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Accession Number
2010696092
Authors
Jooste E.H. Muhly W.T. Ibinson J.W. Suresh T. Damian D. Phadke A. Callahan
P. Miller S. Feingold B. Lichtenstein S.E. Cain J.G. Chrysostomou C. Davis
P.J.
Institution
(Jooste, Muhly, Ibinson, Suresh, Damian, Phadke, Callahan, Feingold,
Lichtenstein, Cain, Davis) Department of Pediatric Anesthesia, Transplant
Division, United States
(Miller) Department of Pediatric Cardiology, Transplant Division, Japan
(Chrysostomou) Department of Pediatric Cardiac Critical Care, Children's
Hospital of Pittsburgh, Pittsburgh, PA, United States
Title
Acute hemodynamic changes after rapid intravenous bolus dosing of
dexmedetomidine in pediatric heart transplant patients undergoing routine
cardiac catheterization.
Source
Anesthesia and Analgesia. 111 (6) (pp 1490-1496), 2010. Date of
Publication: December 2010.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background: Dexmedetomidine is a highly selective <sup>alpha</sup>
<sub>2</sub>-adrenoceptor agonist with sedative, anxiolytic, and analgesic
properties that has minimal effects on respiratory drive. Its sedative and
hypotensive effects are mediated via central <sup>alpha</sup><sub>2A</sub>
and imidazoline type 1 receptors while activation of peripheral
<sup>alpha</sup><sub>2B</sub>-adrenoceptors result in an increase in
arterial blood pressure and systemic vascular resistance. In this
randomized, prospective, clinical study, we attempted to quantify the
short-term hemodynamic effects resulting from a rapid IV bolus
administration of dexmedetomidine in pediatric cardiac transplant
patients. Methods: Twelve patients, aged 10 years or younger, weighing
<=40 kg, presenting for routine surveillance of right and left heart
cardiac catheterization after cardiac transplantation were enrolled. After
an inhaled or IV induction, the tracheas were intubated and anesthesia was
maintained with 1 minimum alveolar concentration of isoflurane in room
air, fentanyl (1 mug/kg), and rocuronium (1 mg/kg). At the completion of
the planned cardiac catheterization, 100% oxygen was administered. After
recording a set of baseline values that included heart rate (HR), systolic
blood pressure, diastolic blood pressure, central venous pressure,
systolic pulmonary artery pressure, diastolic pulmonary artery pressure,
pulmonary artery wedge pressure, and thermodilution-based cardiac output,
a rapid IV dexmedetomidine bolus of either 0.25 or 0.5 mug/kg was
administered over 5 seconds. The hemodynamic measurements were repeated at
1 minute and 5 minutes. Results: There were 6 patients in each group.
Investigation suggested that systolic blood pressure, diastolic blood
pressure, systolic pulmonary artery pressure, diastolic pulmonary artery
pressure, pulmonary artery wedge pressure, and systemic vascular
resistance all increased at 1 minute after rapid IV bolus for both doses
and decreased significantly to near baseline for both doses by 5 minutes.
The transient increase in pressures was more pronounced in the systemic
system than in the pulmonary system. In the systemic system, there was a
larger percent increase in the diastolic pressures than the systolic
pressures. Cardiac output, central venous pressure, and pulmonary vascular
resistance did not change significantly. HR decreased at 1 minute for both
doses and was, within the 0.5 mug/kg group, the only hemodynamic variable
still changed from baseline at the 5-minute time point. Conclusion: Rapid
IV bolus administration of dexmedetomidine in this small sample of
children having undergone heart transplants was clinically well tolerated,
although it resulted in a transient but significant increase in systemic
and pulmonary pressure and a decrease in HR. In the systemic system, there
is a larger percent increase in the diastolic pressures than the systolic
pressures and, furthermore, these transient increases in pressures were
more pronounced in the systemic system than in the pulmonary system.
Copyright 2010 International Anesthesia Research Society.
<2>
Accession Number
2011003600
Authors
Adamson P.B. Abraham W.T. Aaron M. Aranda Jr. J.M. Bourge R.C. Smith A.
Stevenson L.W. Bauman J.G. Yadav J.S.
Institution
(Adamson) Heart Failure Institute, Oklahoma Heart Hospital, Oklahoma
Foundation for Cardiovascular Research, Oklahoma City, OK, United States
(Abraham) Ohio State University Medical Center, Ross Cardiovascular
Research Institute, Columbus, OH, United States
(Aaron) St Thomas Hospital Department of Cardiology, Nashville, TN, United
States
(Aranda Jr.) University of Florida College of Medicine, Gainesville, FL,
United States
(Bourge) University of Alabama, Birmingham, AL, United States
(Smith) Emory University Hospital, Atlanta, GA, United States
(Stevenson) Brigham and Women's Hospital, Boston, MA, United States
(Bauman, Yadav) CardioMEMS, Atlanta, GA, United States
(Yadav) Piedmont Hospital, Atlanta, GA, United States
Title
CHAMPION trial rationale and design: The long-term safety and clinical
efficacy of a wireless pulmonary artery pressure monitoring system.
Source
Journal of Cardiac Failure. 17 (1) (pp 3-10), 2011. Date of Publication:
January 2011.
Publisher
Churchill Livingstone Inc. (650 Avenue of the Americas, New York NY 10011,
United States)
Abstract
Background: Decompensated heart failure (HF) is associated with
unacceptable morbidity and mortality risks. Recent implantable technology
advancements allow frequent filling pressure monitoring and provide
insight into HF pathophysiology and a new tool for HF management. Methods:
The CHAMPION trial is a prospective, multicenter, randomized, single-blind
clinical trial testing the hypothesis that HF management guided by
frequently assessed pulmonary artery pressures is superior to traditional
methods. A total of 550 subjects with New York Heart Association (NYHA)
functional class III HF were enrolled at 64 sites in the United States.
All subjects received the CardioMEMS HF sensor as a permanent pulmonary
artery implant and were randomized to the treatment or the control group
before discharge. The treatment group received traditional HF management
guided by hemodynamic information from the sensor. The control group
received traditional HF disease management. Safety endpoints include
freedom from device/system-related complications and freedom from HF
sensor failure at 6 months. The efficacy endpoint is a reduction in the
rate of HF-related hospitalizations in the treatment group versus the
control group at 6 months. Conclusions: The CHAMPION trial will
investigate the safety and clinical efficacy of the CardioMEMS hemodynamic
monitoring system and may establish this management strategy as a new
paradigm for the medical management of patients with symptomatic HF. 2011
Elsevier Inc. All rights reserved.
<3>
Accession Number
2010710466
Authors
Sato T. Carvalho G. Sato H. Lattermann R. Schricker T.
Institution
(Sato, Carvalho, Sato, Lattermann, Schricker) Department of Anaesthesia,
Royal Victoria Hospital, McGill University Health Centre, Montreal, QC,
Canada
Title
Glucose and insulin administration while maintaining normoglycemia during
cardiac surgery using a computer-assisted algorithm.
Source
Diabetes Technology and Therapeutics. 13 (1) (pp 79-84), 2011. Date of
Publication: 01 Jan 2011.
Publisher
Mary Ann Liebert Inc. (140 Huguenot Street, New Rochelle NY 10801-5215,
United States)
Abstract
Background: Applying the principles of the hyperinsulinemic-normoglycemic
clamp technique we have introduced glucose and insulin administration
while maintaining normoglycemia (GIN therapy) to surgical patients. The
objective of this study was to evaluate a novel computer software (GIN
Computer Software [GINCS]) program using an algorithm based on the
original clamp equation and modified for its use during cardiac surgery.
Methods: Thirty-six patients without diabetes undergoing elective cardiac
surgery were randomly assigned to manually controlled or computer-guided
GIN therapy. In both groups insulin was administered at 5 mU/kg/min during
surgery. Simultaneously, 20% dextrose was infused at a rate adjusted to
maintain blood glucose (BG) between 4.0 and 6.0 mmol/L. The adjustments
were made either following an algorithm based on our previous GIN
experience or suggestions made by the software program. The primary
outcome was the achievement of target glycemia. Results: Normoglycemia was
achieved in both groups as reflected by mean BG concentrations of 5.0 +/-
0.5 mmol/L and 5.1 +/- 0.2 mmol/L. Mean sampling intervals were longer in
the GINCS group than in the manual group (21.5 +/- 1.9 vs. 14.2 +/- 2.2
min, P < 0.001). The GINCS therapy was associated with a greater
percentage of BG measurements within target (manual group, before
cardiopulmonary bypass [CPB] 79.7%, during CPB 68.1%, and after CPB 69.1%;
GINCS group, before CPB 94.1%, during CPB 92.4%, and after CPB 97.7%; P <
0.001). No hypoglycemia was observed. Conclusions: The use of a
computer-guided GIN protocol in patients without diabetes undergoing open
heart surgery provided excellent and safe glycemic control. Copyright
2011, Mary Ann Liebert, Inc. 2011.
<4>
Accession Number
2010710689
Authors
Adluri R.K.P. Singh A.V. Skoyles J. Robins A. Parton J. Baker M. Mitchell
I.M.
Institution
(Adluri, Singh, Mitchell) Departments of Cardiac Surgery, United Kingdom
(Skoyles) Departments of Cardiac Anaesthesia, United Kingdom
(Baker) Departments of Clinical Perfusion, Trent Cardiac Centre,
Nottingham City Hospital, Nottingham, United Kingdom
(Robins) Department of Immunology, Queen's Medical Centre, Nottingham,
United Kingdom
(Parton) Department of Medical Microbiology, Wales College of Medicine,
Cardiff University, Cardiff, United Kingdom
Title
The eff ect of fenoldopam and dopexamine on cytokine and endotoxin release
following on-pump coronary artery bypass grafting: A prospective
randomized double-blind trial.
Source
Heart Surgery Forum. 13 (6) (pp E353-E361), 2010. Date of Publication:
December 2010.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Background: Surgical trauma, exposure to an external circuit, and reduced
organ perfusion contribute to the systemic inflammatory response following
cardiopulmonary bypass (CPB). Reduced splanchnic perfusion causes
disruption of the gastrointestinal mucosal barrier and the release of
endotoxins. Fenoldopam (a new dopamine 1 receptor agonist) has been shown
to be a specific renosplanchnic vasodilator in animal and human studies.
We studied the effects of fenoldopam on the systemic inflammatory response
and the release of endotoxins after CPB and compared the results with
those for dopexamine. Methods: Our prospective randomized study included
42 consecutive patients with good to moderate left ventricular function
who were to undergo elective or inpatient coronary artery bypass grafting.
We used closed envelope method to randomize patients to receive 0.2 mug/kg
per minute of fenoldopam (n = 14), 2 mug/kg per minute of dopexamine (n =
14), or normal saline (n = 14). Patients received their respective
treatments continuously from anesthesia induction until the end of the
first 24 postoperative hours. Interleukin 1beta (IL-1beta), IL-6, IL-8,
IL-10, IL-12, tumor necrosis factor alpha, complement 3a (C3a), C4a, C5a,
and endotoxins were measured during the perioperative period.
Repeated-measures analysis of variance was used to evaluate the results
for the timed samples. Results: There were no statistical differences
between the groups with respect to pre- and intraoperative variables.
Release of C3a was attenuated in the fenoldopam group (P = .002), and
release of IL-6 and IL-8 was attenuated in the postoperative period in the
fenoldopam group (P = .012 and .015, respectively). The other interleukins
showed no uniform release in any of the 3 groups. There were no
statistically significant differences in serum endotoxin elevation between
the 3 groups. Conclusion: A partial attenuation in the inflammatory
response is possible with fenoldopam infusion. The elevation in serum
endotoxin levels was not affected by dopexamine or fenoldopam infusion.
2010 Forum Multimedia Publishing, LLC.
<5>
Accession Number
2010711038
Authors
Sheth S. Wang D.D. Kasapis C.
Institution
(Sheth) Department of Internal Medicine, University of Michigan, Ann
Arbor, MI, United States
(Kasapis) Division of Cardiovascular Medicine, University of Michigan, Ann
Arbor, MI, United States
(Wang) Henry Ford Hospital, Division of Cardiovascular Medicine, 2799 west
Grand Blvd, K-14, Detroit, MI, United States
Title
Current and emerging strategies for the treatment of acute pericarditis: A
systematic review.
Source
Journal of Inflammation Research. 3 (1) (pp 135-142), 2010. Date of
Publication: 2010.
Publisher
Dove Medical Press (Beechfield House, Winterton Way, Macclesfield SK11
0JL, United Kingdom)
Abstract
Pericarditis is a common disorder that has multiple causes and presents in
various primary-care and secondary-care settings. It is diagnosed in 0.1%
of all hospital admissions and in 5% of emergency room visits for chest
pain. Despite the advance of new diagnostic techniques, pericarditis is
most commonly idiopathic, and radiation therapy, cardiac surgery, and
percutaneous procedures have become important causes. Pericarditis is
frequently benign and self-limiting. Nonsteroidal anti-inflammatory agents
remain the first-line treatment for uncomplicated cases. Integrated use of
new imaging methods facilitates accurate detection and management of
complications such as pericardial effusion or constriction. In this
article, we perform a systematic review on the etiology, clinical
presentation, diagnostic evaluation, and management of acute pericarditis.
We summarize current evidence on contemporary and emerging treatment
strategies. 2010 Sheth et al.
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