Results Generated From:
Embase <1980 to 2011 Week 49>
Embase (updates since 2011-12-01)
<1>
Accession Number
2011643674
Authors
Mantz J. Samama C.M. Tubach F. Devereaux P.J. Collet J.-P. Albaladejo P.
Cholley B. Nizard R. Barre J. Piriou V. Poirier N. Mignon A. Schlumberger
S. Longrois D. Aubrun F. Farese M.E. Ravaud P. Steg P.G.
Institution
(Mantz) APHP, Hopital Beaujon, Service d'Anesthesie Reanimation et SMUR,
Clichy F-92110, France
(Mantz, Tubach, Nizard, Farese, Steg) Universite Paris Diderot, Paris
F-75018, France
(Mantz) INSERM U 676, Paris F-75019, France
(Samama, Ravaud) Universite Paris Descartes, Paris F-75005, France
(Samama, Ravaud) APHP, Hopital Hotel-Dieu, Centre d'Epidemiologie
Clinique, Paris F-75004, France
(Tubach, Farese, Ravaud) INSERM, UMR-S 738, Paris F-75018, France
(Tubach, Farese, Ravaud) Universite Paris Diderot, UMR-S 738, Paris
F-75018, France
(Tubach, Farese) INSERM, CIE 801, Paris F-75018, France
(Tubach) APHP, Hopital Bichat-Claude Bernard, Departement d'Epidemiologie,
Biostatistique et Recherche Clinique, Paris F-75018, France
(Devereaux, Farese) Department of Clinical Epidemiology and Biostatistics,
Michael de Groote School of Medicine, McMaster University, Hamilton, ON,
Canada
(Devereaux, Farese) Department of Medicine, Michael de Groote School of
Medicine, McMaster University, Hamilton, ON, Canada
(Collet) Institut de Cardiologie, INSERM UMRS 937, APHP, Hopital
Pitie-Salpetriere, Paris F-75013, France
(Collet) Universite Pierre et Marie Curie, Paris F-75013, France
(Albaladejo) Centre Hospitalier Universitaire, Pole d'Anesthesie et de
Reanimation, Grenoble, France
(Albaladejo) Universite Joseph Fourier, Grenoble F-38043, France
(Cholley) APHP Hopital Europeen Georges Pompidou, Service d'Anesthesie
Reanimation, Paris F-75015, France
(Nizard) APHP, Hopital Lariboisiere, Service de chirurgie orthopedique,
Paris F-75018, France
(Barre) Centre Hospitalier Universitaire, Service d'Anesthesie
Reanimation, Reims F-51000, France
(Piriou) Hopitaux Universitaires de Lyon, Groupe Hospitalier Sud, Service
d'Anesthesie Reanimation, Lyon F-69000, France
(Poirier) Centre Hospitalier Universitaire, Service d'Anesthesie
Reanimation, Angers F-49000, France
(Mignon) APHP Hopital Cochin, Service d'Anesthesie Reanimation, Universite
Paris Descartes, Paris F-75005, France
(Schlumberger) CMC Foch, Service d'Anesthesie Reanimation, Suresnes
F-92200, France
(Longrois) INSERM U-676, Paris, France
(Longrois) Universite Paris Diderot, Paris, France
(Longrois) APHP, Hopital Bichat-Claude Bernard, Service d'Anesthesie
Reanimation, Paris F-75018, France
(Aubrun) Hopitaux Universitaires de Lyon, Groupe Hospitalier Nord, Service
d'Anesthesie Reanimation, Lyon F-69000, France
(Steg) INSERM U-698, Paris, France
(Steg) AP-HP, Hopital Bichat-Claude Bernard, Service de Cardiologie, Paris
F-75018, France
Title
Impact of preoperative maintenance or interruption of aspirin on
thrombotic and bleeding events after elective non-cardiac surgery: The
multicentre, randomized, blinded, placebo-controlled, STRATAGEM trial.
Source
British Journal of Anaesthesia. 107 (6) (pp 899-910), 2011. Date of
Publication: December 2011.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Background. Patients receiving anti-platelet agents for secondary
cardiovascular prevention frequently require non-cardiac surgery. A
substantial proportion of these patients have their anti-platelet drug
discontinued before operation; however, there is uncertainty about the
impact of this practice. The aim of this study was to compare the effect
of maintenance or interruption of aspirin before surgery, in terms of
major thrombotic and bleeding events. Methods. Patients treated with
anti-platelet agents for secondary prevention and undergoing intermediate-
or high-risk non-cardiac surgery were included in this multicentre,
randomized, placebo-controlled, trial. We substituted non-aspirin
anti-platelets with aspirin (75 mg daily) or placebo starting 10 days
before surgery. The primary outcome was a composite score evaluating both
major thrombotic and bleeding adverse events occurring within the first 30
postoperative days weighted by their severity (weights were established a
priori using a Delphi consensus process). Analyses followed the
intention-to-treat principle. Results. We randomized 291 patients (n=145,
aspirin group, and n=146, placebo group). The most frequent surgical
procedures were orthopaedic surgery (52.2%), abdominal surgery (20.6%),
and urologic surgery (15.5%). No significant difference was observed
neither in the primary outcome score [mean values (sd)=0.67 (2.05) in the
aspirin group vs 0.65 (2.04) in the placebo group, P=0.94] nor at day 30
in the number of major complications between groups. Conclusions. In these
at-risk patients undergoing elective non-cardiac surgery, we did not find
any difference in terms of occurrence of major thrombotic or bleeding
events between preoperative maintenance or interruption of aspirin. The
Author [2011]. Published by Oxford University Press on behalf of the
British Journal of Anaesthesia. All rights reserved.
<2>
Accession Number
21733178
Authors
Bilotta F. Doronzio A. Stazi E. Titi L. Zeppa I.O. Cianchi A. Rosa G.
Paoloni F.P. Bergese S. Asouhidou I. Ioannou P. Abramowicz A.E. Spinelli
A. Delphin E. Ayrian E. Zelman V. Lumb P.
Institution
(Bilotta) Department of Anaesthesiology, Critical Care and Pain Medicine,
Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
Title
Early postoperative cognitive dysfunction and postoperative delirium after
anaesthesia with various hypnotics: study protocol for a randomised
controlled trial--the PINOCCHIO trial.
Source
Trials. 12 (pp 170), 2011. Date of Publication: 2011.
Abstract
Postoperative delirium can result in increased postoperative morbidity and
mortality, major demand for postoperative care and higher hospital costs.
Hypnotics serve to induce and maintain anaesthesia and to abolish
patients' consciousness. Their persisting clinical action can delay
postoperative cognitive recovery and favour postoperative delirium. Some
evidence suggests that these unwanted effects vary according to each
hypnotic's specific pharmacodynamic and pharmacokinetic characteristics
and its interaction with the individual patient.We designed this study to
evaluate postoperative delirium rate after general anaesthesia with
various hypnotics in patients undergoing surgical procedures other than
cardiac or brain surgery. We also aimed to test whether delayed
postoperative cognitive recovery increases the risk of postoperative
delirium. After local ethics committee approval, enrolled patients will be
randomly assigned to one of three treatment groups. In all patients
anaesthesia will be induced with propofol and fentanyl, and maintained
with the anaesthetics desflurane, or sevoflurane, or propofol and the
analgesic opioid fentanyl.The onset of postoperative delirium will be
monitored with the Nursing Delirium Scale every three hours up to 72 hours
post anaesthesia. Cognitive function will be evaluated with two cognitive
test batteries (the Short Memory Orientation Memory Concentration Test and
the Rancho Los Amigos Scale) preoperatively, at baseline, and
postoperatively at 20, 40 and 60 min after extubation.Statistical analysis
will investigate differences in the hypnotics used to maintain anaesthesia
and the odds ratios for postoperative delirium, the relation of early
postoperative cognitive recovery and postoperative delirium rate. A
subgroup analysis will be used to categorize patients according to
demographic variables relevant to the risk of postoperative delirium (age,
sex, body weight) and to the preoperative score index for delirium. The
results of this comparative anaesthesiological trial should whether each
the three hypnotics tested is related to a significantly different
postoperative delirium rate. This information could ultimately allow us to
select the most appropriate hypnotic to maintain anaesthesia for specific
subgroups of patients and especially for those at high risk of
postoperative delirium. REGISTERED AT TRIAL.GOV NUMBER:
ClinicalTrials.gov: NCT00507195.
<3>
Accession Number
2011651578
Authors
Mazzeffi M. Khelemsky Y.
Institution
(Mazzeffi, Khelemsky) Department of Anesthesiology, Mt Sinai School of
Medicine, New York, NY, United States
Title
Poststernotomy pain: A clinical review.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (6) (pp 1163-1178),
2011. Date of Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
<4>
Accession Number
2011651568
Authors
Li Y. Dong H. Chen M. Liu J. Yang L. Chen S. Xiong L.
Institution
(Li, Dong, Chen, Yang, Chen, Xiong) Department of Anesthesiology, Xijing
Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi
Province, China
(Liu) Department of Cardiovascular Surgery, Xijing Hospital, Fourth
Military Medical University, Xi'an, China
Title
Preconditioning with repeated hyperbaric oxygen induces myocardial and
cerebral protection in patients undergoing coronary artery bypass graft
surgery: A prospective, randomized, controlled clinical trial.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (6) (pp 908-916),
2011. Date of Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To evaluate the cerebral and myocardial protective effects of
hyperbaric oxygen preconditioning in both on-pump and off-pump coronary
artery bypass graft surgery. Design: A prospective, randomized,
single-blinded study including patients scheduled for elective on-pump or
off-pump surgery between December 2007 and February 2009. Setting: A
tertiary care university teaching hospital. Participants: Forty-nine
elective on-pump or off-pump coronary artery bypass graft surgery
patients. Interventions: Patients were randomized to either the control
(15 patients with on-pump procedure and 10 patients with off-pump
procedure, respectively) or hyperbaric oxygen (HBO; 14 patients with
on-pump procedure and 10 patients with off-pump procedure, respectively)
groups. Patients in the HBO groups underwent preconditioning for 5 days
before surgery. Measurements and Main Results: On-pump coronary artery
bypass graft surgery patients preconditioned with HBO had significant
decreases in S100B protein, neuron-specific enolase, and troponin I
perioperative serum levels compared with the on-pump control group.
Postsurgically, patients in the on-pump HBO group had a reduced length of
stay in the intensive care unit and a decreased use of inotropic drugs.
Serum catalase activity 24 hours postoperatively was significantly
increased compared with the on-pump control group. In the off-pump groups,
there was no difference in any of the same parameters. Conclusions:
Preconditioning with HBO resulted in both cerebral and cardiac protective
effects as determined by biochemical markers of neuronal and myocardial
injury and clinical outcomes in patients undergoing on-pump coronary
artery bypass graft surgery. No protective effects were noted in off-pump
coronary artery bypass graft surgery. 2011 Elsevier Inc. All rights
reserved.
<5>
Accession Number
2011640141
Authors
Takagi H. Yamamoto H. Goto S.-N. Matsui M. Umemoto T.
Institution
(Takagi, Yamamoto, Goto, Matsui, Umemoto) Department of Cardiovascular
Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun,
Shizuoka 411-8611, Japan
Title
Less invasiveness may not always result in less mortality: A meta-analysis
of transcatheter versus surgical aortic valve replacement for aortic
stenosis.
Source
International Journal of Cardiology. 153 (2) (pp 207-237), 2011. Date of
Publication: 01 Dec 2011.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
<6>
Accession Number
2011651561
Authors
Onan I.S. Onan B. Korkmaz A.A. Oklu L. Kilickan L. Gonca S. Dalcik H.
Sanisoglu I.
Institution
(Onan, Onan, Korkmaz, Sanisoglu) Department of Cardiovascular Surgery,
Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey
(Oklu, Kilickan) Department of Anesthesiology, Istanbul Bilim University,
Florence Nightingale Hospital, Istanbul, Turkey
(Gonca, Dalcik) Department of Histology and Embryology, Kocaeli
University, Kocaeli, Turkey
Title
Effects of thoracic epidural anesthesia on flow and endothelium of
internal thoracic artery in coronary artery bypass graft surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (6) (pp 1063-1070),
2011. Date of Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: The internal thoracic artery (ITA) is the preferred conduit
for coronary artery bypass graft (CABG) surgery. The authors investigated
whether thoracic epidural anesthesia (TEA) as an adjunct to general
anesthesia (GA) can increase the blood flow of the ITA. Design: A
prospective randomized study. Setting: A university hospital.
Participants: Patients with ischemic heart disease. Interventions: Thirty
patients scheduled for elective CABG surgery were randomized to receive
either GA (n = 15) or GA + TEA (n = 15) after receiving institutional
review board approval. Demographics showed similarity between the groups.
The epidural catheter was inserted in the thoracic region between T1 and
T5 levels. In the GA + TEA group, the patients received a 20-mg bolus of
0.25% bupivacaine through epidural catheters 1 hour before surgery, and
this was followed by the infusion (20 mg/h) of 0.25% bupivacaine. In all
patients, ITA free blood flow was measured before cardiopulmonary bypass
and without the administration of any vasodilatory agent. A short segment
of ITA was excised for histologic examination; immunocytochemistry
analysis was performed using antirabbit polyclonal VEGF antibody, rabbit
polyclonal inducible nitric oxide synthase (i-NOS) antibody, and adenosine
anti-A2B receptor antibody. The immunoreactivity rates then were
evaluated. Main Results: The mean ITA free flow in the GA + TEA group was
significantly higher than in the GA group (56.0 +/- 9.0 mL/min v 39.6 +/-
14 mL/min, p = 0.001). Immunostaining intensity in the sections after
incubation with each primary antibody increased in the GA + TEA group
compared with the GA group. Conclusions: The results of this study
indicated that TEA increased ITA free blood flow significantly via
increased VEGF, i-NOS, and adenosine-A2B receptor expressions. Therefore,
the use of TEA as an adjunct to GA might be considered as an alternative
to vasoactive agents for increasing ITA flow in CABG surgery. 2011
Elsevier Inc. All rights reserved.
<7>
Accession Number
2011653345
Authors
Avidan M.S. Smith J.R. Skrupky L.P. Hill L. Jacobsohn E. Burnside B.
Tymkew H. Eby C. Damiano R. Despotis G.J.
Institution
(Avidan, Hill, Burnside) Department of Anesthesiology, School of Medicine,
Washington University, 660 S Euclid, St. Louis, MO 63110, United States
(Smith, Skrupky) Department of Pharmacy, Barnes-Jewish Hospital, St.
Louis, MO, United States
(Jacobsohn) Department of Anesthesia, University of Manitoba, Winnipeg,
MB, Canada
(Tymkew) Perioperative Services, Barnes-Jewish Hospital, St. Louis, MO,
United States
(Eby, Despotis) Department of Pathology/Hematology, Washington University,
School of Medicine, St. Louis, MO, United States
(Damiano) Department of Surgery, Washington University, School of
Medicine, St. Louis, MO, United States
Title
The occurrence of antibodies to heparin-platelet factor 4 in cardiac and
thoracic surgical patients receiving desirudin or heparin for
postoperative venous thrombosis prophylaxis.
Source
Thrombosis Research. 128 (6) (pp 524-529), 2011. Date of Publication:
December 2011.
Publisher
Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom)
Abstract
Introduction: This randomized, exploratory study compared the incidence of
heparin-dependent antibodies associated with subcutaneous (SC) desirudin
or heparin given for deep-vein thrombosis prophylaxis following cardiac
and thoracic surgery. Materials and Methods: Adult patients scheduled for
elective cardiac or thoracic surgery received desirudin 15 mg SC twice
daily or unfractionated heparin 5000 units SC thrice daily. Duration of
thrombosis prophylaxis was determined by the treating physician. Primary
outcome measure was the incidence of new antibody formation directed
against platelet factor 4 (PF4)/heparin complex. Secondary outcomes
included bleeding and thrombotic complications. Blood was tested for
anti-PF4/heparin antibodies at baseline, after surgery prior to study drug
administration, postdrug day (PDD) 2, PDD 7, and at 1 month. Doppler
studies were done before discharge. Results: Of 120 patients, 61 received
desirudin, 59 received heparin. New PF4/heparin antibodies occurred in
10.2% and 13.6% of desirudin- and heparin-treated patients, respectively.
Among desirudin patients with no heparin exposure, none (0/36) developed
PF4/heparin antibodies versus 17.1% with heparin exposure. Incidence of
deep venous thrombosis was 4.9% and 3.4% in the desirudin and heparin
groups, respectively. Two heparin-group patients developed pulmonary
embolism. Two patients per group had bleeding events; no patients required
re-exploration for bleeding complications. Median chest tube output was
similar with desirudin (900 mL) and heparin (692 mL) as was blood
transfusion requirements of more than 2 units (5/61, desirudin; 2/59
heparin). Conclusions: The incidence of thrombotic events was low in both
groups. There were no safety concerns, and desirudin was not associated
with anti-PF4/heparin antibodies. 2011 Published by Elsevier Ltd.
<8>
Accession Number
2011651557
Authors
Sato H. Hatzakorzian R. Carvalho G. Sato T. Lattermann R. Matsukawa T.
Schricker T.
Institution
(Sato, Hatzakorzian, Carvalho, Sato, Lattermann, Schricker) Department of
Anaesthesia, Royal Victoria Hospital, McGill University Health Center,
Montreal, QC, Canada
(Matsukawa) Department of Anesthesiology, Yamanashi University, Yamanashi,
Japan
Title
High-dose insulin administration improves left ventricular function after
coronary artery bypass graft surgery.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (6) (pp 1086-1091),
2011. Date of Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To test the hypothesis that the intravenous administration of
high doses of insulin while maintaining normoglycemia (GIN therapy)
improves myocardial function after coronary artery bypass graft (CABG)
surgery. Design: A prospective, randomized clinical trial. Setting: A
university hospital. Participants: Forty patients undergoing elective CABG
surgery. Interventions: Patients were randomized to the GIN or control
group. Applying the principles of the hyperinsulinemic-normoglycemic clamp
technique in the GIN group, insulin was administered at 5 mU/kg/min during
surgery. Glucose 20% was infused at a rate adjusted to maintain blood
glucose (BG) between 4.0 and 6.0 mmol/L. Patients in the control group
received insulin on a sliding scale, also aiming at normoglycemia.
Measurements and Main Results: Systemic hemodynamic parameters included
heart rate, mean arterial pressure, pulmonary artery wedge pressure,
vascular resistance index, and cardiac index (CI). Left ventricular
function was assessed by transesophageal echocardiography using the
myocardial performance index (MPI) as a parameter of global left
ventricular function, the fractional area change (FAC) for systolic
function, and flow propagation velocity for diastolic function before and
after surgery. All patients receiving GIN therapy were hyperinsulinemic
(3,474 +/- 1,204 pmol/L) and normoglycemic, showing a lower mean BG
concentration (4.9 +/- 0.5 mmol/L) than patients in the control group (8.2
+/- 2.0 mmol/L). Patients receiving GIN therapy had an increased CI after
surgery compared with the control group (p = 0.005). The GIN therapy was
associated with improved MPI and FAC values when compared with standard
care. Also, there was no difference in the parameters indicating left
ventricular diastolic function. Conclusions: Intraoperative GIN therapy
improves global and systolic left ventricular function after CABG surgery.
2011 Elsevier Inc. All rights reserved.
<9>
Accession Number
2011651553
Authors
Richebe P. Pouquet O. Jelacic S. Mehta S. Calderon J. Picard W. Rivat C.
Cahana A. Janvier G.
Institution
(Richebe, Jelacic, Mehta, Rivat, Cahana) Department of Anesthesiology and
Pain Medicine, University of Washington Medical Center, Campus Box 356640,
1959 NE Pacific Street, BB1459, Seattle, WA 98195-6540, United States
(Pouquet, Calderon, Janvier) Department of Anesthesiology and Intensive
Care II, Centre Hospitalier et Universitaire de Bordeaux, Pessac, France
(Picard) Department of Intensive Care, Centre Hospitalier de Pau, Pau,
France
Title
Target-controlled dosing of remifentanil during cardiac surgery reduces
postoperative hyperalgesia.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (6) (pp 917-925),
2011. Date of Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: One of the strategies to attenuate opioid-induced hyperalgesia
(OIH) may be to decrease intraoperative doses of opioids by using
target-controlled infusion (TCI). Design: Double-blind and randomized
study. Setting: A single university hospital. Participants: Forty American
Society of Anesthesiologists II to III patients scheduled for elective
cardiac surgery. Interventions: patients were randomized to 1 of the 2
groups: 1 group received an infusion of intraoperative remifentanil using
TCI (target: 7 ng/mL), and the 2nd one was given an intraoperative
continuous infusion (CI) (0.3 mug/kg/min). The anesthestic protocol and
postoperative pain management were the same in both groups. The extent of
mechanical dynamic hyperalgesia on the middle line perpendicular to the
wound was considered the primary endpoint. The secondary endpoints were
other results of dynamic and punctuate hyperalgesia until postoperative
day 7, visual analog scale (VAS) and verbal rating scale (VRS) scores, and
total morphine consumption until postoperative day 2. Measurements and
Main Results: Morphometric and demographic characteristics and duration of
surgery were comparable in both groups. Intraoperative remifentanil
consumption was greater in CI than in TCI group (5,329 [1,833] v 3,662
[1,160] mug, p = 0.003). During the first 44 hours, there were no
differences in morphine consumption, VAS, and VRS. The extent of
hyperalgesia was significantly lower on postoperative days 1, 2, and 4 in
the TCI group than in the CI group on the 3 evaluated lines (p < 0.05).
Punctuate hyperalgesia evaluating 3 different points was lower in the TCI
than in the CI group from postoperative day 1 until postoperative day 7 (p
< 0.05). Conclusions: The intraoperative decrease of opioid consumption
when comparing the CI versus TCI mode of administration of remifentanil
led to less OIH after cardiac surgery.
<10>
Accession Number
2011651551
Authors
Lecomte P. Foubert L. Coddens J. Dewulf B. Nobels F. Casselman F. Cammu G.
Institution
(Lecomte, Foubert, Coddens, Cammu) Department of Anesthesiology and
Critical Care Medicine, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300
Aalst, Belgium
(Nobels) Department of Endocrinology, Onze-Lieve-Vrouw Hospital, Aalst,
Belgium
(Casselman) Department of Cardiothoracic and Vascular Surgery,
Onze-Lieve-Vrouw Hospital, Aalst, Belgium
(Dewulf) Department of Anesthesiology, University Hospital of Ghent,
Ghent, Belgium
Title
Management of tight intraoperative glycemic control during off-pump
coronary artery bypass surgery in diabetic and nondiabetic patients.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (6) (pp 937-942),
2011. Date of Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: To optimize intra- and postoperative insulin management in
cardiac surgical patients. Design: A prospective, randomized, open-label,
single-center study. Setting: A large nonuniversity hospital.
Participants: Sixty diabetics and 60 nondiabetics undergoing off-pump
cardiac bypass surgery. Interventions: Intra- and postoperative tight
glycemic control were achieved using different approaches with a modified
insulin protocol. Measurements and Main Results: Nondiabetics were divided
randomly: in the ND-ind group (n = 30), insulin was started at induction
according to preinduction blood glucose (BG) concentrations. In group ND
>110 (n = 30), insulin was started when BG concentrations exceeded 110
mg/dL during surgery. Up to 85% of the ND >110 group started on insulin
intraoperatively. Intraoperatively, the ND-ind group had more BG within
target (80-110 mg/dL) (p = 0.002), less BG >130 mg/dL (p = 0.015), and
more BG between 70 and 79 mg/dL (p = 0.002). In diabetics, BG
concentration was checked every 30 (DM-30), n = 30) versus 60 minutes
(DM-60, n = 30) to improve the protocol's performance. Intraoperatively,
there were more BG concentrations within target (80-110 mg/dL) (p = 0.02)
and less >130 mg/dL (p = 0.0002) in the DM-30 group. During surgery, the
hyperglycemic index and the glycemic penalty index were lower in the
ND-ind group (p < 0.05). Postoperatively, the mean BG concentrations,
hyperglycemic index, and glycemic penalty index in diabetics and
nondiabetics were comparable between groups (p < 0.05). In the overall
2,641 BG samples, the lowest BG concentration in the operating room was 71
and in the intensive care unit (ICU) it was 61 mg/dL. Conclusions: In
diabetics and nondiabetics undergoing off-pump coronary artery bypass
surgery, tight perioperative glycemic control is feasible and efficient,
with minimal risks for hypo- and hyperglycemia. In nondiabetics, starting
insulin therapy from induction onwards results in more measurements within
target, without affecting the mean BG. In diabetics, decreasing the
sampling interval from 60 to 30 minutes results in more measurements
within target and in a mean blood glucose within target at ICU arrival.
2011 Elsevier Inc. All rights reserved.
<11>
Accession Number
2011651549
Authors
Murphy G.S. Sherwani S.S. Szokol J.W. Avram M.J. Greenberg S.B. Patel K.M.
Wade L.D. Vaughn J. Gray J.
Institution
(Murphy, Szokol, Greenberg, Vaughn, Gray) Department of Anesthesiology,
NorthShore University HealthSystem, University of Chicago Pritzker School
of Medicine, Chicago, IL, United States
(Sherwani, Avram, Patel, Wade) Department of Anesthesiology, Northwestern
University Feinberg School of Medicine, Chicago, IL, United States
Title
Small-dose dexamethasone improves quality of recovery scores after
elective cardiac surgery: A randomized, double-blind, placebo-controlled
study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (6) (pp 950-960),
2011. Date of Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objectives: The use of steroid therapy in cardiac surgical patients
remains controversial. The aim of this clinical investigation was to
determine the effect of small-dose dexamethasone therapy on
patient-perceived quality of recovery (QoR) scores in elective cardiac
surgical patients. In addition, the authors assessed the impact of
dexamethasone on the incidence of common adverse events after
cardiopulmonary bypass (CPB). Design: A prospective, randomized study.
Setting: University hospitals. Participants: One hundred seventeen
patients undergoing cardiac surgery with CPB and anticipated early
tracheal extubation. Interventions: Subjects were randomized to receive
either dexamethasone (dexamethasone group, 8 mg at the induction of
anesthesia and at the initiation of CPB) or placebo (control group,
saline). Measurements and Main Results: The QoR was assessed using the
QoR-40 scoring system preoperatively and on postoperative days (PODs) 1
and 2. Secondary outcome measures assessed in the postoperative period
included nausea, vomiting, fatigue, febrile responses, shivering,
pulmonary gas exchange, and analgesic requirements. Global QoR-40 scores
(median [range]) were higher in the dexamethasone group compared with the
control group on POD 1 (167 [133-192] v 157 [108-195]; p < 0.0001) and POD
2 (173 [140-196] v 166 [122-196]; p = 0.001). In the dexamethasone group,
improved QoR was observed in the QoR-40 dimensions of emotional state (p =
0.002), physical comfort (p = 0.0001-0.006), and pain (p < 0.0001). The
incidences or severity of postoperative fatigue (p < 0.0001), febrile
responses (p < 0.0001), and shivering (p = 0.001) were reduced in the
dexamethasone group. Conclusions: Patient-perceived postoperative QoR in
cardiac surgical patients is enhanced significantly by small-dose
dexamethasone treatment. 2011 Elsevier Inc. All rights reserved.
<12>
Accession Number
2011651545
Authors
Kocum A. Sener M. Calskan E. Bozdogan N. Atalay H. Aribogan A.
Institution
(Kocum, Sener, Calskan, Bozdogan, Aribogan) Baskent Universitesi Adana
Seyhan Hastanesi, Anesteziyoloji Ve Reanimasyon AD, Barajyolu 1, Durak no
37, TR01150 Seyhan/Adana, Turkey
(Atalay) Department of Cardiovascular Surgery, Baskent University Faculty
of Medicine, Ankara, Turkey
Title
An alternative central venous route for cardiac surgery: Supraclavicular
subclavian vein catheterization.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 25 (6) (pp 1018-1023),
2011. Date of Publication: December 2011.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To evaluate the clinical success rate, safety, and usefulness
for intraoperative central venous pressure monitoring, and the intravenous
access of the supraclavicular subclavian vein approach when compared with
the infraclavicular subclavian vein approach and the internal jugular vein
approach for central venous catheterization during open-chest cardiac
surgery. Design: A prospective, randomized, single-center study. Setting:
A university hospital. Participants: One hundred ninety-five patients
scheduled for open-chest cardiac surgery. Interventions: The study
population consisted of patients for whom central vein catheterization was
intended during cardiac surgery. Patients were randomized to 3 groups
according to the route of central vein catheterization: the
supraclavicular group: the supraclavicular approach for the subclavian
vein (n = 65); the infraclavicular group: the infraclavicular approach for
the subclavian vein (n = 65); and the jugular group: the internal jugular
vein approach (n = 65). After the induction of anesthesia, central venous
catheterization was performed according to the assigned approach.
Measurements and Main Results: The success rates for the assigned approach
were 98%, 98%, and 92% for the supraclavicular, infraclavicular, and
jugular groups, respectively (p > 0.05). The success rates in the first 3
attempts in patients who were catheterized successfully according to the
assigned approach were 96%, 100%, and 96% for the supraclavicular,
infraclavicular, and jugular groups, respectively (p > 0.05). There was no
difference among groups in catheter insertion time (p > 0.05). After
sternal retraction, central venous pressure trace loss and difficulty in
fluid infusion were significantly more frequent in the infraclavicular
group (21%) when compared with the supraclavicular (3%) and jugular groups
(0%) (p = 0.01). There was no difference among groups in terms of catheter
malposition, complications during catheterization, and rate of
catheter-related infection. Conclusion: The supraclavicular approach for
subclavian vein catheterization is an acceptable alternative for central
venous access during cardiac surgery in terms of procedural success rate,
ease of placement, rate of complications, and usability after sternal
retractor expansion. 2011 Elsevier Inc. All rights reserved.
<13>
Accession Number
2011651414
Authors
Bolli R. Chugh A.R. D'Amario D. Loughran J.H. Stoddard M.F. Ikram S.
Beache G.M. Wagner S.G. Leri A. Hosoda T. Sanada F. Elmore J.B. Goichberg
P. Cappetta D. Solankhi N.K. Fahsah I. Rokosh D.G. Slaughter M.S. Kajstura
J. Anversa P.
Institution
(Bolli, Chugh, Loughran, Stoddard, Ikram, Wagner, Elmore, Solankhi,
Fahsah, Rokosh) Division of Cardiovascular Medicine, University of
Louisville, Ambulatory Care Building, 550 S Jackson Street, Louisville, KY
40202, United States
(Slaughter) Cardiothoracic Surgery, University of Louisville, Louisville,
KY, United States
(Beache) Department of Radiology, University of Louisville, Louisville,
KY, United States
(D'Amario, Leri, Hosoda, Sanada, Goichberg, Cappetta, Kajstura, Anversa)
Department of Anesthesia and Medicine, Brigham and Women's Hospital,
Harvard Medical School, Boston, MA, United States
Title
Cardiac stem cells in patients with ischaemic cardiomyopathy (SCIPIO):
Initial results of a randomised phase 1 trial.
Source
The Lancet. 378 (9806) (pp 1847-1857), 2011. Date of Publication:
November 26-December 2, 2011.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
c-kit-positive, lineage-negative cardiac stem cells (CSCs) improve
post-infarction left ventricular (LV) dysfunction when administered to
animals. We undertook a phase 1 trial (Stem Cell Infusion in Patients with
Ischemic cardiOmyopathy [SCIPIO]) of autologous CSCs for the treatment of
heart failure resulting from ischaemic heart disease. In stage A of the
SCIPIO trial, patients with post-infarction LV dysfunction (ejection
fraction [EF] <=40) before coronary artery bypass grafting were
consecutively enrolled in the treatment and control groups. In stage B,
patients were randomly assigned to the treatment or control group in a 2:3
ratio by use of a computer-generated block randomisation scheme. 1 million
autologous CSCs were administered by intracoronary infusion at a mean of
113 days (SE 4) after surgery; controls were not given any treatment.
Although the study was open label, the echocardiographic analyses were
masked to group assignment. The primary endpoint was short-term safety of
CSCs and the secondary endpoint was efficacy. A per-protocol analysis was
used. This study is registered with ClinicalTrials.gov, number
NCT00474461. This study is still in progress. 16 patients were assigned to
the treatment group and seven to the control group; no CSC-related adverse
effects were reported. In 14 CSC-treated patients who were analysed, LVEF
increased from 303 (SE 19) before CSC infusion to 385 (28) at 4 months
after infusion (p=0001). By contrast, in seven control patients, during
the corresponding time interval, LVEF did not change (301 [24] at 4 months
after CABG vs 302 [25] at 8 months after CABG). Importantly, the
salubrious effects of CSCs were even more pronounced at 1 year in eight
patients (eg, LVEF increased by 123 ejection fraction units [21] vs
baseline, p=00007). In the seven treated patients in whom cardiac MRI
could be done, infarct size decreased from 326 g (63) by 78 g (17; 24) at
4 months (p=0004) and 98 g (35; 30) at 1 year (p=004). These initial
results in patients are very encouraging. They suggest that intracoronary
infusion of autologous CSCs is effective in improving LV systolic function
and reducing infarct size in patients with heart failure after myocardial
infarction, and warrant further, larger, phase 2 studies. University of
Louisville Research Foundation and National Institutes of Health. 2011
Elsevier Ltd.
<14>
Accession Number
2011651814
Authors
Chan V. Chen L. Mesana L. Mesana T.G. Ruel M.
Institution
(Chan, Mesana, Mesana, Ruel) Division of Cardiac Surgery, University of
Ottawa, Ottawa, ON, Canada
(Chen, Ruel) Department of Epidemiology and Community Medicine, University
of Ottawa, Ottawa, ON, Canada
Title
Heart valve prosthesis selection in patients with end-stage renal disease
requiring dialysis: A systematic review and meta-analysis.
Source
Heart. 97 (24) (pp 2033-2037), 2011. Date of Publication: December 2011.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Context: There is little evidence guiding heart valve prosthesis selection
in patients with end-stage renal disease (ESRD) on dialysis. Objectives:
To perform: 1) a systematic review of studies examining valve replacement
in patients with ESRD on dialysis; and 2) a quantitative meta-analysis
comparing survival and valve-related outcomes following valve replacement
with bioprostheses versus mechanical prostheses in this population. Data
sources: English studies published from 1990 onwards. Study selection:
Studies were included in the metaanalysis if they compared bioprostheses
with mechanical prostheses in patients with ESRD on dialysis. Data
extraction: Extracted summary estimates included the hazard ratio (HR) for
death, and the odds ratio (OR) for developing valve-related complications
due to the use of bioprostheses versus mechanical prosthesis. Results:
Twelve studies published from 1997 to 2010 were included in this review,
of which 9 were used in the meta-analysis. No evidence of publication bias
was detected. The aortic valve was the most common valve replaced in these
studies (4339/6350), although 11 of the 12 studies also included mitral or
multiple valve replacements. No difference in survival was observed
between valve types (bioprostheses versus mechanical prostheses hazard
ratio 1.3, 95% confidence interval (CI) 1.0-1.9, p=0.09). However, valve
replacement with bioprostheses was associated with fewer valve-related
complications compared to mechanical prostheses (odds ratio 0.4, 95% CI
0.2-0.7, p=0.002). Conclusions: A meta-analysis of the published
literature demonstrates no survival difference following valve replacement
with either bioprostheses or mechanical prosthesis in patients with ESRD
on dialysis. Bioprosthetic valve replacement was associated with fewer
valve-related complications. Although this metaanalysis cannot
discriminate between the sites of valve implant, these data can likely be
extended to include at least aortic valve replacement.
<15>
Accession Number
2011658093
Authors
Martins G.F. de Siqueira Filho A.G. de Figueiredo Santos J.B. Assuncao
C.R.C. Bottino F. de Carvalho K.G. Valencia A.
Institution
(Martins, de Figueiredo Santos, Assuncao, Bottino, de Carvalho, Valencia)
Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro RJ,
Brazil
(de Siqueira Filho) Universidade Federal do Rio de Janeiro, Rio de Janeiro
RJ, Brazil
Title
Trimetazidine on Ischemic Injury and Reperfusion in Coronary Artery Bypass
Grafting.
Source
Arquivos Brasileiros de Cardiologia. 97 (3) (pp 209-216), 2011. Date of
Publication: September 2011.
Publisher
Arquivos Brasileiros de Cardiologia (Rua Beira Rio, 45, 3.o andar, Sao
Paolo SP 04548-050, Brazil)
Abstract
Background: The ischemia and reperfusion ischemia is a common
physiopathological mechanisms, which has difficult control during Coronary
Artery Bypass Grafting (CABG) with cardiopulmonary bypass, the critical
moment of which happening by the end of surgery, when there is declamping
of aorta and release of hyperoxic radicals causing the injury. Objective:
Evaluate, in a randomized double-blind prospective study, controlled with
placebo, the effects of Trimetazidine (Tmz) on ischemic injury and
myocardial reperfusion, identifying the change in plasma markers of a
myocardial aggression (troponin T and CPK-MB), and echocardiographic
changes of ventricular function. Methods: We studied 60 patients divided
in two groups (placebo and Tmz) with mild ventricular dysfunction at the
most, stratified by echocardiography and receiving medication/placebo at a
dose of 20 mg/3x/day, starting from 12 to 15 days after pre-operative
period up to 5 to 8 days after post-operative period. Troponin T and
CPK-Mb were measured preoperatively without medication, 12 to 15 days of
medication/ placebo taken five minutes after aortic declamping, and at
subsequent 12, 24 and 48 hours. Results: Both Troponin T and CPK-Mb
reached highly significant values (p = 0.0001) in the treated group
compared to the control group at the four moments analyzed - 5 min, 12 h,
24 h and 48 h. The echocardiographic variables did not show evolutive
changes in each group severally considered and when compared among
themselves. Conclusion: Trimetazidine was effective in reducing ischemic
injury and reperfusion, had no effect on left ventricular function, and no
side effects were observed.
<16>
Accession Number
2011645917
Authors
Kastrati A. Neumann F.-J. Schulz S. Massberg S. Byrne R.A. Ferenc M.
Laugwitz K.-L. Pache J. Ott I. Hausleiter J. Seyfarth M. Gick M.
Antoniucci D. Schomig A. Berger P.B. Mehilli J.
Institution
(Kastrati, Schulz, Massberg, Byrne, Pache, Ott, Hausleiter, Schomig,
Mehilli) Deutsches Herzzentrum, Technische Universitat, Munich, Germany
(Laugwitz, Schomig) 1. Medizinische Klinik Rechts der Isar, Technische
Universitat, Munich, Germany
(Neumann, Ferenc, Gick) Herz-Zentrum, Bad Krozingen, Germany
(Seyfarth) HELIOS Klinikum Wuppertal, Wuppertal, Germany
(Seyfarth) Universitat Witten/Herdecke, Witten, Germany
(Antoniucci) Careggi Hospital, Florence, Italy
(Berger) Geisinger Medical Center, Danville, PA, United States
Title
Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial
infarction.
Source
New England Journal of Medicine. 365 (21) (pp 1980-1989), 2011. Date of
Publication: 24 Nov 2011.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
Background: The combination of glycoprotein IIb/IIIa inhibitors and
heparin has not been compared with bivalirudin in studies specifically
involving patients with non-ST-segment elevation myocardial infarction
undergoing percutaneous coronary intervention (PCI). We compared the two
treatments in this patient population. Methods: Immediately before PCI, we
randomly assigned, in a double-blind manner, 1721 patients with acute
non-ST-segment elevation myocardial infarction to receive abciximab plus
unfractionated heparin (861 patients) or bivalirudin (860 patients). The
study tested the hypothesis that abciximab and heparin would be superior
to bivalirudin with respect to the primary composite end point of death,
large recurrent myocardial infarction, urgent target-vessel
revascularization, or major bleeding within 30 days. Secondary end points
included the composite of death, any recurrent myocardial infarction, or
urgent target-vessel revascularization (efficacy end point) and major
bleeding (safety end point) within 30 days. Results: The primary end point
occurred in 10.9% of the patients in the abciximab group (94 patients) and
in 11.0% in the bivalirudin group (95 patients) (relative risk with
abciximab, 0.99; 95% confidence interval [CI], 0.74 to 1.32; P = 0.94).
Death, any recurrent myocardial infarction, or urgent target-vessel
revascularization occurred in 12.8% of the patients in the abciximab group
(110 patients) and in 13.4% in the bivalirudin group (115 patients)
(relative risk, 0.96; 95% CI, 0.74 to 1.25; P = 0.76). Major bleeding
occurred in 4.6% of the patients in the abciximab group (40 patients) as
compared with 2.6% in the bivalirudin group (22 patients) (relative risk,
1.84; 95% CI, 1.10 to 3.07; P = 0.02). Conclusions: Abciximab and
unfractionated heparin, as compared with bivalirudin, failed to reduce the
rate of the primary end point and increased the risk of bleeding among
patients with non-ST-segment elevation myocardial infarction who were
undergoing PCI. (Funded by Nycomed Pharma and others; ISAR-REACT 4
ClinicalTrials.gov number, NCT00373451.) Copyright 2011 Massachusetts
Medical Society.
<17>
Accession Number
2011650163
Authors
Shimony A. Joseph L. Mottillo S. Eisenberg M.J.
Institution
(Shimony, Mottillo, Eisenberg) Divisions of Cardiology and Clinical
Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical
Research, McGill University, Montreal, QC, Canada
(Joseph, Eisenberg) Departments of Epidemiology Biostatistics, and
Occupational Health, McGill University, Montreal, QC, Canada
(Mottillo) Faculty of Medicine, University of Montreal, Montreal, QC,
Canada
Title
Coronary Artery Perforation During Percutaneous Coronary Intervention: A
Systematic Review and Meta-analysis.
Source
Canadian Journal of Cardiology. 27 (6) (pp 843-850), 2011. Date of
Publication: November 2011.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Numerous studies have examined the incidence, predictors, outcomes, and
management strategies of coronary artery perforation (CAP). Individually,
these studies have been inconclusive because of their limited sample sizes
and/or single-centre designs. We conducted a systematic review and
meta-analysis of studies pertaining to CAP in order to estimate its
incidence and outcomes and to critically review its risk factors and
treatment. We systematically searched the literature to identify all
registry studies investigating CAP. Data were pooled by means of the
random-effects model. In 16 studies involving 197,061 percutaneous
coronary interventions, the pooled incidence of CAP was 0.43% (95%
confidence interval, 0.35%-0.52%). The most reproducible risk factors were
treatment of complex lesions and use of atheroablative devices. A variety
of major management strategies for CAP were used, in particular,
observation, heparin reversal, prolonged balloon inflation, covered stent
implantation, pericardiocentesis, and surgery. In a hierarchical Bayesian
random-effects model, the pooled tamponade rates were 0.4% (95% credible
interval [CrI], 0.0%-5.7%), 3.3% (95% CrI, 0.0%-11.4%), and 45.7% (95%
CrI, 34.9%-57.5%) for patients with Ellis class I, II, and III CAP,
respectively. Pooled mortality rates were 0.3% (95% CrI, 0.0%-4.4%), 0.4%
(95% CrI, 0.0%-2.8%), and 21.2% (95% CrI, 12.0%-31.4%) for patients with
Ellis class I, II, and III CAP respectively. CAP complicating percutaneous
coronary intervention is rare, and its morbidity and mortality vary
directly with Ellis classification. Management discrepancies highlight the
need to establish a uniform treatment paradigm for CAP. 2011 Canadian
Cardiovascular Society.
<18>
Accession Number
2011650158
Authors
Teo K.K. Corsi D.J. Tam J.W. Dumesnil J.G. Chan K.L.
Institution
(Teo, Corsi) Population Health Research Institute, McMaster University,
Hamilton, ON, Canada
(Tam) St. Boniface Hospital, Winnipeg, MB, Canada
(Dumesnil) Quebec Heart and Lung Institute, Laval University, Quebec City,
QC, Canada
(Chan) University of Ottawa Heart Institute, Ottawa, ON, Canada
Title
Lipid Lowering on Progression of Mild to Moderate Aortic Stenosis:
Meta-analysis of the Randomized Placebo-Controlled Clinical Trials on 2344
Patients.
Source
Canadian Journal of Cardiology. 27 (6) (pp 800-808), 2011. Date of
Publication: November 2011.
Publisher
Pulsus Group Inc. (2902 South Sheridan Way, Oakville ONT L6J 7L6, Canada)
Abstract
Background: Aortic stenosis (AS) is believed to develop through an
inflammatory similar to the atherosclerosis process. Based on findings
from animal studies and uncontrolled clinical studies, lipid-lowering
therapy with a statin is postulated to slow this process. Randomized
trials, however, reported neutral results. This meta-analysis of
randomized lipid trials on patients with AS examined the effects of
treatment on AS progression and clinical outcomes. Methods:
Echocardiographic measures of AS (aortic valve jet velocity, peak and mean
valve gradients, and aortic valve area) were pooled and clinical outcomes
were evaluated in 4 randomized placebo controlled trials (N = 2344).
Results: Although active treatment with statin therapy was associated with
highly significant 50% reduction in low-density lipoprotein cholesterol
levels, there were no statistical differences between active and placebo
groups in any of the echocardiographic indicators of AS severity: annual
increase in AS velocity was 0.16 +/- 0.28 m/sec, and mean gradient was 2.8
+/- 3.0 mm Hg. Each trial reported no differences in clinical outcomes
between the 2 treatment groups. Substantial events rates (6.6% aortic
valve surgery and 1.2% cardiovascular deaths per year in SEAS with
follow-up of 4.4 years and 5.8% aortic valve surgery and 0.7%
cardiovascular deaths per year in ASTRONOMER over 3.5 years) were observed
in these patients despite the relatively mild disease. Conclusion: The
current data do not support the hypothesis that statin therapy reduces AS
progression. Patients with mild to moderate AS may require closer
follow-up because despite the less severe disease in these trials, event
rates remain substantial. 2011 Canadian Cardiovascular Society.
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