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Perioperative bridging

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https://www.readbyqxmd.com/read/28184261/dual-antiplatelet-therapy-and-non-cardiac-surgery-evolving-issues-and-anesthetic-implications
#1
REVIEW
Jong Wook Song, Sarah Soh, Jae-Kwang Shim
Dual antiplatelet therapy (DAPT) consisting of aspirin plus a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) is imperative for the treatment of acute coronary syndrome, particularly during the re-endothelialization period after percutaneous coronary intervention (PCI). When patients undergo surgery during this period, the consequences of stent thrombosis are far more serious than those of bleeding complications, except in cases of intracranial surgery. The recommendations for perioperative DAPT have changed with emerging evidence regarding the improved efficacy of non-first-generation drug (everolimus, zotarolimus)-eluting stents (DES)...
February 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28156447/practice-patterns-and-outcomes-of-rivaroxaban-usage-in-patients-with-cancer
#2
Ali Zalpour, Juhee Song, Marsha N Richardson, Tony Lam, Josiah Halm, SWamique Yusuf, Shuwei Gao
: 194 Background: Patients with cancer have an increased risk of venous thromboembolism (VTE) and frequently require anticoagulation. In addition, many patients with cancer also have comorbidities such as atrial fibrillation (AF) and are on stroke prevention. Rivaroxaban (RV) is an oral (factor Xa inhibitor) used in these scenarios; however, there is little experience utilizing this agent in patients with cancer. Our aim is to describe practice patterns and outcomes of RV usage in patients with cancer...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28139304/development-and-implementation-of-a-comprehensive-multidisciplinary-emergency-department-extracorporeal-membrane-oxygenation-program
#3
Joseph E Tonna, Craig H Selzman, Michael P Mallin, Brigham R Smith, Scott T Youngquist, Antigoni Koliopoulou, Frederick Welt, Kathleen Diane Stoddard, Ram Nirula, Richard Barton, James Franklin Fair, James C Fang, Stephen McKellar
Despite advances in the medical and surgical management of cardiovascular disease, greater than 350,000 patients experience out-of-hospital cardiac arrest in the United States annually, with only a 12% neurologically favorable survival rate. Of these patients, 23% have an initial shockable rhythm of ventricular fibrillation/pulseless ventricular tachycardia (VF/VT), a marker of high probability of acute coronary ischemia (80%) as the precipitating factor. However, few patients (22%) will experience return of spontaneous circulation and sufficient hemodynamic stability to undergo cardiac catheterization and revascularization...
January 27, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28107271/perioperative-care-of-the-patient-with-the-total-artificial-heart
#4
Jill Yaung, Francisco A Arabia, Michael Nurok
Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns...
January 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28105752/exclusive-enteral-nutrition-provides-an-effective-bridge-to-safer-interval-elective-surgery-for-adults-with-crohn-s-disease
#5
N Heerasing, B Thompson, P Hendy, G A Heap, G Walker, R Bethune, S Mansfield, C Calvert, N A Kennedy, T Ahmad, J R Goodhand
BACKGROUND: Few studies have reported the systematic use of exclusive enteral nutrition in the perioperative setting. AIM: To test the hypothesis that exclusive enteral nutrition provides a safe and effective bridge to surgery and reduces post-operative complications, in adult patients with Crohn's disease requiring urgent surgery for stricturing or penetrating complications. METHODS: Patients treated with exclusive enteral nutrition prior to surgery were each matched with two control patients for disease behaviour, type of surgery, age at diagnosis and disease duration...
March 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28058712/two-stage-hepatectomy-in-two-regional-district-community-hospitals-perioperative-safety-and-long-term-survival
#6
Guido Griseri, Michela Ceriotti, Andrea Percivale, Angelo Franceschi, Gregorio Santori, Marco Benasso, Riccardo Pellicci
INTRODUCTION: Surgical resection offers the best chance of cure for patients with colorectal liver metastases (CRLMs). Two-stage hepatectomy (TSH) has been demonstrated to be safe and effective to obtain curative resection in patients with multiple, bilobar CRLMs that are unresectable in a single procedure. Up to now TSH has been the prerogative of dedicated liver surgery centers. The aim of this study was to assess the safety and effectiveness of TSH also in community hospitals. METHODS: Of 294 patients operated on for CRLMs between September 1997 and June 2012 in 2 district community hospitals (belonging to the same regional healthcare district), 43 (14...
December 26, 2016: Tumori
https://www.readbyqxmd.com/read/28058211/organ-transplantation-and-drug-eluting-stents-perioperative-challenges
#7
REVIEW
Aparna Dalal
Patients listed for organ transplant frequently have severe coronary artery disease (CAD), which may be treated with drug eluting stents (DES). Everolimus and zotarolimus eluting stents are commonly used. Newer generation biolimus and novolimus eluting biodegradable stents are becoming increasingly popular. Patients undergoing transplant surgery soon after the placement of DES are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel, prasugrel and ticagrelor is instated post stenting to decrease the incident of ST...
December 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/28045242/evidence-for-periprocedural-antiplatelet-therapy-heparinization-and-bridging-of-coumarin-therapy-in-carotid-revascularization
#8
Art Brand, Gert J DE Borst
Thromboembolism prevention is a crucial factor determining both the natural outcome and outcome of intervention of stenotic atherosclerotic carotid artery pathology. Roughly 80% of all natural course cerebral ischemic events are caused by thromboembolism, versus 20% due to hemodynamic insufficiency. The risk of periprocedural cerebral (micro) thromboembolization during carotid revascularization is considered to be even higher, with a higher rate in carotid artery stenting (CAS) as compared to carotid endarterectomy (CEA)...
January 3, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28043992/direct-oral-anticoagulants-and-heparins-laboratory-values-and-pitfalls-in-bridging-therapy
#9
Thomas Eller, Tobias Flieder, Vanessa Fox, Tatjana Gripp, Marcus Dittrich, Joachim Kuhn, Susanne Alban, Cornelius Knabbe, Ingvild Birschmann
OBJECTIVES: The three direct oral anticoagulants (DOACs) dabigatran, apixaban and rivaroxaban are now widely used in clinical practice. For patients requiring perioperative interruption of DOACs, heparin bridging is still under discussion. Here we show, for the first time, the influence of concomitantly used DOACs and heparins on laboratory assays. METHODS: For spiking experiments, 10 healthy donors and nine patients treated with DOACs were investigated. The measurement of DOACs and heparins was performed with routine methods on the ACL TOP [HEMOCLOT(®) direct thrombin inhibitor (CoaChrom Diagnostica, Austria), COAMATIC(®) Heparin (Chromogenix, USA) calibrated with rivaroxaban, apixaban, unfractionated heparin (UFH) and low molecular weight heparin (LMWH), additionally PT reagent RecombiPlasTin 2G and aPTT reagent SynthASil (Instrumentation Laboratory, Germany)] and the DOACs were additionally quantified with liquid chromatography-mass spectrometry...
January 2, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28042389/clinical-problems-with-antithrombotic-therapy-for-endoscopic-submucosal-dissection-for-gastric-neoplasms
#10
REVIEW
Toshiyuki Yoshio, Tsutomu Nishida, Yoshito Hayashi, Hideki Iijima, Masahiko Tsujii, Junko Fujisaki, Tetsuo Takehara
Endoscopic submucosal dissection (ESD) is minimally invasive and thus has become a widely accepted treatment for gastric neoplasms, particularly for patients with comorbidities. Antithrombotic agents are used to prevent thrombotic events in patients with comorbidities such as cardio-cerebrovascular diseases and atrial fibrillation. With appropriate cessation, antithrombotic therapy does not increase delayed bleeding in low thrombosis-risk patients. However, high thrombosis-risk patients are often treated with combination therapy with antithrombotic agents and occasionally require the continuation of antithrombotic agents or heparin bridge therapy (HBT) in the perioperative period...
December 16, 2016: World Journal of Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28027087/standardized-care-versus-precision-medicine-in-the-perioperative-setting-can-point-of-care-testing-help-bridge-the-gap
#11
Marc Iravani, Lisa K Lee, Maxime Cannesson
No abstract text is available yet for this article.
December 22, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28018809/airway-management-via-laryngeal-mask-in-laryngotracheal-resection
#12
Patrick Zardo, Tom Kreft, Thomas Hachenberg
We present a case of impassable subglottic stenosis scheduled for tracheal resection and reconstruction managed by establishing a supraglottic airway. Despite careful preoperative evaluation, the stenosis was localized higher than anticipated, rendering conventional intubation impossible. Laryngeal mask bridging to cross-field ventilation was feasible and jet ventilation and cardiopulmonary bypass were available as emergency strategies. Surgery and emergence went uneventful. Perioperative considerations are discussed in this report...
December 2016: Thoracic and Cardiovascular Surgeon Reports
https://www.readbyqxmd.com/read/28003693/all-india-difficult-airway-association-2016-guidelines-for-the-management-of-anticipated-difficult-extubation
#13
Pankaj Kundra, Rakesh Garg, Apeksh Patwa, Syed Moied Ahmed, Venkateswaran Ramkumar, Amit Shah, Jigeeshu Vasishtha Divatia, Sumalatha Radhakrishna Shetty, Ubaradka S Raveendra, Jeson R Doctor, Dilip K Pawar, Ramesh Singaravelu, Sabyasachi Das, Sheila Nainan Myatra
Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity...
December 2016: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/27993199/the-beneficial-role-of-simultaneous-splenectomy-after-extended-hepatectomy-experimental-study-in-pigs
#14
Antonios Athanasiou, Apostolos Papalois, Michael Kontos, John Griniatsos, Dimitrios Liakopoulos, Eleftherios Spartalis, George Agrogiannis, Theodoros Liakakos, Emmanouil Pikoulis
BACKGROUND: The role of hepatic hemodynamic modulation in the development of "small-for-size" syndrome (SFSS) after extended hepatectomy (EH) or living-donor liver transplantation is still controversial. We have designed an experimental study to investigate the effect of hemodynamic parameters of the liver circulation on the development of SFSS after EH in a porcine model. METHODS: Eighteen pigs were randomly divided into two groups: group A has received EH (75%-80%) without splenectomy, and group B with EH and simultaneous splenectomy was carried out...
February 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/27976439/prospective-multicentre-cohort-study-on-9154-surgical-procedures-to-assess-the-risk-of-postoperative-bleeding-a-dessi-study
#15
W Koenen, C Kunte, D Hartmann, H Breuninger, M Moehrle, F G Bechara, H J Schulze, A Lösler, C R Löser, T Wetzig, D Pappai, S Rapprich, C Weiß, J Faulhaber
BACKGROUND: To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin. OBJECTIVE: To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy. METHODS: Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI (DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions...
December 15, 2016: Journal of the European Academy of Dermatology and Venereology: JEADV
https://www.readbyqxmd.com/read/27925241/vertebral-subluxation-repair-in-a-pet-goat
#16
Sara Nannarone, Enrico Bellezza, Yves P Moens, Paula Larenza Menzies
OBJECTIVES: To describe the perioperative management, including surgery, anesthesia, metabolic derangements, and physiotherapy, in a goat referred for paraparesis secondary to a road traffic accident. STUDY DESIGN: Case report. ANIMALS: 2-year-old mixed breed dwarf 44 kg female pet goat. METHODS: Clinical examination showed symptoms of early compensatory stages of shock, paraparesis with hyperextension of the thoracic limbs, pain on palpation of the thoracolumbar spine, increased patellar reflexes of both pelvic limbs without superficial sensitivity, but preserved deep pain sensation...
January 2017: Veterinary Surgery: VS
https://www.readbyqxmd.com/read/27913784/the-effectiveness-of-the-bone-bridge-transtibial-amputation-technique-a-systematic-review-of-high-quality-evidence
#17
Jason T Kahle, M Jason Highsmith, John Kenney, Tim Ruth, Paul A Lunseth, Janos Ertl
BACKGROUND: This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature. METHODS: Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent...
December 1, 2016: Prosthetics and Orthotics International
https://www.readbyqxmd.com/read/27873215/current-and-future-treatment-approaches-in-transthyretin-familial-amyloid-polyneuropathy
#18
REVIEW
Philippe Kerschen, Violaine Planté-Bordeneuve
Treatment of transthyretin familial amyloid polyneuropathy (TTR FAP) must be tailored to disease stage. Patients with early stage disease (i.e., without major impairment in walking ability), especially younger patients, should be referred as soon as possible for liver transplantation (LT) in the absence of major comorbid conditions. LT remains the most effective treatment option to date and should be offered to these patients as early as possible. Bridging therapy with an oral TTR stabilizer (tafamidis or diflunisal, according to local access to these treatments) should be started as soon as the diagnosis of TTR FAP is established...
December 2016: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/27849842/199-perioperative-eptifibatide-as-bridging-therapy-in-patients-with-renal-impairment-and-coronary-stents
#19
Hannah Pope, Rafael Garcia-Cortes, Morganne Hockett, Lavigne Paul, Richard Bach
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27832003/development-of-a-model-of-pediatric-lung-failure-pathophysiology
#20
John M Trahanas, Fares Alghanem, Catalina Ceballos-Muriel, Hayley R Hoffman, Alice Xu, Kristopher B Deatrick, Marie Cornell, Alvaro Rojas-Pena, Robert H Bartlett, Ronald B Hirschl
A pediatric artificial lung (PAL) is under development as a bridge to transplantation or lung remodeling for children with end-stage lung failure (ESLF). In order to evaluate the efficiency of a PAL, a disease model mimicking the physiologic derangements of pediatric ESLF is needed. Our previous right pulmonary artery ligation (rPA-LM) ovine model achieved that goal, but caused immediate mortality in nearly half of the animals. In this study, we evaluated a new technique of gradual postoperative right pulmonary artery (rPA) occlusion using a Rummel tourniquet (rPA-RT) in seven (25-40 Kg) sheep...
November 9, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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