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https://www.readbyqxmd.com/read/29353319/management-strategies-for-noncardiac-surgery-following-a-coronary-artery-event
#1
REVIEW
Thomas F Whayne, Sibu P Saha
PURPOSE OF REVIEW: Coronary artery event includes acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Following such an event, risk of noncardiac surgery is increased. Of major concern is what can make this surgery safer? RECENT FINDINGS: High functional capacity improves cardiovascular (CV) risk; at least 4.0 metabolic equivalents (METs) on stress test are favorable. Risk scores can suggest need for further evaluation...
January 20, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29332544/the-possible-use-of-preoperative-natriuretic-peptides-for-discriminating-low-versus-moderate-high-surgical-risk-patient
#2
Luigi Vetrugno, Daniele Orso, Carola Matellon, Marilù Giaccalone, Tiziana Bove, Elena Bignami
Perioperative risk scores for patients undergoing noncardiac surgery are generally considered inaccurate, poor, or, at best, modest. We propose estimating a patient's pretest and posttest probability of cardiac morbidity and death using the preoperative scoring system plus the negative likelihood ratio from brain natriuretic peptide (BNP) or N-terminal proB-type natriuretic peptide (NT-proBNP) plasma levels. Our clinical challenge scenario showed a pretest probability of postoperative major cardiac complications with the patient risk factor as 6...
January 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29328896/do-cardiac-risk-stratification-indexes-accurately-estimate-perioperative-risk-in-noncardiac-surgery-patients
#3
Rohan Mandaliya, Geno Merli
No abstract text is available yet for this article.
January 2018: Cleveland Clinic Journal of Medicine
https://www.readbyqxmd.com/read/29317808/clinical-utility-of-the-revised-cardiac-risk-index-in-older-chinese-patients-with-known-coronary-artery-disease
#4
Lu Che, Li Xu, Yuguang Huang, Chunhua Yu
Objectives: The revised Cardiac Risk Index (RCRI) is the most widely used risk prediction tool for postoperative cardiac adverse events. We aim to explore the predictive ability of the RCRI in older Chinese patients with coronary artery disease (CAD) undergoing noncardiac surgery, which has not been previously evaluated. Methods: We performed a multicenter, prospective study. We enrolled a total of 1,202 patients, aged >60 years, with a history of CAD who underwent noncardiac surgery...
2018: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29298372/multidisciplinary-perioperative-management-of-pulmonary-arterial-hypertension-in-patients-undergoing-noncardiac-surgery
#5
José L Díaz-Gómez, Juan G Ripoll, Isabel Mira-Avendano, John E Moss, Gavin D Divertie, Ryan D Frank, Charles D Burger
OBJECTIVES: To describe the effect of implementing a contemporary perioperative pulmonary hypertension (PH)-targeted protocol in patients with pulmonary arterial hypertension (PAH) undergoing noncardiac surgery (NCS). METHODS: The data of consecutive patients with PAH diagnosed by right heart catheterization who underwent NCS between January 1, 2006 and February 9, 2016 were reviewed. Patient demographics, etiology of PAH, clinical features, diagnostic data, utilization of PH-specific medications, and trend of perioperative complications rate were recorded during the study period...
January 2018: Southern Medical Journal
https://www.readbyqxmd.com/read/29290081/b-type-natriuretic-peptide-and-other-risk-factors-for-predicting-postoperative-atrial-fibrillation-after-thoracic-surgery
#6
Zhenye Pu, Xiaotong Qi, Tao Xue, Zhiyong Liu, Yanhu Wu
BACKGROUND:  Postoperative atrial fibrillation (POAF) is associated with increased morality rate, prolonged hospitalization, and reduced long-term survival after surgery. Thus, prediction of POAF is important to assess surgical risk and provide prophylaxis. METHODS:  It was a prospective study of 207 consecutive patients who underwent a routine preoperative laboratory testing before thoracic surgery from October 2016 to May 2017. Comprehensive data were collected...
December 31, 2017: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/29210843/intraoperative-hypotension-is-associated-with-acute-kidney-injury-in-noncardiac-surgery-an-observational-study
#7
Linn Hallqvist, Fredrik Granath, Elin Huldt, Max Bell
BACKGROUND: Perioperative acute kidney injury (AKI) is common and increases the risk of morbidity and mortality. OBJECTIVES: To determine the association between intraoperative hypotension, defined as an individual decrease from baseline and the risk of perioperative AKI. DESIGN: Observational cohort study. SETTING: Karolinska University Hospital, Stockholm, Sweden, from October 2012 to May 2013 and October 2015 and April 2016...
November 27, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29203498/perioperative-myocardial-injury-after-noncardiac-surgery-incidence-mortality-and-characterization
#8
Christian Puelacher, Giovanna Lurati Buse, Daniela Seeberger, Lorraine Sazgary, Stella Marbot, Andreas Lampart, Jaqueline Espinola, Christoph Kindler, Angelika Hammerer, Esther Seeberger, Ivo Strebel, Karin Wildi, Raphael Twerenbold, Jeanne du Fay de Lavallaz, Luzius Steiner, Lorenz Gurke, Tobias Breidthardt, Katharina Rentsch, Andreas Buser, Danielle M Gualandro, Stefan Osswald, Christian Mueller
Background -Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. Methods -We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine...
December 4, 2017: Circulation
https://www.readbyqxmd.com/read/29200064/informed-consent-and-cognitive-dysfunction-after-noncardiac-surgery-in-the-elderly
#9
Kirk J Hogan, Lisa C Bratzke, Kendra L Hogan
Cognitive dysfunction 3 months after noncardiac surgery in the elderly satisfies informed consent thresholds of foreseeability in 10%-15% of patients, and materiality with new deficits observed in memory and executive function in patients with normal test performance beforehand. At present, the only safety step to avoid cognitive dysfunction after surgery is to forego surgery, thereby precluding the benefits of surgery with removal of pain and inflammation, and resumption of normal nutrition, physical activity, and sleep...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29200062/is-compliance-with-surgical-care-improvement-project-cardiac-scip-card-2-measures-for-perioperative-%C3%AE-blockers-associated-with-reduced-incidence-of-mortality-and-cardiovascular-related-critical-quality-indicators-after-noncardiac-surgery
#10
Miklos D Kertai, Mary Cooter, Richard J Pollard, William Buhrman, Solomon Aronson, Joseph P Mathew, Mark Stafford-Smith
BACKGROUND: While continuation of β-blockers (BBs) perioperatively has become a national quality improvement measure, the relationship between BB withdrawal and mortality and cardiovascular-related critical quality indicators has not been studied in a contemporary cohort of patients undergoing noncardiac surgery. METHODS: For this retrospective study, the quality assurance database of a large community-based anesthesiology group practice was used to identify 410,288 surgical cases, 18 years of age or older, who underwent elective or emergent noncardiac surgical procedures between January 1, 2009, and December 31, 2014...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29197827/intermediate-term-risk-of-stroke-following-cardiac-procedures-in-a-nationally-representative-data-set
#11
Laura Stein, Alison Thaler, John W Liang, Stanley Tuhrim, Amit S Dhamoon, Mandip S Dhamoon
BACKGROUND: Studies on stroke risk following cardiac procedures addressed only perioperative and long-term risk following limited higher-risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions. METHODS AND RESULTS: The Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013...
December 2, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29193085/elevated-brain-natriuretic-peptide-bnp-is-an-early-marker-for-patients-at-risk-for-complications-after-cytoreductive-surgery-and-hyperthermic-intraperitoneal-chemotherapy-crs%C3%A2-%C3%A2-hipec
#12
Sarah B Fisher, Safia Rafeeq, Ken Hess, Travis E Grotz, Paul Mansfield, Richard Royal, Brian Badgwell, Jason Fleming, Keith Fournier, Gary N Mann
BACKGROUND: Elevated BNP is associated with adverse cardiac outcomes after noncardiac surgery. We assessed BNP values as markers of perioperative fluid status and their correlation with major/cardiopulmonary (CP) complications following CRS + HIPEC. METHODS: Fluid balance, BNP levels, and morbidity data were collected for all patients undergoing CRS + HIPEC between 6/2014 and 2/2016. RESULTS: One hundred and twenty-nine patients underwent CRS + HIPEC for appendiceal adenocarcinoma (n = 99), mesothelioma (n = 16), and colon cancer (n = 14)...
November 28, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29178294/advanced-cardiac-imaging-techniques-assist-in-characterizing-a-cardiac-mass-and-directing-management
#13
Chadi Ayoub, Sushil A Luis, Joseph J Maleszewski, Patricia A Pellikka
Advanced imaging techniques, including contrast echocardiography and CMR, provided valuable characterization and evaluation of a boy with an unusual cardiac mass. Imaging features assisted with differentiation of benign from malignant etiology and excluding thrombus. Accurate imaging techniques saved our patient risks associated with unnecessary surgery or anticoagulation. The ability to accurately define size serially assisted in guiding expectant management. He died from a noncardiac cause at age 28, and autopsy demonstrated a hamartoma of mature cardiac myocytes...
November 2017: Echocardiography
https://www.readbyqxmd.com/read/29161395/postoperative-cognitive-dysfunction-and-dementia-what-we-need-to-know-and-do
#14
M J Needham, C E Webb, D C Bryden
Approximately 12% of apparently previously cognitively well patients undergoing anaesthesia and noncardiac surgery will develop symptoms of cognitive dysfunction after their procedure. Recent articles in this Journal have highlighted the difficulties of confirming any clear links between anaesthesia and cognitive dysfunction, in part because of the lack of consistency regarding definition and diagnosis. Postoperative cognitive dysfunction (POCD) is usually self-limiting and rarely persists in the longer term, although plausible biological mechanisms for an impact on brain protein deposition do exist...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29146612/derivation-and-validation-of-a-geriatric-sensitive-perioperative-cardiac-risk-index
#15
Rami Alrezk, Nicholas Jackson, Mohanad Al Rezk, Robert Elashoff, Nancy Weintraub, David Elashoff, Gregg C Fonarow
BACKGROUND: Surgical patients aged 65 and over face a higher risk of cardiac complications from noncardiac surgery. The Revised Cardiac Risk Index (RCRI) and the Gupta Myocardial Infarction or Cardiac Arrest (MICA) calculator are widely used to predict this risk, but they are not specifically designed to predict MICA in geriatric patients. Our hypothesis is that a new geriatric-sensitive index, derived from geriatric data, will capture this population's unique response to risk factors...
November 16, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29132159/aspirin-in-patients-with-previous-percutaneous-coronary-intervention-undergoing-noncardiac-surgery
#16
Michelle M Graham, Daniel I Sessler, Joel L Parlow, Bruce M Biccard, Gordon Guyatt, Kate Leslie, Matthew T V Chan, Christian S Meyhoff, Denis Xavier, Alben Sigamani, Priya A Kumar, Marko Mrkobrada, Deborah J Cook, Vikas Tandon, Jesus Alvarez-Garcia, Juan Carlos Villar, Thomas W Painter, Giovanni Landoni, Edith Fleischmann, Andre Lamy, Richard Whitlock, Yannick Le Manach, Meylin Aphang-Lam, Juan P Cata, Peggy Gao, Nicolaas C S Terblanche, Pamidimukkala V Ramana, Kim A Jamieson, Amal Bessissow, Gabriela R Mendoza, Silvia Ramirez, Pierre A Diemunsch, Salim Yusuf, P J Devereaux
Background: Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. Objective: To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. Design: Nonprespecified subgroup analysis of a multicenter factorial trial. Computerized Internet randomization was done between 2010 and 2013. Patients, clinicians, data collectors, and outcome adjudicators were blinded to treatment assignment...
November 14, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29132156/low-dose-aspirin-to-reduce-the-risk-for-myocardial-infarction-among-patients-with-coronary-stents-undergoing-noncardiac-surgery
#17
Raffaele Piccolo, Stephan Windecker
No abstract text is available yet for this article.
November 14, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29119935/perioperative-management-of-hyperlipidemia-medications
#18
J Ross Renew
BACKGROUND: Coronary artery disease is a common comorbidity encountered during the perioperative period. Whether patients are scheduled for cardiac or noncardiac surgery, this cardiovascular disease must be addressed in the preoperative period to decrease the accompanying risks and potential postoperative problems. Lipid-lowering medications are often used to treat hyperlipidemia, a risk factor for the development of atherosclerosis and coronary artery disease. OBJECTIVE: To discuss the medications most commonly used to treat hyperlipidemia and to describe strategies for handling these treatment regimens in the perioperative period...
November 7, 2017: Current Clinical Pharmacology
https://www.readbyqxmd.com/read/29099425/unexpected-cardiac-computed-tomography-findings-in-patients-with-postoperative-myocardial-injury
#19
Remco B Grobben, Judith A R van Waes, Tim Leiner, Linda M Peelen, Gert Jan de Borst, Henri C Vogely, Diederick E Grobbee, Pieter A Doevendans, Wilton A van Klei, Hendrik M Nathoe
BACKGROUND: Postoperative myocardial injury (PMI) is a strong predictor of mortality after noncardiac surgery. PMI is believed to be attributable to coronary artery disease (CAD), yet its etiology is largely unclear. We aimed to quantify the prevalence of significant CAD in patients with and without PMI using coronary computed tomography angiography (CCTA). METHODS: This prospective cohort study included patients of 60 years or older without a history of cardiac disease and with and without PMI after intermediate- to high-risk noncardiac surgery...
November 1, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29055835/preoperative-severe-hypoalbuminemia-is-associated-with-an-increased-risk-of-postoperative-delirium-in-elderly-patients-results-of-a-secondary-analysis
#20
Dan-Feng Zhang, Xian Su, Zhao-Ting Meng, Fan Cui, Hong-Liang Li, Dong-Xin Wang, Xue-Ying Li
PURPOSE: To explore the association between the severity of preoperative hypoalbuminemia and the occurrence of postoperative delirium. MATERIALS AND METHODS: This was a secondary analysis of the database from a previously conducted clinical trial. 700 elderly patients (age ≥65years) who were admitted to intensive care unit (ICU) after noncardiac surgery were included. Delirium was assessed with the Confusion Assessment Method for the ICU twice daily during the first 7days postoperatively...
September 29, 2017: Journal of Critical Care
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