Results Generated From:
Embase <1980 to 2012 Week 07>
Embase (updates since 2012-02-10)
<1>
Accession Number
2012050720
Authors
Tricoci P. Huang Z. Held C. Moliterno D.J. Armstrong P.W. Van De Werf F.
White H.D. Aylward P.E. Wallentin L. Chen E. Lokhnygina Y. Pei J. Leonardi
S. Rorick T.L. Kilian A.M. Jennings L.H.K. Ambrosio G. Bode C. Cequier A.
Cornel J.H. Diaz R. Erkan A. Huber K. Hudson M.P. Jiang L. Jukema J.W.
Lewis B.S. Lincoff A.M. Montalescot G. Nicolau J.C. Ogawa H. Pfisterer M.
Prieto J.C. Ruzyllo W. Sinnaeve P.R. Storey R.F. Valgimigli M. Whellan
D.J. Widimsky P. Strony J. Harrington R.A. Mahaffey K.W.
Institution
(Tricoci, Huang, Lokhnygina, Leonardi, Rorick, Harrington, Mahaffey) Duke
Clinical Research Institute, Duke University Medical Center, Durham, NC,
United States
(Held, Wallentin) Department of Medical Sciences, Uppsala Clinical
Research Center, Uppsala University, Uppsala, Sweden
(Moliterno) University of Kentucky, Lexington, United States
(Armstrong) Canadian Virtual Coordinating Center for Global Collaborative
Cardiovascular Research, University of Alberta, Edmonton, Canada
(Van De Werf, Sinnaeve) University Hospital Gasthuisberg, Leuven
Coordinating Center, Leuven, Belgium
(White) Green Lane Cardiovascular Service, Auckland City Hospital,
Auckland, New Zealand
(Aylward) Flinders Medical Centre, Bedford Park, SA, Australia
(Chen, Pei, Kilian, Strony) Merck, Whitehouse Station, NJ, United States
(Jennings) CirQuest Labs., Department of Medicine, University of
Tennessee, Memphis, TN, United States
(Ambrosio) University of Perugia School of Medicine, Perugia, Italy
(Bode) Department of Internal Medicine III-Cardiology and Angiology,
University Hospital, Freiburg, Germany
(Cequier) Hospital Universitari de Bellvitge, Universitat de Barcelona,
Barcelona, Spain
(Cornel) Medisch Centrum Alkmaar, Alkmaar, Netherlands
(Diaz) Estudios Clinicos Latino America, Rosario, Argentina
(Erkan) Department of Cardiology, Ufuk University, Ankara, Turkey
(Huber) Department of Medicine, Cardiology, and Emergency Medicine,
Wilhelminen Hospital, Vienna, Greece
(Hudson) Henry Ford Hospital, Detroit, United States
(Jiang) Cardiovascular Institute and Fuwai Hospital, Chinese Academy of
Medical Sciences, Peking Union Medical College, Beijing, China
(Jukema) Department of Cardiology, Leiden University Medical Center,
Leiden, Netherlands
(Lewis) Lady Davis Carmel Medical Center, Haifa, Israel
(Lincoff) Cleveland Clinic Coordinating Center for Clinical Research,
Cleveland, United States
(Montalescot) Institut de Cardiologie, Hopital Pitie-Salpetriere, Paris,
France
(Nicolau) Unidade de Coronariopatia Aguda, Faculdade de Medicina,
Universidade de Sao Paulo, Sao Paulo, Brazil
(Ogawa) Department of Cardiovascular Medicine, Kumamoto University
Graduate School of Medical Sciences, Kumamoto City, Japan
(Pfisterer) Division of Cardiology, University Hospital Basel, Basel,
Switzerland
(Prieto) Cardiovascular Department, Clinical Hospital, University of
Chile, Santiago, Chile
(Ruzyllo) Department of Coronary Artery Disease, Cardiac Catheterization
Laboratory, Institute of Cardiology, Warsaw, Poland
(Storey) Department of Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
(Valgimigli) Universitaria di Ferrara, Unita Operativa di Cardiologia,
Ferrara, Italy
(Whellan) Division of Cardiology, Thomas Jefferson University,
Philadelphia, United States
(Widimsky) University Hospital Kralovske Vinohrady, Charles University,
Prague, Czech Republic
Title
Thrombin-receptor antagonist vorapaxar in acute coronary syndromes.
Source
New England Journal of Medicine. 366 (1) (pp 20-33), 2012. Date of
Publication: 05 Jan 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1)
antagonist that inhibits thrombin-induced platelet activation. METHODS: In
this multinational, double-blind, randomized trial, we compared vorapaxar
with placebo in 12,944 patients who had acute coronary syndromes without
ST-segment elevation. The primary end point was a composite of death from
cardiovascular causes, myocardial infarction, stroke, recurrent ischemia
with rehospitalization, or urgent coronary revascularization. RESULTS:
Follow-up in the trial was terminated early after a safety review. After a
median follow-up of 502 days (interquartile range, 349 to 667), the
primary end point occurred in 1031 of 6473 patients receiving vorapaxar
versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate,
18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to
1.01; P = 0.07). A composite of death from cardiovascular causes,
myocardial infarction, or stroke occurred in 822 patients in the vorapaxar
group versus 910 in the placebo group (14.7% and 16.4%, respectively;
hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P = 0.02). Rates of moderate and
severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo
group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial
hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95%
CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were
similar in the two groups. CONCLUSIONS: In patients with acute coronary
syndromes, the addition of vorapaxar to standard therapy did not
significantly reduce the primary composite end point but significantly
increased the risk of major bleeding, including intracranial hemorrhage.
(Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.)
Copyright 2011 Massachusetts Medical Society.
<2>
Accession Number
2012050719
Authors
Mega J.L. Braunwald E. Wiviott S.D. Bassand J.-P. Bhatt D.L. Bode C.
Burton P. Cohen M. Cook-Bruns N. Fox K.A.A. Goto S. Murphy S.A. Plotnikov
A.N. Schneider D. Sun X. Verheugt F.W.A. Gibson C.M.
Institution
(Mega, Braunwald, Wiviott, Bhatt, Murphy, Gibson) Brigham and Women's
Hospital, Harvard Medical School, Boston, United States
(Bhatt) Veterans Affairs Boston Healthcare System, Boston, United States
(Bassand) Department of Cardiology, University Hospital Jean Minjoz,
Besancon, France
(Bode) University Hospital Freiburg, Freiburg, Germany
(Cook-Bruns) Bayer Healthcare, Wuppertal, Germany
(Burton, Plotnikov, Sun) Johnson and Johnson Pharmaceutical Research and
Development, Raritan, NJ, United States
(Cohen) Newark Beth Israel Medical Center, Newark, NJ, United States
(Fox) Centre for Cardiovascular Science, Edinburgh University and Royal
Infirmary, Edinburgh, United Kingdom
(Goto) Tokai University School of Medicine, Tokyo, Japan
(Schneider) University of Vermont/Fletcher Allen Health Care, Burlington,
United States
(Verheugt) Radboud University Nijmegen Medical Center, Nijmegen,
Netherlands
Title
Rivaroxaban in patients with a recent acute coronary syndrome.
Source
New England Journal of Medicine. 366 (1) (pp 9-19), 2012. Date of
Publication: 05 Jan 2012.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Acute coronary syndromes arise from coronary atherosclerosis
with superimposed thrombosis. Since factor Xa plays a central role in
thrombosis, the inhibition of factor Xa with low-dose rivaroxaban might
improve cardiovascular outcomes in patients with a recent acute coronary
syndrome. METHODS: In this double-blind, placebo-controlled trial, we
randomly assigned 15,526 patients with a recent acute coronary syndrome to
receive twice-daily doses of either 2.5 mg or 5 mg of rivaroxaban or
placebo for a mean of 13 months and up to 31 months. The primary efficacy
end point was a composite of death from cardiovascular causes, myocardial
infarction, or stroke. RESULTS: Rivaroxaban significantly reduced the
primary efficacy end point, as compared with placebo, with respective
rates of 8.9% and 10.7% (hazard ratio in the rivaroxaban group, 0.84; 95%
confidence interval [CI], 0.74 to 0.96; P = 0.008), with significant
improvement for both the twice-daily 2.5-mg dose (9.1% vs. 10.7%, P =
0.02) and the twice-daily 5-mg dose (8.8% vs. 10.7%, P = 0.03). The
twice-daily 2.5-mg dose of rivaroxaban reduced the rates of death from
cardiovascular causes (2.7% vs. 4.1%, P = 0.002) and from any cause (2.9%
vs. 4.5%, P = 0.002), a survival benefit that was not seen with the
twice-daily 5-mg dose. As compared with placebo, rivaroxaban increased the
rates of major bleeding not related to coronary-artery bypass grafting
(2.1% vs. 0.6%, P<0.001) and intracranial hemorrhage (0.6% vs. 0.2%, P =
0.009), without a significant increase in fatal bleeding (0.3% vs. 0.2%, P
= 0.66) or other adverse events. The twice-daily 2.5-mg dose resulted in
fewer fatal bleeding events than the twice-daily 5-mg dose (0.1% vs. 0.4%,
P = 0.04). CONCLUSIONS: In patients with a recent acute coronary syndrome,
rivaroxaban reduced the risk of the composite end point of death from
cardiovascular causes, myocardial infarction, or stroke. Rivaroxaban
increased the risk of major bleeding and intracranial hemorrhage but not
the risk of fatal bleeding. (Funded by Johnson & Johnson and Bayer
Healthcare; ATLAS ACS 2-TIMI 51 ClinicalTrials.gov number, NCT00809965.)
Copyright 2011 Massachusetts Medical Society.
<3>
[Use Link to view the full text]
Accession Number
2012067247
Authors
Lucchinetti E. Bestmann L. Feng J. Freidank H. Clanachan A.S. Finegan B.A.
Zaugg M.
Institution
(Lucchinetti, Zaugg) Department of Anesthesiology and Pain Medicine,
University of Alberta, 8-120 Clinical Sciences Building, Edmonton, AB T6G
2G3, Canada
(Bestmann, Feng) Department of Anesthesiology and Pain Medicine,
University of Alberta, Edmonton, AB T6G 2G3, Canada
(Freidank) Department of Pharmacology, University of Alberta, Canada
(Clanachan) Chief Operating Officer, UNILABS, St. Gallen, Switzerland
(Finegan) Department of Radiation Oncology, University of Zurich, Zurich,
Switzerland
Title
Remote ischemic preconditioning applied during isoflurane inhalation
provides no benefit to the myocardium of patients undergoing on-pump
coronary artery bypass graft surgery: Lack of synergy or evidence of
antagonism in cardioprotection?.
Source
Anesthesiology. 116 (2) (pp 296-310), 2012. Date of Publication:
February 2012.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND:: Two preconditioning stimuli should induce a more consistent
overall cell protection. We hypothesized that remote ischemic
preconditioning (RIPC, second preconditioning stimulus) applied during
isoflurane inhalation (first preconditioning stimulus) would provide more
protection to the myocardium of patients undergoing on-pump coronary
artery bypass grafting. METHODS:: In this placebo-controlled randomized
controlled study, patients in the RIPC group received four 5-min cycles of
300 mmHg cuff inflation/deflation of the leg before aortic cross-clamping.
Anesthesia consisted of opioids and propofol for induction and isoflurane
for maintenance. The primary outcome was high-sensitivity cardiac troponin
T release. Secondary endpoints were plasma levels of N-terminal pro-brain
natriuretic peptide, high-sensitivity C-reactive protein, S100 protein,
and short- and long-term clinical outcomE.S. Gene expression profiles were
obtained from atrial tissue using microarrays. RESULTS:: RIPC (n = 27) did
not reduce high-sensitivity cardiac troponin T release when compared with
placebo (n = 28). Likewise, N-terminal pro-brain natriuretic peptide, a
marker of myocardial dysfunction; high-sensitivity C-reactive protein, a
marker of perioperative inflammatory response; and S100, a marker of
cerebral injury, were not different between the groups. The incidence for
the perioperative composite endpoint combining new arrhythmias and
myocardial infarctions was higher in the RIPC group than the placebo group
(14/27 vs. 6/28, P = 0.036). However, there was no difference in the
6-month cardiovascular outcome. N-terminal pro-brain natriuretic peptide
release correlated with isoflurane-induced transcriptional changes in
fatty-acid metabolism (P = 0.001) and DNA-damage signaling (P < 0.001),
but not with RIPC-induced changes in gene expression. CONCLUSIONS:: RIPC
applied during isoflurane inhalation provides no benefit to the myocardium
of patients undergoing on-pump coronary artery bypass grafting. Copyright
2012, the American Society of Anesthesiologists, Inc. Lippincott.
<4>
Accession Number
2012080659
Authors
Mihalcz A. Kassai I. Kardos A. Foldesi C. Theuns D. Szili-Torok T.
Institution
(Mihalcz, Kassai, Kardos, Foldesi) Department of Electrophysiology,
Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
(Theuns, Szili-Torok) Department of Clinical Cardiac Electrophysiology,
Thoraxcentre, Erasmus MC, Dr Molewaterplein 40, kamer Ba 577, Postbus
2040, 3000 CA Rotterdam, Netherlands
Title
Comparison of the efficacy of two surgical alternatives for cardiac
resynchronization therapy: Trans-apical versus epicardial left ventricular
pacing.
Source
PACE - Pacing and Clinical Electrophysiology. 35 (2) (pp 124-130), 2012.
Date of Publication: February 2012.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background: Epicardial pacing lead implantation is the currently preferred
surgical alternative for left ventricular (LV) lead placement. For
endocardial LV pacing, we developed a fundamentally new surgical method.
The trans-apical lead implantation is a minimally invasive technique that
provides access to any LV segments. The aim of this prospective randomized
study was to compare the outcome of patients undergoing either
trans-apical endocardial or epicardial LV pacing. Methods: In group I, 11
end-stage heart failure (HF) patients (mean age 59.7 +/- 7.9 years)
underwent trans-apical LV lead implantation. Epicardial LV leads were
implanted in 12 end-stage HF patients (group II; mean age 62.8 +/- 7.3
years). Medical therapy was optimized in all patients. The following
parameters were compared during an 18-month follow-up period: LV ejection
fraction (LVEF), LV end-diastolic diameter (LVEDD), LV end-systolic
diameter, and New York Heart Association (NYHA) functional class. Results:
Nine out of 11 patients responded favorably to the treatment in group I
(LVEF 39.7 +/- 12.5 vs 26.0 +/- 7.8%, P < 0.01; LVEDD 70.4 +/- 13.6 mm vs
73.7 +/- 10.5 mm, P = 0.002; NYHA class 2.2 +/- 0.4 vs 3.5 +/- 0.4, P <
0.01) and eight out of 12 in group II (LVEF 31.5 +/- 11.5 vs 26.4 +/-
8.9%, P = < 0.001; NYHA class 2.7 +/- 0.4 vs 3.6 +/- 0.4, P < 0.05).
During the follow-up period, one patient died in group I and three in
group II. There was one intraoperative LV lead dislocation in group I and
one early postoperative dislocation in each group. None of the patients
developed thromboembolic complications. Conclusions: Our data suggest that
trans-apical endocardial LV lead implantation is an alternative to
epicardial LV pacing. 2012 Wiley Periodicals, Inc.
<5>
Accession Number
2012074986
Authors
El Deen H.M.S. Deeb A.E.
Institution
(El Deen, Deeb) Department of Anesthesiology, Faculty of Medicine,
Mansoura University, Egypt
Title
Ketamine-propofol versus ketamine fentanyl for anesthesia in pediatric
patients undergoing cardiac catheterization: A prospective randomized
study.
Source
Egyptian Journal of Anaesthesia. 28 (1) (pp 49-53), 2012. Date of
Publication: January 2012.
Publisher
Central Society of Egyptian Anaesthesiologists (P.O. Box 167, Panorama
October 11811, Nasr City, Cairo, Egypt)
Abstract
Objective: The aim of the study was to assess, compare the safety and
efficacy of continuous IV administration of a combination of
ketamine-propofol versus ketamine fentanyl for anesthesia in children
undergoing cardiac catheterization procedures with RT to Lt Shunt.
Methods: Thirty-six children aged from 1 to 8 years, with RT to Lt Shunt
scheduled for Cardiac catheterization in Mansoura Children Hospital were
included in this study. Patients in group KP (n = 18) received ketamine (1
mg/kg) and propofol (2 mg/kg) as induction agents followed by combination
of ketamine (25 mug/kg/min) and propofol (25 mug/kg/min) for maintenance
of anesthesia. On other hand, patients in group KF (n = 18) received
ketamine (1 mg/kg) and fentanyl (1 mug/kg) as induction agents followed by
combination of ketamine (25 mug/kg/min) and fentanyl (0.75 mug/kg/min) for
maintenance of anesthesia. Hemodynamic, oxygenation, recovery variables
and side effects were recorded. Results: There were no statistical
significant differences with age, sex, duration of anesthesia. There were
statistical significant decreases in mean arterial blood pressure (MAP),
systemic vascular resistance (SVR), pulmonary to systemic vascular
resistance ratio in KP group. Additionally, Sao<sub>2</sub> and
Pao<sub>2</sub> after anesthesia in KF group were statistically
significant higher than the other group. Also there was significant
prolongation of time to full recovery in KF group compared with KP group.
Conclusion: We concluded that a combination of ketamine-fentanyl is safer
and more efficacious than ketamine-propofol for pediatric cardiac
catheterization although it was associated with prolonged recovery time.
2011 Egyptian Society of Anesthesiologists. Production and hosting by
Elsevier B.V. All rights reserved.
<6>
Accession Number
2012063351
Authors
Heneghan C. Ward A. Perera R.
Institution
(Heneghan, Ward, Perera) Oxford University, Department of Primary Care
Health Sciences, 23-38 Hythe Bridge St, Oxford, OX1 2ET, United Kingdom
Title
Self-monitoring of oral anticoagulation: Systematic review and
meta-analysis of individual patient data.
Source
The Lancet. 379 (9813) (pp 322-334), 2012. Date of Publication: January
28-February 3, 2012.
Publisher
Elsevier Limited (32 Jamestown Road, London NW1 7BY, United Kingdom)
Abstract
Background: Uptake of self-testing and self-management of oral coagulation
has remained inconsistent, despite good evidence of their effectiveness.
To clarify the value of self-monitoring of oral anticoagulation, we did a
meta-analysis of individual patient data addressing several important gaps
in the evidence, including an estimate of the effect on time to death,
first major haemorrhage, and thromboembolism. Methods: We searched Ovid
versions of Embase (1980-2009) and Medline (1966-2009), limiting searches
to randomised trials with a maximally sensitive strategy. We approached
all authors of included trials and requested individual patient data:
primary outcomes were time to death, first major haemorrhage, and first
thromboembolic event. We did prespecified subgroup analyses according to
age, type of control-group care (anticoagulation-clinic care vs primary
care), self-testing alone versus self-management, and sex. We analysed
patients with mechanical heart valves or atrial fibrillation separately.
We used a random-effect model method to calculate pooled hazard ratios and
did tests for interaction and heterogeneity, and calculated a
time-specific number needed to treat. Findings: Of 1357 abstracts, we
included 11 trials with data for 6417 participants and 12 800 person-years
of follow-up. We reported a significant reduction in thromboembolic events
in the self-monitoring group (hazard ratio 051; 95 CI 031-085) but not for
major haemorrhagic events (088, 074-106) or death (082, 062-109).
Participants younger than 55 years showed a striking reduction in
thrombotic events (hazard ratio 033, 95 CI 017-066), as did participants
with mechanical heart valve (052, 035-077). Analysis of major outcomes in
the very elderly (age >=85 years, n=99) showed no significant adverse
effects of the intervention for all outcomes. Interpretation: Our analysis
showed that self-monitoring and self-management of oral coagulation is a
safe option for suitable patients of all ages. Patients should also be
offered the option to self-manage their disease with suitable health-care
support as back-up. Funding: UK National Institute for Health Research
(NIHR) Technology Assessment Programme, UK NIHR National School for
Primary Care Research. 2012 Elsevier Ltd.
<7>
Accession Number
2012059181
Authors
Aggarwal V. Rajpathak S. Singh M. Romick B. Srinivas V.S.
Institution
(Aggarwal) Department of Medicine, Jacobi Medical Center, Bronx, NY,
United States
(Rajpathak) Department of Epidemiology and Population Health, Albert
Einstein College of Medicine, Bronx, NY, United States
(Singh) Department of Medicine, Bronx-Lebanon Hospital, Bronx, NY, United
States
(Romick, Srinivas) Division of Cardiology, Department of Medicine,
Montefiore Medical Center, 1825, Eastchester Road, Bronx, NY 10461, United
States
Title
Clinical outcomes based on completeness of revascularisation in patients
undergoing percutaneous coronary intervention: A meta-analysis of
multivessel coronary artery disease studies.
Source
EuroIntervention. 7 (9) (pp 1095-1102), 2012. Date of Publication:
January 2012.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: Most studies investigating completeness of revascularisation and
outcomes for multivessel disease (MVD) patients are limited by small
sample size. Methods and results: We searched PUBMED, Cochrane and EMBASE
for studies comparing outcomes of MVD patients with complete
revascularisation (CR) vs. incomplete revascularisation (IR) in the stent
era. We identified nine studies that met our selection criteria. Compared
to IR, patients undergoing CR had significantly lower risk of mortality
(relative risk (RR): 0.82; 95% confidence interval (CI): 0.68-0.99;
p=0.05), non-fatal myocardial infarction (MI) (RR: 0.67; 95% CI:
0.53-0.84; p <0.01) and subsequent coronary artery bypass graft surgery
(CABG) (RR: 0.70; 95% CI: 0.52-0.95; p=0.02) whereas no difference was
noted in the incidence of repeat percutaneous coronary intervention (PCI)
(RR: 0.87; 95% CI: 0.69-1.11; p=0.28). Average weighted follow up was
approximately 29 months for mortality, subsequent CABG and Repeat PCI
whereas it was 19 months for non-fatal MI. The results were similar after
excluding the only RCT or the one study restricted to diabetics or the
study restricted to drug-eluting stent use. Conclusions: In patients with
multivessel coronary disease, complete revascularisation with PCI may be
associated with better outcomes than incomplete revascularisation. Europa
Edition 2012. All rights reserved.
<8>
[Use Link to view the full text]
Accession Number
2012065461
Authors
Ballester M. Llorens J. Garcia-De-La-Asuncion J. Perez-Griera J. Tebar E.
Martinez-Leon J. Belda J. Juez M.
Institution
(Ballester, Llorens, Garcia-De-La-Asuncion, Belda) Department of
Anaesthesiology and Critical Care, Hospital Clinico Universitario, Av de
Vicente Blasco Ibanez 17, 46010 Valencia, Spain
(Perez-Griera) Biochemical Laboratory, Alicante, Spain
(Tebar, Martinez-Leon, Juez) Department of Cardiovascular Surgery,
Alicante, Spain
(Martinez-Leon) Hospital Clinico Universitario, Consorcio Hospital General
Universitario, Alicante, Spain
(Tebar) Valencia and Hospital de Vinalopo, Alicante, Spain
Title
Myocardial oxidative stress protection by sevoflurane vs. propofol: A
Randomised controlled study in patients undergoing off-pump coronary
artery bypass graft surgery.
Source
European Journal of Anaesthesiology. 28 (12) (pp 874-881), 2011. Date of
Publication: December 2011.
Publisher
Lippincott Williams and Wilkins (250 Waterloo Road, London SE1 8RD, United
Kingdom)
Abstract
Context Myocardial oxidative stress plays an essential role in the
pathogenesis of ischaemia-reperfusion injury associated with coronary
artery bypass grafting (CABG). Both propofol and volatile anaesthetics
have been shown to reduce reactive oxygen species in experimental and
clinical studies. Main objective To compare the influence of sevoflurane
and propofol on myocardial oxidative stress markers (F2-isoprostanes and
nitrates/nitrites) in coronary sinus blood samples from patients
undergoing off-pump CABG. Design and setting Randomised controlled
clinical study of patients scheduled for off-pump CABG in a tertiary
academic university hospital from June 2007 to August 2009. Forty patients
consented to enrolment and were assigned to receive either propofol or
sevoflurane. Interventions Upon completion of the proximal anastomosis, a
retroplegia cannula was inserted in the coronary sinus to obtain blood
samples, according to the study protocol. Main outcome measures Markers of
lipoperoxidation (F2-isoprostanes) and nitrosative stress
(nitrates/nitrites) were measured in coronary sinus blood samples at three
time points: after the end of the proximal anastomosis (T1), after
completion of all grafts (T2) and 15min after revascularisation (T3).
Results Of the 40 recruited patients, 38 fully completed the study. In the
sevoflurane group (n - 20), concentrations of oxidative stress markers in
the coronary sinus remained almost constant and were significantly lower
than those in the propofol group (n=18) at all time points.
F2-isoprostanes concentrations were as follows at T1:sevoflurane group
37.2 +/-27.5 pgml<sup>1</sup> vs. propofol group 170.7+/-30.9pgml
<sup>-1</sup> [95% confidence interval (CI) 112.16-155.08, P<0.0001); at
T2:sevoflurane group 31.94+/-24.6pgml<sup>-1</sup> vs. propofol group
171.6+/-29.7 pgm<sup>-1</sup> (95% CI 119.78-159.63, P< 0.0001); and at
T3:sevoflurane group 23.8 +/-13.0pgml<sup>-1</sup> vs. propofol group
43.6+/-31 pgml<sup>-1</sup> (95% CI 2.87-36.63, P = 0.023). Conclusion In
patients undergoing off-pump CABG, sevoflurane showed better antioxidative
properties than propofol. 2011 Copyright European Society of
Anaesthesiology.
<9>
Accession Number
70660946
Authors
Vlasakov V. Thomas-Rueddel D.O. Rueddel H. Hutagalung R. Reinhart K.
Hartog C.S.
Institution
(Vlasakov, Thomas-Rueddel, Rueddel, Hutagalung, Reinhart, Hartog)
Department of Anesthesiology and Intensive Care Medicine, Jena University
Hospital, Germany
(Thomas-Rueddel, Rueddel, Reinhart) Center for Sepsis Control and Care,
Jena University Hospital, Germany
Title
Efficacy and safety of gelatin for fluid therapy in hypovolemia: A
systematic review and meta-analysis.
Source
Infection. Conference: 5th International Congress "Sepsis and Multiorgan
Dysfunction" Weimar Germany. Conference Start: 20110907 Conference End:
20110910. Conference Publication: (var.pagings). 39 (pp S142-S143),
2011. Date of Publication: September 2011.
Publisher
Urban und Vogel
Abstract
Introduction: Gelatin is frequently used as volume expander. There are
growing concerns about safety. Objectives: To systematically assess
clinical evidence concerning mortality, coagulation and renal function.
Methods: Systematic review of randomised controlled trials (RCT) on
gelatin in hypovolemia in comparison to any other fluid with comprehensive
search strategy [Ovid Medline (1948-May 2011), EMBASE (1947-May 2011),
Cochrane Library]. Data were independently extracted and risk of bias
assessed using the 2010 Cochrane tool. Primary outcome was overall
mortality. Secondary outcomes were number of patients exposed to
allogeneic transfusion, frequency of renal replacement therapy (RRT) or
acute renal failure (ARF). Albumin and crystalloid solutions were defined
as ''suitable'', other synthetic colloids as ''unsuitable'' control fluids
since they carry similar risk of side effects. Relative risks (RR) and
weighted mean differences with 95% confidence intervals (CIs) were
calculated. Data were pooled using a random-effects model (RevMan 5.1,
Cochrane Collaboration). Results: The search yielded 1,288 citations, 210
reports were read in full. The final sample contained 73 RCT in English,
German, French and Italian, published between 1975 and 2010, with 5,915
patients overall, 2,538 of which received gelatin. Median sample size in
the gelatin groups was 20 patients (range 10-249). In 54 RCT (74%), the
study period was <=24.0 h. Total gelatin dose was 20 ml/kg (median, range
6-62). Only 39 RCT (53%) used ''suitable'' control fluids. 49 RCT (67%)
investigated elective surgical patients, mostly from cardiac surgery (33
RCT, 465). 9 RCT (12%) investigated critically ill patients, 7 RCT (10%)
were in emergency patients and 7 RCT (10%) were in children. Risk ratio
(RR) for mortality was 1.02 (CI 0.87-1.19, data from 23 RCT with 2,694
patients which reported mortality). Numbers of patients exposed to
allogeneic transfusions were provided in 12 RCT, n = 1,193 patients and RR
was 1.15 (0.94-1.41). When only studies with ''suitable'' control fluids
were included, RR for mortality was 1.13 [0.88-1.46, 10 RCT, 1,392
patients] and risk for transfusion exposure was 1.24 (0.87-1.79, 8 RCT, n
= 702), tending towards control. Only six RCT (n = 662 patients) reported
the occurrence of RRT or ARF, five of them in comparison to HES solutions.
3 RCT reported anaphylactoid events. Conclusions: Most published studies
on gelatin are small and shorttime, use unsuitable control fluids and
report too few events to reliably assess the safety of gelatin.
No comments:
Post a Comment