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<1>
Accession Number
2011574110
Authors
Kernan S. Rehman S. Meyer T. Bourbeau J. Caron N. Tobias J.D.
Institution
(Kernan, Rehman, Meyer, Bourbeau) Department of Anesthesiology, University
of Missouri, Columbia, MO, United States
(Caron) Department of Cardiothoracic Surgery, University of Missouri,
Columbia, MO, United States
(Tobias) Department of Anesthesiology and Pain Medicine, Nationwide
Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United
States
Title
Effects of dexmedetomidine on oxygenation during one-lung ventilation for
thoracic surgery in adults.
Source
Journal of Minimal Access Surgery. 7 (4) (pp 227-231), 2011. Date of
Publication: October-December 2011.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
STUDY OBJECTIVE: To evaluate the effects of dexmedetomidine on hypoxic
pulmonary vasoconstriction (HPV) and oxygenation during one-lung
ventilation (OLV) in adults undergoing thoracic surgery. DESIGN:
Prospective, randomized, double-blinded trial. SETTING: Tertiary care,
University-based hospital. PATIENTS: Nineteen adult patients undergoing
thoracic surgery requiring OLV. INTERVENTIONS: During inhalational
anesthesia with desflurane, patients were randomized to receive either
dexmedetomidine (bolus dose of 0.3 mug/kg followed by an infusion of 0.3
mug/kg/hr) or saline placebo. MEASUREMENTS: Three arterial blood gas
samples (ABG) were obtained to evaluate the effects of dexmedetomidine on
oxygenation. Secondary outcomes included differences in hemodynamic
parameters (heart rate and mean arterial pressure), end-tidal desflurane
concentration required to maintain the bispectral index (BIS) at 40-60,
supplemental fentanyl to maintain hemodynamic stability, and phenylephrine
to keep the mean arterial pressure (MAP) within 10% of baseline values.
MAIN RESULTS: Oxygenation during OLV did not change following the
administration of dexmedetomidine (PaO2/FiO2 ratio of 188 +/- 115 in
dexmedetomidine patients versus 135 +/- 70 mmHg in placebo patients).
There were no differences in hemodynamic variables or depth of anaesthesia
between the two groups. With the administration of dexmedetomidine, there
was a decrease in the expired concentration of desflurane required to
maintain the BIS at 40-60 when compared with the control group (4.5 +/-
0.8% versus 5.1 +/- 0.8%). In patients receiving dexmedetomidine, fentanyl
requirements were decreased when compared to placebo (2.7 mug/kg/patient
versus 3.1 mug/kg/patient). However, more patients receiving
dexmedetomidine required phenylephrine to maintain hemodynamic stability
(6 of 9 patients versus 3 of 10 patients) and the total dose of
phenylephrine was greater in patients receiving dexmedetomidine when
compared with placebo 10.3 mug/kg/patient versus 1.1 mug/kg/patient).
CONCLUSION: Dexmedetomidine does not adversely affect oxygenation during
OLV in adults undergoing thoracic surgical procedures. The improvement in
oxygenation in the dexmedetomidine patients may be related to a decrease
in the requirements for inhalational anaesthetic agents thereby limiting
its effects on HPV.
<2>
Accession Number
2011584716
Authors
Wang H. Wu H. Jiang H. Wang Z. Potapov E. Stepanenko A.
Institution
(Wang, Wu, Jiang, Wang) Division of Cardiovascular Surgery, Northern
Hospital, Shenyang, China
(Potapov, Stepanenko) Department of Thoracic Cardiovascular Surgery,
Deutches Herzzentrum Berlin, Berlin, Germany
Title
Initial experience with endoscopic saphenous vein harvesting for coronary
artery bypass graft ing in Chinese patients.
Source
Heart Surgery Forum. 14 (5) (pp E291-E296), 2011. Date of Publication:
October 2011.
Publisher
Carden Jennings Publishing Co. Ltd (375 Greenbrier Drive, Suite #100,
Charlottesville VA 22901-1618, United States)
Abstract
Objective: We aimed to investigate the initial experience of endoscopic
vein harvesting (EVH) for coronary artery bypass grafting (CABG) in
Chinese patients. Methods: Forty patients scheduled for isolated CABG were
prospectively randomized into an EVH group (n = 20) and an open vein
harvesting (OVH) group (n = 20). Clinical data were collected, and all of
the vein grafts were assessed by macroscopic appearance, histologic
quality (endothelial integrity), and functional characteristics of
endothelial nitric oxide synthase. Results: The 2 groups were similar with
respect to hospital mortality (EVH group, 0; OVH group, 1; P = 1). There
were no postoperative myocardial infarctions in either group and no deaths
or reinterventions in either group during the follow-up period. Harvesting
times in the 2 groups were similar (EVH, 12.15 +/- 2.32 min; OVH, 12.55
+/- 2.11 min; P = .571). Three patients in the EVH group were converted to
a partly open or skin-bridge technique. Electrocautery at least 2 mm
distal to the origin of the side branch was the safety margin.
Conclusions: The use of EVH in Chinese patients was not related to adverse
events and may be safely used for CABG procedures. Preoperative duplex
mapping, systemic heparinization before harvesting, minimal surgical
manipulation, and sectioning of side branches at least 2 mm distal to the
origin may help improve the quality of vein grafts harvested with EVH and
maximize the benefit of this less-invasive technique. 2011 Forum
Multimedia Publishing, LLC.
<3>
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Accession Number
2011576943
Authors
Tricoci P. Newby L.K. Hasselblad V. Kong D.F. Giugliano R.P. White H.D.
Theroux P. Stone G.W. Moliterno D.J. Van De Werf F. Armstrong P.W.
Prabhakaran D. Rasoul S. Bolognese L. Durand E. Braunwald E. Califf R.M.
Harrington R.A.
Institution
(Tricoci, Newby, Hasselblad, Kong, Harrington) Duke Clinical Research
Institute, PO Box 17969, Durham, NC 27715, United States
(Giugliano, Braunwald) TIMI Study Group, Brigham and Women's Hospital,
Boston, MA, United States
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Theroux) Institute de Cardiologie de Montreal, University de Montreal,
Quebec, Canada
(Stone) New York-Presbyterian Hospital, Columbia University Medical
Center, New York, NY, United States
(Moliterno) Gill Heart Institute, University of Kentucky, Lexington, KY,
United States
(Van De Werf) University Hospital Gasthuisberg, Leuven Coordinating
Center, Leuven, Belgium
(Armstrong) University of Alberta, Edmonton, AB, Canada
(Prabhakaran) Center for Chronic Disease Control, Safdarjung Development
Area, New Delhi, India
(Rasoul) Department of Cardiology, Isala klinieken, Zwolle, Netherlands
(Bolognese) Division of Cardiology, San Donato Hospital, Arezzo, Italy
(Durand) University Paris Descartes, Cardiology Department, European
Georges Pompidou Hospital, Paris, France
(Califf) Duke Translational Medical Institute, Durham, NC, United States
Title
Upstream use of small-molecule glycoprotein IIb/IIIa inhibitors in
patients with non-ST-segment elevation acute coronary syndromes a
systematic overview of randomized clinical trials.
Source
Circulation: Cardiovascular Quality and Outcomes. 4 (4) (pp 448-458),
2011. Date of Publication: July 2011.
Publisher
Lippincott Williams and Wilkins (351 West Camden Street, Baltimore MD
21201-2436, United States)
Abstract
Background-The use of upstream small-molecule glycoprotein (GP) IIb/IIIa
inhibitors in non-ST-segment elevation acute coronary syndromes (NSTE ACS)
has been studied in multiple randomized clinical trials. We systematically
reviewed the effect of upstream GP IIb/IIIa inhibitor use in NSTE ACS as
reported in published clinical trials. Methods and Results-Randomized
clinical trials of upstream small-molecule GP IIb/IIIa inhibitors in NSTE
ACS were identified through a PubMed and EMBASE search and were included
if they contained 30-day outcome data. Odds ratios were generated from the
published data and pooled by means of random effects modeling. The primary
outcome measures were 30-day death and 30-day death or myocardial
infarction. Primary safety measures were major bleeding and transfusion
during the index hospitalization. Twelve clinical trials were included,
evaluating tirofiban, eptifibatide, and lamifiban. Of these, 7 evaluated
upstream GP IIb/IIIa inhibitors versus placebo (n=24 031) and 5 evaluated
a strategy of upstream GP IIb/IIIa inhibitors versus upstream placebo with
later provisional use at the time of percutaneous coronary intervention
(n=19 643). Overall, upstream GP IIb/IIIa inhibitor use was associated
with an 11% reduction in 30-day death/myocardial infarction (odds ratio
[OR], 0.89; 95% confidence interval [CI], 0.83 to 0.95) but no significant
mortality effect (OR, 0.93; 95% CI, 0.83 to 1.05). The risk of major
bleeding was 23% higher in patients treated with upstream GP IIb/IIIa
inhibitors (OR, 1.23; 95% CI, 1.02 to 1.48). Results were similar when
only trials comparing upstream GP IIb/IIIa inhibitors versus placebo were
considered: 30-day death/myocardial infarction (OR, 0.88; 95% CI, 0.81 to
0.95); 30-day death (OR, 0.89; 95% CI, 0.76 to 1.03); and major bleeding
(OR, 1.17; 95% CI, 0.88 to 1.54). Upstream versus selective use at
percutaneous coronary intervention trended toward lower 30-day
death/myocardial infarction (OR, 0.91; 95% CI, 0.82 to 1.01) but had no
effect on mortality (OR, 1.00; 95% CI, 0.81 to 1.23) and increased major
bleeding risk by 34% (OR, 1.34; 95% CI, 1.10 to 1.63). Conclusions-In NSTE
ACS, treatment with upstream small-molecule GP IIb/IIIa inhibitors
provides a significant but modest ischemic benefit when compared with
initial placebo. Compared with delayed, selective use at percutaneous
coronary intervention, early upstream use is associated with a trend
toward fewer ischemic events. However, these modest benefits are
associated with an increased risk of bleeding. 2011 American Heart
Association, Inc.
<4>
Accession Number
2011584335
Authors
Dungan K. Hall C. Schuster D. Osei K.
Institution
(Dungan, Hall, Schuster, Osei) Division of Endocrinology, Diabetes, and
Metabolism, Ohio State University, 491 McCampbell Hall, 1581 Dodd Dr,
Columbus, OH 43210, United States
Title
Comparison of 3 algorithms for basal insulin in transitioning from
intravenous to subcutaneous insulin in stable patients after
cardiothoracic surgery.
Source
Endocrine Practice. 17 (5) (pp 753-758), 2011. Date of Publication: 01
Sep 2011.
Publisher
Endocrine Practice (245 Riverside Ave,Suite 200, Jacksonville FL 32202,
United States)
Abstract
Objective: To determine the effectiveness of an algorithm containing 1 of
3 initial subcutaneous doses of insulin detemir and flexible prandial and
supplemental insulin aspart in stable patients who have undergone cardiac
surgery and are being transitioned off intravenous insulin infusion.
Methods: Patients were extubated, were not taking vasopressors, and were
otherwise stable, requiring at least 1 unit per hour of intravenous
insulin at least 48 hours after surgery. Patients were randomly assigned
to once-daily insulin detemir at 50%, 65%, or 80% of intravenous basal
insulin requirements and received insulin aspart according to carbohydrate
intake. The dose of insulin detemir was adjusted daily over 72 hours.
Results: Eighty-two patients were included. The percentages of patients
with an initial morning glucose concentration of 80 to 130 mg/dL were 36%,
63%, and 56% of patients at the 50%, 65%, and 80% doses, respectively (P =
.12). However, the mean overall glucose value at 24 and 72 hours was
similar between groups, and 86%, 93%, and 92% of patients in each group,
respectively, achieved a mean glucose concentration of 80 to 180 mg/dL at
72 hours (P = .60). Hypoglycemia (glucose <65 mg/dL) only occurred in the
65% group (21%) and the 80% group (12%) over the first 72 hours (P = .02
in the 50% group compared with the 65% and 80% groups combined) with 1
event of a glucose concentration less than 40 mg/dL in the 80% group.
There was no loss of glycemic control by the end of the once-daily dosing
interval. Conclusions: Glycemic targets can be achieved without
hypoglycemia by 72 hours in most patients who have undergone cardiac
surgery and require intravenous insulin with a regimen consisting of an
initial insulin detemir dose of 50% of basal intravenous insulin
requirements and prandial and supplemental insulin. Copyright 2011 AACE.
<5>
Accession Number
2011577187
Authors
Tamborero D. Vidal B. Tolosana J.M. Sitges M. Berruezo A. Silva E. Castel
M. Matas M. Arbelo E. Rios J. VillacastIn J. Brugada J. Mont L.
Institution
(Tamborero, Vidal, Tolosana, Sitges, Berruezo, Silva, Castel, Matas,
Arbelo, Brugada, Mont) Thorax Institute, Hospital Clinic, Universitat de
Barcelona, Villarroel170, 08036 Barcelona, Catalonia, Spain
(Rios) Laboratory of Biostatistics and Epidemiology, Universitat Autonoma
de Barcelona, Spain
(Rios) Hospital Clinic, Universitat de Barcelona, Institut
d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Catalonia,
Spain
(VillacastIn) Arrhythmia Unit, Hospital Clinico, Universitario San Carlos,
Madrid, Spain
Title
Electrocardiographic versus echocardiographic optimization of the
interventricular pacing delay in patients undergoing cardiac
resynchronization therapy.
Source
Journal of Cardiovascular Electrophysiology. 22 (10) (pp 1129-1134),
2011. Date of Publication: October 2011.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Electrocardiographic VV Optimization. Introduction: Echocardiographic
optimization of the VV interval may improve CRT response, but it is
time-consuming and not routinely performed. The aim of this study was to
compare the response to cardiac resynchronization therapy (CRT) when the
interventricular pacing (VV) interval was optimized by Tissue Doppler
Imaging (TDI) to CRT response when it was optimized following QRS width
criteria. Methods and Results: The study included 156 consecutive CRT
patients with severe heart failure and left bundle-branch block
configuration. Atrioventricular interval was selected according to a
pulsed Doppler assessment, and VV optimization was randomly assigned to
echocardiography (ECHO group, n = 78) or electrocardiography (ECG group, n
= 78). Optimal VV was defined for the ECHO group as producing the best LV
intraventricular synchrony according to TDI displacement curves and for
the ECG group as resulting in the narrowest QRS measured from the earliest
deflection. At 6-month follow-up, percentage of echocardiographic
responders (defined as neither death nor heart transplantation and a LV
end-systolic volume reduction >10%) was higher in the ECG optimized group
(50.0% vs 67.9%; P = 0.023), whereas clinical response (defined as neither
death nor heart transplantation and >10% improvement in the 6-minute
walking test) was similar in both groups (71.8% vs 73.1%; P = 0.858).
Conclusions: VV optimization based on QRS width obtained a higher
percentage of responders in terms of LV reverse remodeling compared to the
TDI method. 2011 Wiley Periodicals, Inc.
<6>
Accession Number
21991740
Authors
Akhlagh S.H. Vaziri M.T. Masoumi T. Anbardan S.J.
Institution
(Akhlagh) Department of Anesthesiology, Nemazee Hospital, Shiraz
University of Medical Sciences, Shiraz, Iran.
Title
Hemodynamic response to tracheal intubation via direct laryngoscopy and
intubating laryngeal mask airway (ILMA) in patients undergoing coronary
artery bypass graft (CABG).
Source
Middle East journal of anesthesiology. 21 (1) (pp 99-103), 2011. Date of
Publication: Feb 2011.
Abstract
A marked stress response including hypertension, tachycardia, arrhythmias
and an increase in intracranial pressure often follows direct
laryngoscopy. This response can be harmful specially in patients with
underlying cardiac disease. The intubating laryngeal mask airway (ILMA)--a
new modified laryngeal mask airway--has been introduced that facilitates
tracheal intubation without using laryngoscopy. Oropharyngeal
stimulation-proposed as the probable cause of stress response--have been
shown to be attenuated in ILMA. We conducted this study to evaluate the
stress response following two techniques in patients undergoing coronary
artery surgery which are most likely to benefit from decreased hemodynamic
changes during intubation. In this trial, eighty patients, forty in ILMA
group and forty in DL group were involved. To determine hemodynamic
response during these manipulations, blood pressure (BP) and heart rate
(HR) were recorded before and after anesthetic induction (one minute
before and one, two and five minutes after successful intubation via
either method). A significant increase in heart rate and blood pressure
was detected in both groups after intubation. Despite existence of noted
changes in both groups; quantity of these changes was similar in both
groups, however quality of changes was not completely similar. Finally we
could hardly ascertain if intubation with ILMA is a prefered method in
patients with high cardiac risk or not. But it seems that ILMA does not
have much greater benefit over conventional DL in patients undergoing
coronary artery by-pass grafting.
<7>
Accession Number
21991734
Authors
Kaye A.D. Fox C.J. Hymel B.J. Gayle J.A. Hawney H.A. Bawcom B.A. Cotter
T.D.
Institution
(Kaye) LSU School of Medicine, Department of Anesthesiology, New Orleans,
Louisiana, USA.
Title
The importance of training for ultrasound guidance in central vein
catheterization.
Source
Middle East journal of anesthesiology. 21 (1) (pp 61-66), 2011. Date of
Publication: Feb 2011.
Abstract
To review the complication and success rates associated with CVC placement
in patients undergoing cardiovascular surgery depending on the technique
utilized and the degree of ultrasound experience of the anesthesia
provider. Randomized controlled trial. Operating room and post anesthesia
care unit. 325 patients with CAD requiring cardiovascular surgery with an
ASA of III or above. The subjects underwent CVC of the Internal Jugular
vein with or without ultrasound guidance in preparation for cardiovascular
surgery. Utilization of US, carotid artery puncture/cannulation and the
presence of post procedure pneumothorax. When comparing the group that had
CVC without US versus the group having CVC placement with US, there was
significant difference in complication rates based on Z-testing (95%
confidence level). Furthermore, with 90% confidence (based on Z-testing)
there was a significant difference in complication rates between the
experienced and non experienced US practitioners. With adequate US
training, the complications from CVC including carotid artery puncture and
pneumothorax can be significantly reduced.
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