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<1>
Accession Number
2012011537
Authors
Zangrillo A. Biondi-Zoccai G. Ponschab M. Greco M. Corno L. Covello R.D.
Cabrini L. Bignami E. Melisurgo G. Landoni G.
Institution
(Zangrillo, Greco, Corno, Covello, Cabrini, Bignami, Melisurgo, Landoni)
Department of Anesthesia and Intensive Care, Universita Vita-Salute San
Raffaele, Milan, Italy
(Biondi-Zoccai) Division of Cardiology, University of Modena and Reggio
Emilia, Modena, Italy
(Ponschab) Department of Anaesthesia and Intensive Care, Trauma Hospital
Linz, Linz, Austria
Title
Milrinone and mortality in adult cardiac surgery: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (1) (pp 70-77),
2012. Date of Publication: February 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The authors conducted a review of randomized studies to show
whether there are any increases or decreases in survival when using
milrinone in patients undergoing cardiac surgery. Design: A meta-analysis.
Setting: Hospitals. Participants: Five hundred eighteen patients from 13
randomized trials. Interventions: None. Measurements and Main Results:
BioMedCentral, PubMed EMBASE, the Cochrane central register of clinical
trials, and conference proceedings were searched for randomized trials
that compared milrinone versus placebo or any other control in the setting
of cardiac surgery that reported data on mortality. Overall analysis
showed that milrinone increased perioperative mortality (13/249 [5.2%] in
the milrinone group v 6/269 [2.2%] in the control arm, odds ratio [OR] =
2.67 [1.05-6.79], p for effect = 0.04, p for heterogeneity = 0.23,
I² = 25% with 518 patients and 13 studies included).
Subanalyses confirmed increased mortality with milrinone (9/84 deaths
[10.7%] v 3/105 deaths [2.9%] with other drugs as control, OR = 4.19
[1.27-13.84], p = 0.02) with 189 patients and 5 studies included) but did
not confirm a difference in mortality (4/165 [2.4%] in the milrinone group
v 3/164 [1.8%] with placebo or nothing as control, OR = 1.27 [0.28-5.84],
p = 0.76 with 329 patients and 8 studies included). Conclusions: This
analysis suggests that milrinone might increase mortality in adult
patients undergoing cardiac surgery. The effect was seen only in patients
having an active inotropic drug for comparison and not in the placebo
subgroup. Therefore, the question remains whether milrinone increased
mortality or if the control inotropic drugs were more protective. 2012
Elsevier Inc. All rights reserved.

<2>
Accession Number
2012011543
Authors
Kumar A.B. Suneja M. Bayman E.O. Weide G.D. Tarasi M.
Institution
(Kumar, Bayman, Weide, Tarasi) Department of Anesthesia, University of
Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United
States
(Suneja) Department of Nephrology, University of Iowa Hospitals and
Clinics, Iowa City, IA, United States
(Bayman) Department of Biostatistics, College of Public Health, Iowa City,
IA, United States
Title
Association between postoperative acute kidney injury and duration of
cardiopulmonary bypass: A meta-analysis.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (1) (pp 64-69),
2012. Date of Publication: February 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: This meta-analysis examined the association between
cardiopulmonary bypass (CPB) time and acute kidney injury (AKI). Design:
Meta-analysis of previously published studies. Setting: Each single-center
study was conducted in a surgical intensive care unit and/or academic or
university hospital. Participants: Adult patients undergoing heart surgery
with CPB. Interventions: A systematic literature review was conducted
using PubMed, EMBASE, and Cochrane Library databases and Google Scholar
from January 1980 through September 2009. Initial search results were
refined to include human subjects, age >18 years, randomized controlled
trials, and prospective and retrospective cohort studies, meet the Acute
Kidney Injury Network definition of renal failure, and report times on
CPB. Measurements and main results: The length of time on CPB has been
implicated as an independent risk factor for development of AKI after CPB
(AKI-CPB). The 9 independent studies included in the final meta-analysis
had 12,466 patients who underwent CPB. Out of these, 756 patients (6.06%)
developed AKI-CPB. In 7 of the 9 studies, the mean CPB times were
statistically longer in the AKI-CPB cohort compared with the control group
(cohort without AKI). The absolute mean differences in CPB time between
the 2 groups were 25.65 minutes with the fixed-effects model and 23.18
minutes with the random-effects model. Conclusions: Longer CPB times are
associated with a higher risk of developing AKI-CPB, which, in turn, has a
significant effect on overall mortality as reported by the individual
studies. 2012 Elsevier Inc. All rights reserved.

<3>
Accession Number
2012011542
Authors
Kumbharathi R.B. Taneja R. Mehra R. Quantz M.A. Guo L.R. Bainbridge D.T.
Institution
(Kumbharathi) Department of Anesthesia, Thompson General Hospital,
Burntwood Regional Health Authority, Thompson, MB, Canada
(Taneja, Bainbridge) Department of Anesthesia and Peri-Operative Medicine,
London Health Sciences Centre, University of Western Ontario, London, ON,
Canada
(Mehra) Department of Anesthesia and Perioperative Medicine, Alfred
Hospital, Melbourne, VIC, Australia
(Quantz, Guo) Department of Cardiovascular and Thoracic Surgery, London
Health Sciences Centre, University of Western Ontario, London, ON, Canada
Title
Evaluation of tricuspid and pulmonary valves using epicardial and
transesophageal echocardiography - A comparative study.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (1) (pp 32-38),
2012. Date of Publication: February 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: To compare measurements obtained by transesophageal
echocardiography (TEE) and epicardial echocardiography (EE) for evaluation
of the tricuspid valve (TV) and pulmonary valve (PV). Design: Prospective
observational. Setting: University hospital. Participants: Patients
undergoing elective coronary artery bypass grafting with or without aortic
valve replacement. Interventions: After routine intraoperative TEE, EE was
performed to compare measurements obtained by the 2 methods. Measurements
and main results: After institutional review board approval, 25 patients
>18 years old were recruited. Biases with EE versus TEE for E and A waves
were 11.9 cm/second (95% confidence interval [CI], 48.2 to -24.4) and 6.8
cm/second (95% CI, 28 to -15), respectively, and for E/A ratio was 0.08
(95% CI, 1.2 to -1). Pulmonary velocity bias was 57.94 cm/second (95% CI,
192.9 to -76.98), with higher values using EE. Bias for pulmonary trunk
diameter was -0.31 cm (95% CI, 1.5 to -2.1). For quality of images, means
were 2.4 (standard deviation [SD], 1.0) for EE and 2.3 (SD, 0.57) with TEE
for TV and 2.4 (SD, 1.0) with EE and 2.5 (SD, 1.0) with TEE for PV. For
the number of leaflets visualized, means were 2.2 (SD, 1.0) with EE and
2.5 (SD, 0.5) with TEE for TV and 2.5 (SD, 0.5) for EE and 1.3 (SD, 1.1)
with TEE for PV. Conclusions: There was good agreement for Doppler
measurements across TVs; however, measurements across PVs were
significantly higher with EE versus TEE. TV Doppler measurements were
difficult to acquire even for surgeons experienced in epiaortic scanning.
2012 Elsevier Inc. All rights reserved.

<4>
Accession Number
2012011532
Authors
Greco M. Landoni G. Biondi-Zoccai G. Cabrini L. Ruggeri L. Pasculli N.
Giacchi V. Sayeg J. Greco T. Zangrillo A.
Institution
(Greco, Landoni, Cabrini, Ruggeri, Pasculli, Giacchi, Sayeg, Greco,
Zangrillo) Department of Anesthesiology and Intensive Care, Vita-Salute
San Raffaele University, Milan, Italy
(Biondi-Zoccai) Interventional Cardiology, Division of Cardiology,
University of Turin, Turin, Italy
Title
Remifentanil in cardiac surgery: A meta-analysis of randomized controlled
trials.
Source
Journal of Cardiothoracic and Vascular Anesthesia. 26 (1) (pp 110-116),
2012. Date of Publication: February 2012.
Publisher
W.B. Saunders (Independence Square West, Philadelphia PA 19106-3399,
United States)
Abstract
Objective: The authors conducted a review of randomized controlled trials
to identify advantages in clinically relevant outcomes in patients
undergoing cardiac surgery with remifentanil. Design: Meta-analysis.
Setting: Hospitals. Participants: A total of 1,473 patients from 16
randomized trials. Interventions: None. Measurements and Main Result:
PubMed, BioMedCentral, and conference proceedings were searched (updated
May 2010) for randomized trials that compared remifentanil with fentanyl
or sufentanil in cardiac anesthesia. Four independent reviewers performed
data extraction, with divergences resolved by consensus. Overall analysis
showed that the use of remifentanil was associated with a significant
reduction in postoperative mechanical ventilation (WMD = -139 min [-244,
-32], p for effect = 0.01, p for heterogeneity < 0.001, I₂ =
89%); length of hospital stay (WMD = -1.08 days [-1.60, -0.57], p for
effect < 0.0001, p for heterogeneity = 0.004, I₂ = 71%); and
cardiac troponin-I release (WMD = -2.08 ng/mL [-3.93, -0.24], p for effect
= 0.03, p for heterogeneity < 0.02, I₂ = 74%). No difference
was noted in mortality (3/344 [0.87%] in the remifentanil group vs [1.06%]
the control group, OR 0.76 [0.17-3.38], p for effect = 0.72, p for
heterogeneity = 0.35, I₂ = 5%). Conclusions: Remifentanil
reduces cardiac troponin release, time of mechanical ventilation, and
length of hospital stay in patients undergoing cardiac surgery.

<5>
Accession Number
2011707318
Authors
Ahn S.W. Shim J.K. Youn Y.N. Song J.W. Yang S.Y. Chung S.C. Kwak Y.L.
Institution
(Ahn) Department of Anesthesiology and Pain Medicine, Kwandong University
College of Medicine, Goyang, South Korea
(Shim, Youn, Song, Yang, Chung, Kwak) Department of Anesthesiology and
Pain Medicine, Seoul, South Korea
(Shim, Kwak) Anesthesia and Pain Research Institute, Seoul, South Korea
(Youn) Department of Cardiothoracic Surgery, Seoul, South Korea
(Kwak) Severance Biomedical Science Institute, Yonsei University College
of Medicine, Seoul, South Korea
Title
Effect of tranexamic acid on transfusion requirement in dual
antiplatelet-treated anemic patients undergoing off-pump coronary artery
bypass graft surgery-a randomized controlled study.
Source
Circulation Journal. 76 (1) (pp 96-101), 2012. Date of Publication:
January 2012.
Publisher
Japanese Circulation Society (14 Yoshida Kawaharacho, Sakyo-ku, Kyoto 606,
Japan)
Abstract
Background: Anemia is not rare in patients presenting for coronary artery
bypass graft surgery (CABG) and as these patients are frequently on dual
antiplatelet therapy (DAPT), the coexisting conditions could potentially
increase the risk of bleeding and transfusion. The aim of this study was
to evaluate the effect of tranexamic acid (TA) on blood loss and
transfusion in preoperatively anemic patients who continued DAPT until
within 5 days of off-pump CABG (OPCAB). Methods and Results: Seventy-six
anemic patients were randomized into 2 groups: TA group receiving TA (1 g
bolus followed by infusion at 200 mg/h) and a Control group receiving the
same volume of saline. The amount of blood loss and transfusion
requirement during, and at 4 and 24 h after the operation were assessed.
Patients' characteristics and operative data were similar between the
groups. During the perioperative period, which combined the intraoperative
and postoperative 24 h data, the TA group received significantly smaller
amounts of packed red blood cells and fresh frozen plasma. Total amount of
perioperative blood loss was similar between the groups, although the
blood loss during the postoperative 4 h was significantly less in the TA
group. Conclusions: TA infusion could reduce the amount of transfusion
during the perioperative period in patients with preoperative anemia who
continue DAPT until within 5 days of OPCAB.

<6>
Accession Number
2011662786
Authors
Lip G.Y.H. Andreotti F. Fauchier L. Huber K. Hylek E. Knight E. Lane D.
Levi M. Marin F. Palareti G. Kirchhof P.
Institution
(Lip, Lane, Kirchhof) University of Birmingham Centre for Cardiovascular
Sciences, City Hospital, Birmingham B18 7QH, United Kingdom
(Andreotti) Department of Cardiovascular Medicine, A. Gemelli University
Hospital, Rome, Italy
(Fauchier) Cardiologie B, Centre Hospitalier Universitaire Trousseau et
Universite Francois Rabelais, Tours, France
(Huber) 3rd Dept of Medicine, Cardiology and Emergency Medicine,
Wilhelminenhospital, Vienna, Austria
(Hylek) Department of Medicine, Research Unit-Section of General Internal
Medicine, Boston University Medical Center, Boston, MA, United States
(Knight) Patient Representative, AntiCoagulation Europe, Bromley, United
Kingdom
(Levi) Department of Medicine, Academic Medical Center, University of
Amsterdam, Amsterdam, Netherlands
(Marin) Department of Cardiology, Hospital Universitario Virgen de la
Arrixaca, Murcia, Spain
(Palareti) Department of Angiology and Blood Coagulation, University
Hospital S. Orsola-Malpighi, Bologna, Italy
(Kirchhof) Department of Cardiology and Angiology, Universitatsklinikum
Munster, Munster, Germany
Title
Bleeding risk assessment and management in atrial fibrillation patients:
Executive summary# of a position document from the european heart rhythm
association [EHRA], endorsed by the european society of cardiology [ESC]
working group on thrombosis.
Source
Thrombosis and Haemostasis. 106 (6) (pp 997-1011), 2011. Date of
Publication: 2011.
Publisher
Schattauer GmbH (Hoelderlinstr 3 Stuttgart D-70174, Germany)
Abstract
In this executive summary of a Consensus Document from the European Heart
Rhythm Association, endorsed by the European Society of Cardiology Working
Group on Thrombosis, we comprehensively review the published evidence and
propose a consensus on bleeding risk assessments in atrial fibrillation
(AF) patients. The main aim of the document was to summarise 'best
practice' in dealing with bleeding risk in AF patients when approaching
antithrombotic therapy, by addressing the epidemiology and size of the
problem, and review established bleeding risk factors. We also summarise
definitions of bleeding in the published literature. Patient values and
preferences balancing the risk of bleeding against thromboembolism as well
as the prognostic implications of bleeding are reviewed. We also provide
an overview of published bleeding risk stratification and bleeding risk
schema. Brief discussion of special situations (e.g. periablation,
peri-devices such as implantable cardioverter defibrillators [ICD] or
pacemakers, presentation with acute coronary syndromes and/or requiring
percutanous coronary interventions/stents and bridging therapy) is made,
as well as a discussion of the prevention of bleeds and managing bleeding
complications. Finally, this document puts forwards consensus statements
that may help to define evidence gaps and assist in everyday clinical
practice. Schattauer 2011.

<7>
Accession Number
21645199
Authors
Krohm P. Levionnois O. Ganster M. Zilberstein L. Spadavecchia C.
Institution
(Krohm, Levionnois, Spadavecchia) Anaesthesia Section, Department for
Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern,
Switzerland
(Ganster, Zilberstein) Allevia AG, The Bone CRO, Bern, Switzerland
Title
Antinociceptive activity of pre- versus post-operative intra-articular
bupivacaine in goats undergoing stifle arthrotomy.
Source
Veterinary Anaesthesia and Analgesia. 38 (4) (pp 363-373), 2011. Date of
Publication: July 2011.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Objective To evaluate the peri-operative analgesic efficacy of
intra-articular bupivacaine administered before or after stifle
arthrotomy. Study design Prospective, randomized, blind,
placebo-controlled experimental trial. Animals Thirty-nine healthy goats.
Methods The goats were allocated randomly to one of three intra-articular
treatment groups: group PRE (bupivacaine before and saline after surgery),
group POST (saline before and bupivacaine after surgery) and group CON
(saline before and after surgery). Anaesthesia was maintained with a
constant end-tidal sevoflurane of 2.5%. Intra-operatively heart rate (HR),
respiratory rate and mean arterial blood pressure (MAP) after critical
surgical events (CSE) were recorded and compared with pre-incision values.
Propofol requirements to maintain surgical anaesthesia were recorded.
Flunixin was administered for 5days. Post-operative pain assessment at
20minutes, 2hours, 4hours after recovery and on day 2 and 3 included a
multidimensional pain score (MPS), a lameness score and mechanical
nociceptive threshold (MNT) testing. Rescue analgesia consisted of
systemic opioids. Data were analysed using Kruskal-Wallis, Mann-Whitney,
Friedman or chi-square tests as appropriate. Results Intra-operatively,
group PRE had lower HR and MAP at several CSEs than groups POST/CON and
required less propofol [0mgkg^-1 (0-0mgkg^-1)] than
group POST/CON [0.3mgkg^-1 (0-0.6mgkg^-1)].
Post-operatively, group POST had significantly higher peri-articular MNTs
than groups PRE and CON up to 4hours after recovery. No treatment effect
was detected for MPS, lameness scores and rescue analgesic consumption at
any time point. Conclusions and clinical relevance Pre-operative
intra-articular bupivacaine provided notable intra-operative analgesia in
goats undergoing stifle arthrotomy but did not reduce post-operative pain.
Post-operative intra-articular bupivacaine provided a short lasting
reduction of peri-articular hyperalgesia without affecting the
requirements for systemic analgesia. Multimodal perioperative pain therapy
is recommended to provide adequate analgesia for stifle arthrotomy in
goats. 2011 The Authors. Veterinary Anaesthesia and Analgesia. 2011
Association of Veterinary Anaesthetists and the American College of
Veterinary Anesthesiologists.

<8>
Accession Number
2012002986
Authors
Lawson E.H. Gibbons M.M. Ingraham A.M. Shekelle P.G. Ko C.Y.
Institution
(Lawson, Gibbons, Ingraham, Ko) Department of Surgery, David Geffen School
of Medicine, University of California, Los Angeles, CA 90095, United
States
(Lawson, Ingraham, Ko) Division of Research and Optimal Patient Care,
American College of Surgeons, Chicago, IL, United States
(Gibbons) Department of Surgery, Olive View-UCLA (University of
California, Los Angeles) Medical Center, Sylmar, CA, United States
(Ingraham) Department of Surgery, University of Cincinnati, College of
Medicine, Cincinnati, OH, United States
(Shekelle) RAND Health, Santa Monica, CA, United States
(Shekelle, Ko) VA Greater Los Angeles Healthcare System, Los Angeles, CA,
United States
Title
Appropriateness criteria to assess variations in surgical procedure use in
the United States.
Source
Archives of Surgery. 146 (12) (pp 1433-1440), 2011. Date of Publication:
December 2011.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Objectives: To systematically describe appropriateness criteria (AC)
developed in the United States for surgical procedures and to summarize
how these criteria have been applied to identify overuse and underuse of
procedures in US populations. Data Sources: MEDLINE literature search
performed in February 2010 and May 2011. Study Selection: Studies were
included if they addressed the appropriateness of a surgical procedure
using the RAND-UCLA Appropriateness Method. Non-US studies were excluded.
Data Extraction: Information was abstracted on study design, surgical
procedure, and reported rates of appropriate use, overuse, and underuse.
Identified AC were cross-referenced with lists of common procedures from
the Nationwide Inpatient Sample and the State Ambulatory Surgery
databases. Data Synthesis: A total of 1601 titles were identified; 39 met
the inclusion criteria. Of these, 17 developed AC and 27 applied AC to US
populations. Appropriateness criteria have been developed for 16 surgical
procedures. Underuse has only been studied for coronary artery bypass
graft surgery, and rates range from 24% to 57%. Overuse has been more
broadly studied, with rates ranging from 9% to 53% for carotid
endarterectomy, 0% to 14% for coronary artery bypass graft, 11% to 24% for
upper gastrointestinal tract endoscopy, and 16% to 70% for hysterectomy.
Appropriateness criteria exist for 10 of the 25 most common inpatient
procedures and 6 of the 15 top ambulatory procedures in the United States.
Most studies are more than 5 years old. Conclusions: Most existing AC are
outdated, and AC have never been developed for most common surgical
procedures. A broad and coordinated effort to develop and maintain AC
would be required to implement this tool to address variation in the use
of surgical procedures. 2011 American Medical Association. All rights
reserved.

<9>
Accession Number
2011710920
Authors
Plewka M. Krzeminska-Pakula M. Peruga J.Z. Lipiec P. Kurpesa M.
Wierzbowska-Drabik K. Korycka-Wolowiec A. Kasprzak J.D.
Institution
(Plewka, Krzeminska-Pakula, Peruga, Kurpesa, Wierzbowska-Drabik, Kasprzak)
Department of Cardiology, Medical University of Lodz, ul. Kniaziewicza
1/5, 91-347 Lodz, Poland
(Lipiec) Department of Rapid Cardiac Diagnostics, Medical University of
Lodz, Lodz, Poland
(Korycka-Wolowiec) Department of Haematology, Medical University of Lodz,
Lodz, Poland
Title
The effects of intracoronary delivery of mononuclear bone marrow cells in
patients with myocardial infarction: A two year follow-up results.
Source
Kardiologia Polska. 69 (12) (pp 1234-1240), 2011. Date of Publication:
2011.
Publisher
Klinika Kardiologii CMKP (ul. Grenadierow 51/59, Warsaw 04-073, Poland)
Abstract
Background: Transplantation of bone marrow stem cells (BMSC) is a new
method of prevention of left ventricular (LV) remodelling in
post-infarction patients. Studies published to date point to LV systolic
and diastolic function improvement following this therapy however only a
few studies assessed the long-term effects of BMSC. Aim: To assess the 2
year prognosis in patients with anterior myocardial infarction (MI)
treated with BMSC transplantation in the acute phase. Methods: The study
group consisted of 60 patients with first anterior ST-segment elevation MI
(STEMI), treated with primary percutaneous angioplasty, with baseline LV
ejection fraction (LVEF) < 40%, who were randomly assigned to undergo BMSC
transplantation on day 7 of the STEMI (40 patients, BMSC group) or to
receive standard treatment (20 patients, control group). In all the
patients echocardiography was performed at baseline and after 1, 3, 6, 12
and 24 months. The composite end-point (death, MI, admission for heart
failure or repeat revascularisation) was assessed after 2 years of
follow-up. Results: Absolute increase of LVEF compared to baseline values
was higher in the BMSC group than in the control group. The LVEF increase
in BMSC group at 1 month was 7.1% (95% CI 3.1-11.1%), at 6 months - 9.3%
(95% CI 5.3-13.3%), at 12 months - 11.0% (95% CI 6.2-13.3%) and at 24
months - 10% (95% CI 7.2-12.1%). In the control group, LVEF increase was
3.7% (95% CI 2.3-9.7%) at 1 month, 4.7% (95% CI 1.2-10.6%) at 6 months,
4.8% (95% CI 1.5-11.0%) at 12 months and 4.7% (95% CI 1.4-10.7%) at 24
months. The composite end-point occurred significantly more frequently in
the control group (55%) than in the BMSC group (23%): OR 2.72; 95% CI
1.06-7.02, p = 0.015. Conclusions: Treatment with mononuclear bone marrow
cells on day 7 of the first anterior MI in patients with significant
baseline systolic dysfunction improves 2-year outcome. Copyright Polskie
Towarzystwo Kardiologiczne.

<10>
Accession Number
2011696332
Authors
Mathur P.N.
Institution
(Mathur) Indiana University School of Medicine, Indianapolis, IN, United
States
Title
Intrapleural t-PA plus DNase improved clinical outcomes in patients with
pleural infection.
Source
Annals of Internal Medicine. 155 (12) (pp JC6-9), 2011. Date of
Publication: 20111220.
Publisher
American College of Physicians (190 N. Indenpence Mall West, Philadelphia
PA 19106-1572, United States)

<11>
Accession Number
21526669
Authors
Aghdaii N. Azarfarin R. Yazdanian F. Faritus S.Z.
Institution
(Aghdaii) Department of Anesthesiology, Shahid Rajaii cardiovascular
Medical Center, Iran University of Medical Sciences, Tehran, Iran, Islamic
Republic of
(Azarfarin, Yazdanian, Faritus) Cardiovascular Research Center, Madani
Heart hospital, Tabriz University of Medical Sciences, Tabriz, Iran,
Islamic Republic of
Title
Cardiovascular responses to orotracheal intubation in patients undergoing
coronary artery bypass grafting surgery: Comparing fiberoptic bronchoscopy
with direct laryngoscopy.
Source
Middle East Journal of Anesthesiology. 20 (6) (pp 833-838), 2010. Date
of Publication: October 2010.
Publisher
American University of Beirut (P.O.Box 11-0236, Beirut 1107 2020, Lebanon)
Abstract
Background: The intubation by using fiberoptic brochoscop (FOB) can avoid
the mechanical stimulus to oropharyngolaryngeal structures thereby it is
likely to attenuate hemodynamic response during orotracheal intubation.
Based on this hypothesis, we compared the hemodynamic responses to
orotracheal intubation using an FOB and direct laryngoscope (DLS) in
patients undergoing general anesthesia for coronary artery bypass grafting
(CABG) surgery. Methods: Fifty patients with ASA physical status II and
Mallampati score I and II were scheduled for elective CABG surgery under
general anesthesia requiring orotracheal intubation were randomly
allocated to either DLS group (n = 25) or FOB group (n = 25). The same
protocol of anesthetic medications was used. Invasive systolic and
diastolic blood pressure (SBP & DBP) and heart rate (HR) were recorded
before and after anesthesia induction, during intubation and in the first
and second minutes after intubation. The differences among the hemodynamic
variables recorded over time and differences in the circulatory variables
between the two study groups were compared. Results: Duration of
intubation was shorter in DLS group (19.3 +/- 4.7 sec) compared with FOB
group (34.9 +/- 9.8 sec; p = 0.0001). In both study groups basic SBP and
DBP and HR were not significantly different (P >0.05). During the
observation, there were no significant differences between the two groups
in BP or HR at any time points or in their maximal values (all p values
>0.05). Conclusion: We conclude that the FOB had no advantage in
attenuating the hemodynamic responses to orotracheal intubation in
patients undergoing CABG surgery.

<12>
Accession Number
20557390
Authors
Utriyaprasit K. Moore S.M. Chaiseri P.
Institution
(Utriyaprasit) Mahidol University, Bankoknoi, Bangkok, Thailand
(Moore) School of Nursing, Case Western Reserve University, Cleveland, OH,
United States
(Chaiseri) Central Chest Institute Muang, Nonthaburi, Thailand
Title
Recovery after coronary artery bypass surgery: Effect of an audiotape
information programme.
Source
Journal of Advanced Nursing. 66 (8) (pp 1747-1759), 2010. Date of
Publication: August 2010.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aim.: The aim of the study was to test the effect of an audiotape giving
concrete objective information and strategies to reduce symptoms,
psychological distress and enhance physical functioning in patients having
coronary artery bypass grafts. Background.: The period following hospital
discharge is stressful for patients having coronary artery bypass grafts.
Evident-based interventions are needed to improve outcomes in Thai
populations following coronary artery bypass graft surgery. Methods.: A
randomized controlled trial was conducted during 2004-2005. A sample of
120 Thai patients having coronary artery bypass grafts was randomly
assigned to an intervention group or a control group. The intervention
group was given an information audiotape the day prior to hospital
discharge, and encouraged to listen to it as many times as necessary.
Participants were interviewed using validated instruments predischarge and
at 2 weeks and 4 weeks after discharge. Findings.: Participants in the
intervention group had statistically significantly fewer symptoms of
shoulder, back or neck pain and lack of appetite, and increased physical
activity after discharge, compared to the control group. This effect
remained statistically significant after controlling for age, gender,
co-morbidity and presurgical cardiac functional status. However, no
statistically significant difference in psychological distress was
observed. Conclusion.: Nurses can use an audiotape containing preparatory
information to improve outcomes for patients having coronary artery bypass
grafts during the few weeks after discharge from hospital. Further studies
are recommended to improve its effect on psychological distress. 2010
Blackwell Publishing Ltd.

<13>
Accession Number
70628103
Authors
Preiss D. Seshasai S.R.K. Welsh P. Sattar N. Ray K.
Institution
(Preiss, Seshasai, Welsh, Sattar, Ray) GlasgowUnited Kingdom
(Preiss, Seshasai, Welsh, Sattar, Ray) CambridgeUnited Kingdom
(Preiss, Seshasai, Welsh, Sattar, Ray) LondonUnited Kingdom
Title
Risk of incident diabetes on intensive compared to moderate dose statin
therapy: A collaborative meta-analysis of randomized trials.
Source
Diabetes. Conference: 71st Scientific Sessions of the American Diabetes
Association San Diego, CA United States. Conference Start: 20110624
Conference End: 20110628. Conference Publication: (var.pagings). 60 (pp
A88), 2011. Date of Publication: July 2011.
Publisher
American Diabetes Association Inc.
Abstract
A recent meta-analysis demonstrated that statin therapy is associated with
an excess risk of developing diabetes. Whether any such relationship
exists between intensive statin therapy and new-onset diabetes compared to
moderate dose therapy is unclear. We searched Medline, Embase and the
Cochrane Central Register of Controlled Trials from 1996 to 2010 for
randomized controlled endpoint trials including more than 1000 patients
with identical follow-up in both arms and duration of more than 1 year.
Using published and unpublished data, we calculated trial-specific risk
estimates for patients developing diabetes and experiencing major
cardiovascular events (cardiovascular death, nonfatal myocardial
infarction or stroke, coronary revascularization), and combined these
using random-effects model meta-analysis. Between-study heterogeneity was
assessed using the I ² statistic. We identified five statin
trials with 32,752 participants without diabetes, of whom 2,749 (1,449
assigned intensive therapy, 1,300 assigned standard therapy) developed
diabetes and 6,684 (3,134 and 3,550 respectively) experienced
cardiovascular events over an average follow-up of 4.9 years. Intensive
statin therapy was associated with a 12% higher risk for newonset diabetes
(odds ratio [OR] 1.12; 95% CI 1.04-1.22; I ²=0%) and 16%
reduction in cardiovascular events (OR 0.84; 95% CI 0.75-0.94; I
²=74%). For every three fewer patients experiencing major
cardiovascular events on intensive therapy, one additional case of
diabetes occurred. (Table presented).

<14>
Accession Number
70627056
Authors
Pike K. Brierley R. Rogers C.A. Murphy G.J. Reeves B.C.
Institution
(Pike, Brierley, Rogers, Murphy, Reeves) Bristol Heart Institute,
University of Bristol, Bristol BS2 8HW, United Kingdom
Title
Adherence in a randomised controlled trial comparing liberal and
restrictive red blood cell (RBC) transfusion protocols after cardiac
surgery (TITRe2).
Source
Trials. Conference: Clinical Trials Methodology Conference 2011 Bristol
United Kingdom. Conference Start: 20111004 Conference End: 20111005.
Conference Publication: (var.pagings). 12 , 2011. Date of Publication:
13 Dec 2011.
Publisher
BioMed Central Ltd.
Abstract
Objectives: The TITRe2 trial is comparing two haemoglobin (Hb) thresholds
for RBC transfusion after cardiac surgery, Hb<9.0g/dl (liberal) vs.
Hb<7.5g/dl (restrictive). Based on historic data, and with complete
adherence, transfusion rates should be 100% in the liberal and 30% in the
restrictive group. Convergence of these rates due to non-adherence
severely threatens the power of the trial; there is also concern about
differential nonadherence, with transfusion being delayed or withheld in
the liberal group when Hb remains close to the 9.0g/dl threshold. Methods:
In order to capture non-adherence, research staff collect data describing:
The lowest daily Hb; Date and time of each RBC transfusion and the
preceding Hb measurement; Number of breaches of the allocated threshold
before a transfusion is prescribed. These data allow non-adherence to the
randomisation and transfusion protocols to be detected: Failure to
randomise when the 9.0g/dl threshold is breached; Randomised >24 hours
after first breaching Hb 9.0g/dl threshold; Randomised without or before
breaching Hb 9.0g/dl threshold; After randomisation, transfusion given
when allocated threshold not breached ('extra'), or transfusion withheld
when allocated threshold breached ('withheld'); Instances of extra and
withheld transfusions are classified as mild, moderate or severe depending
on their likely influence on overall transfusion rates. Results: 56% of
participants are being randomised; about 8% of the remaining 44% consented
participants breach the 9.0g/dl threshold but are not randomised. 3% of
randomised participants are randomised >24 hours after first breaching,
but none has been randomised without or before breaching the 9.0g/dl
threshold. 32% of participants have had >=1 instance of non-adherence to
the transfusion protocol; in 6%, non-adherence was judged severe (extra -
transfused and patient did not breach at any point post-randomisation;
withheld - not transfused and patient had no postrandomisation
transfusions). Site-specific rates of non-adherence are being fedback to
try to improve adherence. Rates of transfusion in the liberal and
restrictive groups are confidential to the Data Monitoring and Ethics
Committee (DMEC). Conclusions: We believe that this is the first attempt
to measure withheld transfusions in trials of this kind. Data collection
to do this is burdensome but satisfactory. The current rates of
transfusion in the liberal and restrictive groups are, so far, judged by
the DMEC to be consistent with the sample size justification.

<15>
Accession Number
70626993
Authors
Rogers C.A. Pike K. Angelini G.D. Reeves B.C.
Institution
(Rogers, Pike, Angelini, Reeves) Bristol Heart Institute, University of
Bristol, Bristol BS2 8HW, United Kingdom
Title
Use of an objective measure of time to recovery after cardiac surgery -
The STET randomised controlled trial.
Source
Trials. Conference: Clinical Trials Methodology Conference 2011 Bristol
United Kingdom. Conference Start: 20111004 Conference End: 20111005.
Conference Publication: (var.pagings). 12 , 2011. Date of Publication:
13 Dec 2011.
Publisher
BioMed Central Ltd.
Abstract
Objective: The STET trial is a two-centre open RCT comparing morbidity and
healthcare resource use when off-pump coronary artery bypass surgery is
carried out via a left anterolateral thoracotomy incision (ThoraCAB) or
via a conventional median sternotomy incision (OPCAB). It was hypothesised
that post-operative recovery would be faster with ThoraCAB. Methods:
Post-operative hospital stay is a commonly used measure of recovery.
However, in an open surgical trial, where the decision to discharge the
patient from hospital lies with the surgeon, post operative hospital stay
is susceptible to bias. For the STET trial we developed an objective
measure of recovery. Recovery time was defined as the time from surgery
until the patient was considered fit for discharge. Patients were
classified fit (a) when the x-ray was clear (no evidence of pleural
effusion requiring drainage, lung collapse/consolidation, pneumothorax);
(b) there was no suspected systemic, lower respiratory tract or wound
infection; (c) routine blood results and temperature were normal and (d)
when physically mobile (walking 70m, bowels open and oxygen
saturation>95%). These recovery criteria were monitored daily until
discharge. Results: 184 patients were recruited (91 randomised to
ThoraCAB, 93 to OPCAB). In the OPCAB group 77% were classified fit at or
before discharge versus 68% in the ThoraCAB group. For the remainder, the
recovery time was censored because discharge occurred before all the
criteria were met. Insufficient mobility accounted for the majority of
censored observations. The median recovery time was 6 days, IQR [4,7] in
the ThoraCAB group versus 5 days, IQR [4,7] in the OPCAB group (Time ratio
(ThoraCAB/OPCAB) 1.03 (95%CI [0.94, 1.14], p=0.53). In contrast, the
median time to discharge was 5 days in the ThoraCAB group versus 6 days in
the OPCAB group. Conclusion: The anticipated faster recovery with ThoraCAB
was not found and a significant proportion of patients were discharged
before all the recovery criteria were met. The results from the STET trial
illustrate the bias associated with clinical decision making in an open
RCT. The measure of recovery time (with slightly modified criteria) is
being used in other cardiac surgery trials.

<16>
Accession Number
70626945
Authors
Stocken D.D. Billingham L.J. Johnson P.J. Freemantle N.
Institution
(Stocken, Billingham, Johnson) Cancer Research UK Clinical Trials Unit,
University of Birmingham, Birmingham, United Kingdom
(Freemantle) Primary Care and Population Health, University College
London, London, United Kingdom
Title
Choice of transformation for modelling non-linear continuous biomarkers.
Source
Trials. Conference: Clinical Trials Methodology Conference 2011 Bristol
United Kingdom. Conference Start: 20111004 Conference End: 20111005.
Conference Publication: (var.pagings). 12 , 2011. Date of Publication:
13 Dec 2011.
Publisher
BioMed Central Ltd.
Abstract
Identification of prognostic and predictive biomarkers is important for
targeting treatments to patients and for the design and analysis of
randomised controlled trials. Cox proportional hazards modelling is a
standard method for assessing prognostic value of clinical biomarkers
where time to occurrence of an event is the primary outcome of interest.
An important issue in the analysis of prognostic factors is the functional
form of the relationship between the factor and outcome specifically for
continuous covariates. Continuous covariates are often simplified assuming
a linear relationship with log-hazard or dichotomisation which may be
inappropriate leading to loss of efficiency in statistical tests, bias and
incorrect conclusions. The effects of important prognostic biomarkers may
go unrecognised due to simplistic assumptions made in statistical
modelling. Two polynomial based strategies, restricted cubic splines and
fractional polynomials, are compared directly for determining the
functional form of non-linear relationships between prognostic biomarkers
and survival using two real datasets from randomised controlled trials in
advanced pancreatic cancer and cardiac surgery. Fractional polynomials are
an extended family of curves including non-integer and negative power
terms. Spline functions are piecewise polynomials connected across
intervals of a variable constrained to meet at the 'knots'. Multivariable
models were constructed based on Cox proportional hazards regression using
backward elimination. Internal validation to directly compare the fit of
the restricted cubic spline and fractional polynomial strategies was
carried out by calculating the sampling distribution of the difference in
AIC between the models using nonparametric bootstrap analyses. Further
analysis recalculated the univariate fractional polynomial transformation
within each bootstrap resample to compare directly against a 5-knot
restricted cubic spline. The influence of the size of the bootstrap
samples was also investigated. The fitted functions generated by splines
and fractional polynomials were similar resulting in comparable models.
The methods are generally different in the extremities where there is
often a paucity of data. Larger differences were seen between the two
methods when sample sizes were reduced due to the reduced power to detect
small effects but also to detect nonlinearity. Multivariable fractional
polynomial transformations are an alternative approach to restricted cubic
spline transformations for multivariable model building of continuous
biomarkers with non-linear relationships with outcome.