Results Generated From:
EMBASE <1980 to 2009 Week 43>
EMBASE (updates since 2009-10-15)
<1>
Accession Number
2009473795
Authors
Shahzamani M. Yousefi Z. Frootaghe A.N. Jafarimehr E. Froughi M. Tofighi
F. Azadani A.N. Pourhoseingholi M.A. Azadani P.N.
Institution
(Shahzamani, Frootaghe, Jafarimehr, Froughi, Tofighi, Azadani)
Cardiovascular Surgery Department,
(Tofighi) Department of Anesthesiology,
(Tofighi) Shaheed Modarress Hospital,
(Yousefi) Department of Cardiology, Torfe Hospital,
(Yousefi) Shaheed Beheshti Medical University, Tehran, Iran, Islamic
Republic of.
(Pourhoseingholi) Biostatistics, Research Center of Gastroenterology and
Liver Disease, Shaheed Beheshti Medical University, Tehran, Iran, Islamic
Republic of.
(Azadani) Cardiothoracic Surgery Department, University of California San
Francisco, San Francisco, CA, United States.
(Azadani) #3, Shohreh alley, Kousha Ave, Shariati St, Tehran, 1547716191,
Iran, Islamic Republic of.
Title
The effect of angiotensin-converting enzyme inhibitor on hemodynamic
instability in patients undergoing cardiopulmonary bypass: Results of a
dose-comparison study.
Source
Journal of Cardiovascular Pharmacology and Therapeutics. 14(3)(pp
185-191), 2009. Date of Publication: September 2009.
Publisher
SAGE Publications Ltd
Abstract
Background: Recently, hemodynamic instability including hypotension and
its effect on the clinical outcome in patients treated with
angiotensin-converting enzyme inhibitors (ACEIs) during coronary artery
bypass graft (CABG) has been described. However, no analysis has examined
the dose of ACEIs and its risk of hypotension. In this study, we tested
the hypothesis that a higher dose of ACEIs could lead to increased
episodes of hypotension. Methods: A total of 300 patients scheduled for
CABG were studied prospectively. They were divided into 3 groups according
to their preoperative use of different doses of ACEIs. The demographic and
medical characteristics were compared between these 3 groups. During CABG
and throughout the intensive care unit (ICU), vasoconstrictors were
infused in patients undergoing hypotension (mean arterial pressure [MAP] <
65 mm Hg or >30% below baseline). The predictive factors responsible for
hypotension were investigated separately using univariate and multivariate
logistic regression models. Results: The 3 groups were similar with regard
to the patientsg[euro][trademark] demographic and medical characteristics.
The patients treated with ACEIs were more likely to develop hypotension
(73% of high dose and 47% of low dose) in the operating room than those
without ACEIs (30%). However, in the ICU, there was no significant
association between hemodynamic changes and ACEIstreated patients. Other
independent risk factors identified for hypotension were ejection
fraction, history of myocardial infarction, coronary grafting count, and
pump time during surgery and/or ICU admission. Conclusions: Hemodynamic
changes during CABG were observed to be directly proportional to the
dosage of ACEIs prescribed preoperatively.
<2>
Accession Number
2009467470
Authors
Sezai A. Hata M. Niino T. Yoshitake I. Unosawa S. Wakui S. Osaka S.
Takayama T. Kasamaki Y. Hirayama A. Minami K.
Institution
(Sezai, Hata, Niino, Yoshitake, Unosawa, Wakui, Osaka, Minami) Department
of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo,
Japan.
(Takayama, Kasamaki, Hirayama) Department of Cardiology, Nihon University
School of Medicine, Tokyo, Japan.
Title
Influence of Continuous Infusion of Low-Dose Human Atrial Natriuretic
Peptide on Renal Function During Cardiac Surgery. A Randomized Controlled
Study.
Source
Journal of the American College of Cardiology. 54(12)(pp 1058-1064),
2009. Date of Publication: 15 Sep 2009.
Publisher
Elsevier USA
Abstract
Objectives: The purpose of this study was to determine the effect of human
atrial natriuretic peptide (hANP) in patients who underwent coronary
artery bypass grafting (CABG) on renal function. Background: Acute renal
failure after cardiac surgery is associated with high morbidity and
mortality. Methods: A total of 504 patients who underwent CABG were
divided into 2 groups: 1 group received hANP at 0.02 mug/kg/min from the
start of cardiopulmonary bypass (hANP group), and 1 group did not receive
hANP (placebo group). Various parameters were measured before and after
surgery. Results: There was no difference in mortality between the 2
groups, but post-operative complications were less frequent in the hANP
group (p = 0.0208). In the hANP group, serum creatinine (Cr) was
significantly lower and urinary Cr and Cr clearance were significantly
higher from post-operative day 1 to week 1. The maximum post-operative Cr
level and percent increase of Cr were significantly lower in the hANP
group (p < 0.0001). Patients with Cr exceeding 2.0 mg/dl included 1 in the
hANP group and 8 in the placebo group, showing a significant difference (p
= 0.0374). Four patients in the placebo group and none in the hANP group
required hemodialysis, but the difference was not statistically
significant. Conclusions: Continuous infusion of low-dose hANP from the
start of cardiopulmonary bypass effectively maintained post-operative
renal function. Infusion of hANP prevents early post-operative acute renal
failure and helps to achieve safer cardiac surgery. (Clinical Trial
registration number: UMIN000001440). copyright 2009 American College of
Cardiology Foundation.
<3>
Accession Number
2009513833
Authors
Biccard B.M. Rodseth R.N.
Institution
(Biccard, Rodseth) Department of Anaesthetics, Nelson R Mandela School of
Medicine, Private Bag 7, Congella, 4013, South Africa.
Title
A meta-analysis of the prospective randomised trials of coronary
revascularisation before noncardiac vascular surgery with attention to the
type of coronary revascularisation performed.
Source
Anaesthesia. 64(10)(pp 1105-1113), 2009. Date of Publication: October
2009.
Publisher
Blackwell Publishing Ltd
Abstract
Prospective randomised trials of coronary revascularisation prior to
noncardiac surgery have shown no survival benefit following noncardiac
surgery. However, these studies have not differentiated the outcomes
associated with coronary artery bypass grafting (CABG) and percutaneous
coronary interventions. We performed a meta-analysis of the randomised
controlled trials of pre-operative coronary revascularisation for
noncardiac surgery, extracting data for 30 day and long term all-cause
mortality and myocardial infarction (MI) following revascularisation,
according to the type of revascularisation performed. Pre-operative
percutaneous coronary intervention was associated with significantly
increased 30 day MI and composite death and MI. Pre-operative CABG was
associated with a significantly improved long term composite outcome of
death and MI compared to percutaneous coronary interventions. The adverse
effect of percutaneous coronary interventions on both short and long term
outcomes in vascular surgical patients should be taken into consideration
when interpreting these trials. CABG may improve long term outcomes in
vascular surgical patients. The indications for and timing of CABG in
vascular surgical patients needs further research. copyright 2009 The
Authors.
<4>
Accession Number
2009434516
Authors
Terra R.M. Junqueira J.J.M. Teixeira L.R. Vargas F.S. Pego-Fernandes P.M.
Jatene F.B.
Institution
(Terra, Junqueira, Pego-Fernandes, Jatene) Division of Thoracic Surgery,
Hospital Das Clinicas, University of Sao Paulo Medical School, Sao Paulo,
Brazil.
(Teixeira, Vargas) Pulmonary Division, Hospital Das Clinicas, University
of Sao Paulo Medical School, Sao Paulo, Brazil.
(Terra) Jardim Paulista, Al Fernao Cardim, 161, Sao Paulo, SP, CEP
01403-020, Brazil.
Title
Is full postpleurodesis lung expansion a determinant of a successful
outcome after talc pleurodesis?.
Source
Chest. 136(2)(pp 361-368), 2009. Date of Publication: 01 Aug 2009.
Publisher
American College of Chest Physicians
Abstract
Study objectives: To analyze and compare radiologic lung expansion after
talc pleurodesis performed either by videothoracoscopy or chest tube and
correlate it with clinical outcome. Secondary end points evaluated were as
follows: clinical efficacy; quality of life; safety; and survival.
Methods: Prospective randomized study that included 60 patients (45 women,
15 men; mean age, 55.2 years) with recurrent malignant pleural effusion
between January 2005 and January 2008. They were randomized into the
following two groups: video-assisted thoracic surgery (VATS) talc
poudrage; and talc slurry (TS) administered through a chest tube. Lung
expansion was evaluated through chest CT scans obtained 0, 1, 3 and 6
months after pleurodesis. Complications, drainage time, hospital stay, and
quality of life (Medical Outcomes Study 36-item short form and World
Health Organization quality-of-life questionnaires) were also analyzed.
Results: There were no significant differences in preprocedure clinical
and pathologic variables between groups. The immediate total (ie, > 90%)
lung expansion was observed in 27 patients (45%) and was more frequent in
the VATS group (60% vs 30%, respectively; p = 0.027). During follow-up,
71% of the patients showed unaltered or improved lung expansion and 9
patients (15%) needed new pleural procedures (VATS group, 5 recurrences;
TS group, 4 recurrences; p = 0.999). No differences were found between
groups regarding quality of life, complications, drainage time, hospital
stay, and survival. Immediate lung expansion did not correlate with
radiologic recurrence, clinical recurrence, or complications (p = 0.60,
0.15, and 0.20, respectively). Conclusion: Immediate partial lung
expansion was a frequent finding and was more frequent after TS.
Nonetheless, no correlation between immediate lung expansion and clinical
outcome was found in this study. Trial registration: ClinicalTrials.gov
Identifier: NTC00789087. copyright 2009 American College of Chest
Physicians.
<5>
[Use Link to view the full text]
Accession Number
2009380292
Authors
Rohm K.D. Mengistu A. Boldt J. Mayer J. Beck G. Piper S.N.
Institution
(Rohm, Mengistu, Boldt, Mayer, Piper) Department of Anesthesiology and
Critical Care Medicine, Klinikum Ludwigshafen, Bremserstrasse 79, D-67063
Ludwigshafen, Germany.
(Beck) University Hospital Mannheim, Ruprecht-Karls-University of
Heidelberg, Theodor-Kutzer-Ufer 1-3, Germany.
Title
Renal integrity in sevoflurane sedation in the intensive care unit with
the anesthetic-conserving device: A comparison with intravenous propofol
sedation.
Source
Anesthesia and Analgesia. 108(6)(pp 1848-1854), 2009. Date of
Publication: June 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Increased inorganic fluoride levels after methoxyflurane
exposure in the 1970s and prolonged intraoperative sevoflurane use have
been suggested to be potentially nephrotoxic. In the intensive care unit
we evaluated the effect on renal integrity of short-term inhaled
postoperative sedation with sevoflurane using the Anesthetic Conserving
Device (ACD) compared with propofol. METHODS: In this prospective,
randomized, single-blinded study, after major abdominal, vascular or
thoracic surgery 125 patients were allocated to receive either sevoflurane
(n = 64) via the ACD (end-tidal 0.5-1 vol%) or IV propofol (n = 61) for
postoperative sedation up to 24 h. Urinary alpha-glutathione-s-transferase
as primary outcome variable, urinary N-acetyl-glucosaminidase, serum
creatinine, and inorganic fluoride concentrations, urine output and fluid
management were measured preoperatively, at the end of surgery, and at 24
and 48 h postoperatively. RESULTS: The sedation time in the intensive care
unit was comparable between the sevoflurane (9.2 +/- 4.3 h) and the
propofol (9.3 +/- 4.7 h) group. Alpha-glutathione-s-transferase levels
were significantly increased at 24 and 48 h postoperatively compared with
preoperative values in both groups, without significant differences
between the groups. N-acetyl-glucosaminidase and serum creatinine remained
unchanged in both study groups, and urine output and creatinine clearance
were comparable between the groups throughout the study period. Inorganic
fluoride levels increased significantly (P < 0.001) at 24 h after
sevoflurane exposure (39 +/- 25 mumol/L) compared with propofol (3 +/- 6
mumol/L) and remained elevated 48 h later (33 +/- 26 vs 3 +/- 5 mumol/L).
One patient in each group suffered from renal insufficiency, requiring
intensive diuretic therapy, but not dialysis, during hospital stay.
CONCLUSIONS: Short-term sedation with either sevoflurane using ACD or
propofol did not negatively affect renal function postoperatively.
Although inorganic fluoride levels were elevated after sevoflurane
exposure, glomerular and tubular renal integrity were preserved throughout
the hospital stay. copyright 2009 International Anesthesia Research
Society.
<6>
Accession Number
2009469739
Authors
Olson K.L. Delate T. Rasmussen J. Humphries T.L. Merenich J.A.
Institution
(Olson, Delate, Rasmussen, Humphries) Pharmacy Department, Kaiser
Permanente Colorado, Aurora, CO, United States.
(Merenich) Population and Prevention Services, Kaiser Permanente Colorado,
Aurora, CO, United States.
(Olson, Delate, Rasmussen, Humphries) School of Pharmacy, University of
Colorado, Denver, CO, United States.
(Merenich) School of Medicine, University of Colorado, Denver, CO, United
States.
Title
Outcomes of patients discharged from pharmacy-managed cardiovascular
disease management.
Source
American Journal of Managed Care. 15(8)(pp 497-503), 2009. Date of
Publication: August 2009.
Publisher
Ascend Media
Abstract
Objective:To evaluate whether patients with coro-nary artery disease (CAD)
discharged from the Clinical Pharmacy Cardiac Risk Service (CPCRS) would
maintain their lipid goals with use of an electronic laboratory reminder
system. Study Design: A 2-year, randomized study at Kaiser Permanente
Colorado. Methods: Patients with prior CAD (acute myocardial infarction,
coronary artery bypass graft surgery, percutaneous coronary intervention)
who had been enrolled in the CPCRS for at least 1 year and who had 2
consecutive low-density lipoprotein cholesterol (LDL-C), non-high-density
lipoprotein cholesterol, and blood pressure readings at goal within 6
months before enrollment were randomized to remain in the CPCRS (CPCRS
care) or to receive usual care from primary care physicians plus
laboratory reminder letters (usual care).The primary outcome was
maintenance of LDL-C goal at study end.The f test and chi2 test of
association were used to assess differences in mean and categorical
values, respectively. Results: A total of 421 patients (214 CPCRS care,
207 usual care) were randomized. Their mean age was 72 years; 74% were
male. After 1.7 years of follow-up, the proportions of patients
maintaining their LDL-C goal of <100 mg/dL were 91% and 93.1% in the CPCRS
care and usual care groups, respectively (P = .46).The proportions
maintaining their LDL-C goal of <70 mg/dL were 68.6% and 56.8% in the
CPCRS care and usual care groups, respectively (P =.23). Conclusion: This
study demonstrated that LDL-C measures can remain controlled in most
patients discharged from a cardiac disease management program.
<7>
Accession Number
2009410031
Authors
De Hert S. Vlasselaers D. Barbe R. Ory J.-P. Dekegel D. Donnadonni R.
Demeere J.-L. Mulier J. Wouters P.
Institution
(De Hert) University of Amsterdam, Division of Cardiothoracic and Vascular
Anaesthesiology, Academic Medical Center, Amsterdam, Netherlands.
(De Hert, Vlasselaers, Barbe, Ory, Dekegel, Donnadonni, Demeere, Mulier,
Wouters) VACMAN (Volatile Anaesthetics and Cardioprotection Multicentre
ANalysis),
(Wouters) University of Ghent, Department of Anaesthesia, University
Hospital Ghent, Ghent, Belgium.
Title
A comparison of volatile and non volatile agents for cardioprotection
during on-pump coronary surgery.
Source
Anaesthesia. 64(9)(pp 953-960), 2009. Date of Publication: September
2009.
Publisher
Blackwell Publishing Ltd
Abstract
A randomised study of 414 patients undergoing coronary artery surgery with
cardiopulmonary bypass was conducted to compare the effects of a volatile
anaesthetic regimen with either deesflurane or sevoflurane, and a total
intravenous anaesthesia (TIVA) regimen on postoperative troponin T
release. The primary outcome variable was postoperative troponin T
release, secondary outcome variables were hospital length of stay and
1-year mortality. Maximal postoperative troponin T values did not differ
between groups (TIVA: 0.30 [0.00-4.79] ng.ml-1 (median [range]),
sevoflurane: 0.33 [0.02-3.68] ng.ml-1, and desflurane: 0.39 [0.08-3.74]
ng.ml-1). The independent predictors of hospital length of stay were the
EuroSCORE (p < 0.001), female gender (p = 0.042) and the group assignment
(p < 0.001). The one-year mortality was 12.3% in the TIVA group, 3.3% in
the sevoflurane group, and 6.7% in the desflurane group. The EuroSCORE (p
= 0.003) was the only significant independent predictor of 1-year
mortality. copyright 2009 The Authors.
<8>
[Use Link to view the full text]
Accession Number
2009380221
Authors
Greilich P.E. Jessen M.E. Satyanarayana N. Whitten C.W. Nuttall G.A.
Beckham J.M. Wall M.H. Butterworth J.F.
Institution
(Greilich, Satyanarayana, Whitten, Beckham) Departments of Anesthesiology
and Pain Management, University of Texas Southwestern Medical Center,
Dallas, TX,
(Jessen) Departments of Cardiovascular and Thoracic Surgery, University of
Texas Southwestern Medical Center, Dallas, TX,
(Nuttall) Department of Anesthesiology, Mayo Clinic College of Medicine,
Minnesota,
(Wall) Department of Anesthesiology, Washington University, St. Louis, MO,
(Butterworth) Department of Anesthesia, Indiana University School of
Medicine, Indiana., Dallas, Rochester, IN,
(Greilich) 5323 Harry Hines Blvd., Dallas, TX 75390-8894,
Title
The effect of epsilon-aminocaproic acid and aprotinin on fibrinolysis and
blood loss in patients undergoing primary, isolated coronary artery bypass
surgery: A randomized, double-blind, placebo-controlled, noninferiority
trial.
Source
Anesthesia and Analgesia. 109(1)(pp 15-24), 2009. Date of Publication:
July 2009.
Publisher
Lippincott Williams and Wilkins
Abstract
BACKGROUND: Until recently, aprotinin was the only antifibrinolytic drug
with a licensed indication in cardiac surgery in the United States. The
most popular alternative, epsilon-aminocaproic acid (EACA), has not been
adequately compared with aprotinin. We undertook this study to test the
hypothesis that EACA, when dosed appropriately, is not inferior to
aprotinin at reducing fibrinolysis and blood loss. METHODS: Seventy-eight
patients scheduled for primary, isolated coronary artery bypass graft
surgery were randomly assigned to receive "full Hammersmith" dose
aprotinin, high dose EACA (100 mg/kg initial loading dose, 5 g in the pump
prime solution, 30 mg * kg * h maintenance infusion) or equal volumes of a
saline-placebo in a double-blind trial. Reductions in peak d-dimer
formation (a measure of fibrinolysis) and 24-h chest tube drainage (CTD)
were the primary end points by which noninferiority of EACA was tested.
The noninferiority limit was set at a 30% increase in peak d-dimer
formation (a difference of 250 mug/mL) and 24-h CTD (a difference of 350
mL) relative to aprotinin. RESULTS: The between-group differences (EACA
versus aprotinin) in peak d-dimer formation (-3.58 mug/L, 95% CI -203 to
195 mug/L) and 24-h CTD (67 mL, 95% CI -90 to 230 mL) were within the
predetermined noninferiority margins (250 mug/mL and 350 mL, respectively)
and satisfied the criteria for noninferiority. Compared with saline,
significant between-group reductions in peak d-dimer formation were
observed using EACA (589 mug/L, 95% CI 399-788 mug/L; P < 0.0001) and
aprotinin (585 mug/L, 95% CI 393-778 mug/L; P < 0.0001). Similar
reductions in 24 h CTD were also seen using EACA (239 mL, 95% CI 50-415
mL; P < 0.05) and aprotinin (323 mL, 95% CI 105-485 mL; P < 0.05) compared
with saline. Plasma EACA levels were maintained well above a target of 260
mug/mL. CONCLUSIONS: When dosed in a pharmacologically guided manner, EACA
is not inferior to aprotinin in reducing fibrinolysis and blood loss in
patients undergoing primary, isolated coronary artery bypass surgery.
Copyright copyright 2009 International Anesthesia Research Society.
No comments:
Post a Comment