may optimize the surgical field; however, evidence of their effect on bleeding and cerebral blood flow is conflicting. The aim of this study was to evaluate the effect of blood pressure (BP) and CO on intraoperative bleeding and middle cerebral artery blood flow velocity (Vmca ) during ESS. METHODS: This was a prospective randomized controlled trial...
July 2016: International Forum of Allergy & Rhinology
Eun-Young Joo, Yeon-Jin Moon, Syn-Hae Yoon, Ji-Hyun Chin, Jai-Hyun Hwang, Young-Kug Kim
Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion...
February 2016: Medicine (Baltimore)
Laurie Seltzer, Michael F Swartz, Jennifer Kwon, James Burchfiel, Jill M Cholette, Hongyue Wang, Dawn Sweeney, Heather R Adams, Cecilia Meagher, Ron Angona, Ronnie Guillet, George M Alfieris
OBJECTIVES: Neonates with congenital heart disease are at risk for impaired neurodevelopment after cardiac surgery. We hypothesized that intraoperative EEG activity may provide insight into future neurodevelopmental outcomes. METHODS: Neonates requiring surgery had continuous intraoperative EEG and hemodynamic monitoring. The level of EEG suppression was classified as either: slow and continuous; moderate burst suppression; severe burst suppression; or isoelectric (no brain activity for >3 minutes)...
April 2016: Journal of Thoracic and Cardiovascular Surgery
Giuseppe Fuda, André Denault, Alain Deschamps, Denis Bouchard, Annik Fortier, Jean Lambert, Pierre Couture
BACKGROUND: A central-to-radial arterial pressure gradient may occur after cardiopulmonary bypass (CPB), which, in some patients, may last for a prolonged time after CPB. Whenever there is a pressure gradient, the radial artery pressure measure may underestimate a more centrally measured systemic pressure, which may result in a misguided therapeutic strategy. It is clinically important to identify the risk factors that may predict the appearance of a central-to-radial pressure gradient, because more central sites of measurements might then be considered to monitor systemic arterial pressure in high-risk patients...
March 2016: Anesthesia and Analgesia
George M Hoffman, Cheryl L Brosig, Laurel M Bear, James S Tweddell, Kathleen A Mussatto
BACKGROUND: Children with congenital heart disease are at increased risk of abnormal neurodevelopment (ND). Demographic and perioperative physiologic factors have both been associated with developmental outcome. The acute physiologic effect of a surgical procedure, anesthesia, and hospitalization may offset any potential advantage gained from anatomic correction and circulatory palliation. The specific risk/benefit balance on ND outcome of the insult of the operation, offset by the benefit of improved anatomy and physiology, has not been addressed...
February 2016: Annals of Thoracic Surgery
Derek J Hausenloy, Luciano Candilio, Richard Evans, Cono Ariti, David P Jenkins, Shyam Kolvekar, Rosemary Knight, Gudrun Kunst, Christopher Laing, Jennifer Nicholas, John Pepper, Steven Robertson, Maria Xenou, Tim Clayton, Derek M Yellon
BACKGROUND: Whether remote ischemic preconditioning (transient ischemia and reperfusion of the arm) can improve clinical outcomes in patients undergoing coronary-artery bypass graft (CABG) surgery is not known. We investigated this question in a randomized trial. METHODS: We conducted a multicenter, sham-controlled trial involving adults at increased surgical risk who were undergoing on-pump CABG (with or without valve surgery) with blood cardioplegia. After anesthesia induction and before surgical incision, patients were randomly assigned to remote ischemic preconditioning (four 5-minute inflations and deflations of a standard blood-pressure cuff on the upper arm) or sham conditioning (control group)...
October 8, 2015: New England Journal of Medicine
Gamze Sarkılar, Mehmet Sargın, Tuba Berra Sarıtaş, Hale Borazan, Funda Gök, Alper Kılıçaslan, Şeref Otelcioğlu
This study aims to compare the hemodynamic responses to endotracheal intubation performed with direct and video laryngoscope in patients scheduled for cardiac surgery and to assess the airway and laryngoscopic characteristics. One hundred ten patients were equally allocated to either direct Macintosh laryngoscope (n = 55) or indirect Macintosh C-MAC video laryngoscope (n = 55). Systolic, diastolic, and mean arterial pressure, and heart rate were recorded prior to induction anesthesia, and immediately and two minutes after intubation...
2015: International Journal of Clinical and Experimental Medicine
Sebastian Heinrich, Andreas Ackermann, Johannes Prottengeier, Ixchel Castellanos, Joachim Schmidt, Jürgen Schüttler
OBJECTIVES: Former analyses reported an increased rate of poor direct laryngoscopy view in cardiac surgery patients; however, these findings frequently could be attributed to confounding patient characteristics. In most of the reported cardiac surgery cohorts, the rate of well-known risk factors for poor direct laryngoscopy view such as male sex, obesity, or older age, were increased compared with the control groups. Especially in the ongoing debate on anesthesia staff qualification for cardiac interventions outside the operating room a detailed and stratified risk analysis seems necessary...
December 2015: Journal of Cardiothoracic and Vascular Anesthesia
Shin Hyung Kim, Hae Keum Kil, Hye Jin Kim, Bon Nyeo Koo
PURPOSE: The Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) are comprehensive assessment methods for evaluating patient and surgical factors widely used to predict 30-day mortality rates. In this retrospective study, we evaluated the usefulness of POSSUM and P-POSSUM in predicting 30-day mortality after intraoperative cardiac arrests in adult patients undergoing non-cardiac surgery. MATERIALS AND METHODS: Among 190486 patients who underwent anesthesia, 51 experienced intraoperative cardiac arrest as defined in our study protocol...
September 2015: Yonsei Medical Journal
Lashmi Venkatraghavan, Tze Ping Tan, Jigesh Mehta, Anil Arekapudi, Arun Govindarajulu, Eric Siu
BACKGROUND: Neutrophil:lymphocyte ratio (NLR)  is an emerging biomarker that is used to predict postoperative mortality and morbidity in cardiac and cancer surgeries. The association of this biomarker with systemic illness and its usefulness in risk assessment of preoperative patients has not been fully elucidated. OBJECTIVES: To determine the prevalence of elevated NLR in preoperative patients and to examine the relationship between elevated NLR and the presence of systemic illnesses as well as anaesthesia risk indices such as American Society of Anesthesia (ASA) and the revised cardiac risk index (RCRI) scores...
2015: F1000Research
Karim Ladha, Marcos F Vidal Melo, Duncan J McLean, Jonathan P Wanderer, Stephanie D Grabitz, Tobias Kurth, Matthias Eikermann
OBJECTIVE: To evaluate the effects of intraoperative protective ventilation on major postoperative respiratory complications and to define safe intraoperative mechanical ventilator settings that do not translate into an increased risk of postoperative respiratory complications. DESIGN: Hospital based registry study. SETTING: Academic tertiary care hospital and two affiliated community hospitals in Massachusetts, United States. PARTICIPANTS: 69,265 consecutively enrolled patients over the age of 18 who underwent a non-cardiac surgical procedure between January 2007 and August 2014 and required general anesthesia with endotracheal intubation...
2015: BMJ: British Medical Journal
Jin Joo, Yong Gyu Park, Jungwon Baek, Young Eun Moon
BACKGROUND: Low-dose haloperidol is known to be effective for the prevention of postoperative nausea and vomiting (PONV). However, precise dose-response studies have not been completed, especially in patients at high risk for PONV who require combination therapy. This study sought to identify which dose of haloperidol 1mg or 2mg could be combined with dexamethasone without adverse effects in high-risk patients undergoing gynecological laparoscopic surgery. METHODS: Female adults (n = 150) with three established PONV risk factors based on Apfel's score were randomized into one of three study groups...
2015: BMC Anesthesiology
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