Results Generated From:
Embase <1980 to 2012 Week 11>
Embase (updates since 2012-03-08)
<1>
Accession Number
2012131977
Authors
Stergiopoulos K. Brown D.L.
Institution
(Stergiopoulos, Brown) Division of Cardiovascular Medicine, Department of
Medicine, Stony Brook University Medical Center, Stony Brook, NY, United
States
Title
Initial coronary stent implantation with medical therapy vs medical
therapy alone for stable coronary artery disease: Meta-analysis of
randomized controlled trials.
Source
Archives of Internal Medicine. 172 (4) (pp 312-319), 2012. Date of
Publication: 27 Feb 2012.
Publisher
American Medical Association (515 North State Street, Chicago IL 60654,
United States)
Abstract
Background: Prior meta-analyses have yielded conflicting results regarding
the outcomes of treatment of stable coronary artery disease (CAD) with
initial percutaneous coronary intervention (PCI) vs medical therapy.
However, most of the studies in prior systematic reviews used balloon
angioplasty as well as medical therapies that do not reflect current
interventional or medical practices. We therefore performed a
meta-analysis of all randomized clinical trials comparing initial coronary
stent implantation with medical therapy to determine the effect on death,
nonfatal myocardial infarction (MI), unplanned revascularization, and
persistent angina. Methods: Prospective randomized trials were identified
by searches of the MEDLINE database from 1970 to September 2011. Trials in
which stents were used in less than 50% of PCI procedures were excluded.
Data were extracted from each study, and summary odds ratios (ORs) were
obtained using a random effects model. Results: Eight trials enrolling
7229 patients were identified. Three trials enrolled stable patients after
MI, whereas 5 studies enrolled patients with stable angina and/or ischemia
on stress testing. Mean weighted follow-up was 4.3 years. The respective
event rates for death with stent implantation and medical therapy were
8.9% and 9.1% (OR, 0.98; 95% CI, 0.84-1.16); for nonfatal MI, 8.9% and
8.1% (OR, 1.12; 95% CI, 0.93-1.34); for unplanned revascularization, 21.4%
and 30.7% (OR, 0.78; 95% CI, 0.57-1.06); and for persistent angina, 29%
and 33% (OR, 0.80; 95% CI, 0.60-1.05). Conclusion: Initial stent
implantation for stable CAD shows no evidence of benefit compared with
initial medical therapy for prevention of death, nonfatal MI, unplanned
revascularization, or angina. 2012 American Medical Association. All
rights reserved.
<2>
Accession Number
2012122459
Authors
Mannacio V. Di Tommaso L. De Amicis V. Stassano P. Musumeci F. Vosa C.
Institution
(Mannacio, Di Tommaso, De Amicis, Stassano, Vosa) Department of Cardiac
Surgery, University of Naples Federico II, Via S. Domenico 62, 80127
Naples, Italy
(Musumeci) Department of Cardiac Surgery, Azienda Ospedaliera S. Camillo
Forlanini, Rome, Italy
Title
Preoperative intraaortic balloon pump for off-pump coronary arterial
revascularization.
Source
Annals of Thoracic Surgery. 93 (3) (pp 804-809), 2012. Date of
Publication: March 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: Prophylactic intraaortic balloon pump (IABP) support showed
better outcomes in critical patients undergoing coronary revascularization
compared with intraoperative or postoperative insertion. We conducted a
prospective, randomized study to determine the optimal timing for
preoperative IABP insertion in high-risk patients undergoing off-pump
coronary artery revascularization. Methods: The study enrolled 230
consecutive high-risk patients (having a logistic European System for
Cardiac Operative Risk Evaluation score of <10) undergoing off-pump
coronary artery revascularization. They were randomized for preoperative
IABP starting at 2 hours (2T, n = 115) or 12 hours (12T, n = 115).
Clinical, biochemical, and hemodynamic results, and the need for inotropic
drug support, were markers of outcome and compared between groups.
Results: Hospital mortality in group 12T was reduced by 60%, but the
difference between groups was not statistically significant (hazard ratio,
0.4; 95% confidence interval, 0.1 to 1.5; p = 0.1). Twelve hours of
preoperative IABP therapy reduced postoperative low output syndrome
(hazard ratio, 0.4; 95% confidence interval, 0.1 to 0.9; p = 0.03) and
biomarker leakage upper normal limit (hazard ratio, 0.3; 95% confidence
interval, 0.1 to 0.7; p = 0.001). Postoperative left ventricular function
was similar between the groups. Group 2T patients required higher
inotropic support for a longer average duration and prolonged
postoperative intensive care unit and hospital length of stay.
Conclusions: Twelve hours preoperative IABP therapy improved treatment
efficacy. Postoperative morbidity was reduced, but hospital mortality rate
was not affected. The IABP-related complication rate was low and not
related to the length of treatment. 2012 The Society of Thoracic
Surgeons.
<3>
Accession Number
2012122458
Authors
Heying R. Wehage E. Schumacher K. Tassani P. Haas F. Lange R. Hess J.
Seghaye M.-C.
Institution
(Heying, Wehage) Department of Pediatric Cardiology, University Hospital
Aachen, Aachen, Germany
(Heying) Department of Pediatric Cardiology, UZ Leuven, Herestraat 49,
3000 Leuven, Belgium
(Schumacher, Seghaye) Department of Pediatrics, University Hospital Lige,
Lige, Belgium
(Tassani) Department of Anesthesiology, German Heart Centre, Technical
University, Munich, Germany
(Haas, Lange) Department of Cardiac Surgery, German Heart Centre,
Technical University, Munich, Germany
(Hess) Department of Pediatric Cardiology, German Heart Centre, Technical
University, Munich, Germany
Title
Dexamethasone pretreatment provides antiinflammatory and myocardial
protection in neonatal arterial switch operation.
Source
Annals of Thoracic Surgery. 93 (3) (pp 869-876), 2012. Date of
Publication: March 2012.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background: This prospective double-blinded randomized study tested the
hypothesis that preoperative treatment with dexamethasone would attenuate
inflammatory priming of the myocardium, reduce the systemic inflammatory
reaction upon cardiac operation, and provide organ protection in neonates.
Methods: Twenty neonates (age, 8 to 21 days) with transposition of the
great arteries scheduled for arterial switch operation were included. Nine
received dexamethasone (1 mg/kg body weight) 4 hours before
cardiopulmonary bypass, and 11 received natrium chloride. We studied
intramyocardial messenger RNA expression of interleukin (IL)-6, IL-8,
IL-1beta, and tumor necrosis factor-alpha (TNF-alpha), as well as IL-10
and expression of TNF-alpha on protein level in right atrial tissue taken
before institution of CPB. We measured plasma levels of IL-6, IL-10,
lipopolysaccharide binding protein, and cardiac troponin T. Cytokine
expression was related to postoperative outcome. Results: Pretreatment
with dexamethasone led to a significant decrease in myocardial expression
of IL-6, IL-8, IL-1beta, and TNF-alpha messenger RNA and to a decrease in
protein synthesis of TNF-alpha. Plasma concentrations of IL-6 were
significantly lower and those of IL-10 significantly higher in pretreated
patients. This was associated with lower cardiac troponin T values and
lower dobutamine requirement. Levels of lipopolysaccharide binding protein
were significantly higher postoperatively in pretreated neonates.
Conclusions: Dexamethasone administration before arterial switch operation
leads to a shift in the myocardial and systemic cytokine expression
profile in neonates with transposition of the great arteries, with
downregulation of proinflammatory and upregulation of antiinflammatory
cytokines. Lower myocardial cell damage and lower catecholamine
requirement suggest myocardial protection in treated patients. 2012 The
Society of Thoracic Surgeons.
<4>
Accession Number
2012128632
Authors
Mehta R.H. Yu J. Piccini J.P. Tcheng J.E. Farkouh M.E. Reiffel J. Fahy M.
Mehran R. Stone G.W.
Institution
(Mehta, Piccini, Tcheng) Duke Clinical Research Institute, Duke University
Medical Center, Durham, NC, United States
(Yu, Farkouh, Mehran) Cardiovascular Research Foundation, Mount Sinai
Medical Center, New York, NY, United States
(Reiffel, Fahy, Stone) Cardiovascular Research Foundation, Columbia
University, Medical Center, New York, NY, United States
Title
Prognostic significance of postprocedural sustained ventricular
tachycardia or fibrillation in patients undergoing primary percutaneous
coronary intervention (from the HORIZONS-AMI trial).
Source
American Journal of Cardiology. 109 (6) (pp 805-812), 2012. Date of
Publication: 15 Mar 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The prognostic significance of postprocedure sustained ventricular
tachycardia or ventricular fibrillation (VT/VF) in patients undergoing
primary percutaneous coronary intervention (PPCI) for ST-segment elevation
myocardial infarction (STEMI) has rarely been studied, although a previous
study has suggested that its occurrence portends decreased survival. We
examined outcomes from the prospective large-scale multicenter randomized
HORIZONS-AMI trial to evaluate the incidence, clinical correlates, and
outcomes of in-hospital sustained VT/VF after PPCI. Of 3,485 patients
undergoing PPCI in whom VT/VF did not occur before or during the
procedure, 181 patients (5.2%) developed VT/VF after PPCI. Most
postprocedural VT/VF episodes (85%) occurred in the first 48 hours.
Patients with postprocedural VT/VF were more likely men with Killip class
>I on presentation but had a lower prevalence of hypertension and
diabetes. Patients with postprocedural VT/VF were also less frequently
taking beta blockers and angiotensin-converting enzyme
inhibitors/angiotensin receptor blockers at admission. Mean
door-to-balloon time was shorter and Thrombolysis In Myocardial Infarction
grade 0 flow before PPCI was more common in patients with VT/VF, although
Thrombolysis In Myocardial Infarction grade 3 flow rates after PPCI did
not vary. There were no significant differences in adjusted 3-year rates
of mortality (hazard ratio 0.73, 95% confidence interval 0.30 to 1.79) or
composite major adverse clinical events (death, myocardial infarction,
target vessel revascularization, or stroke; hazard ratio 0.71, 95%
confidence interval 0.44 to 1.15) in patients with versus without
postprocedural sustained VT/VF. In conclusion, sustained VT/VF after PPCI
in the HORIZONS-AMI trial was not significantly associated with 3-year
mortality or major adverse clinical events. Further studies are required
to address the prognostic significance of VT/VF in patients with STEMI
undergoing PPCI. 2012 Elsevier Inc. All rights reserved.
<5>
Accession Number
2012121115
Authors
Dixon E.
Title
Chlorhexidine-alcohol versus povidone-iodine for surgical site antisepsis.
Source
Journal of the American College of Surgeons. 214 (3) (pp 374-376), 2012.
Date of Publication: March 2012.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
<6>
Accession Number
2012120691
Authors
Baidya D.K. Pawar D.K. Dehran M. Gupta A.K.
Institution
(Baidya, Pawar, Dehran) Department of Anaesthesia and Intensive Care, All
India Institute of Medical Sciences, New Delhi - 110 029, India
(Gupta) Department of Radiology, All India Institute of Medical Sciences,
New Delhi, India
Title
Advancement of epidural catheter from lumbar to thoracic space in
children: Comparison between 18G and 23G catheters.
Source
Journal of Anaesthesiology Clinical Pharmacology. 28 (1) (pp 21-27),
2012. Date of Publication: January-March 2012.
Publisher
Medknow Publications and Media Pvt. Ltd (B9, Kanara Business Centre, off
Link Road, Ghatkopar (E), Mumbai 400 075, India)
Abstract
Backgrounds and Objectives: Lumbar-to-thoracic advancement of epidural
catheter is a safe alternative to direct thoracic placement in children.
In this prospective randomized study, success rate of advancement of two
different types and gauges of catheter from lumbar-to-thoracic space were
studied. Materials and Methods: Forty ASA I and II children (up to 6
years) undergoing thoracic or upper-abdominal surgery were allocated to
either Group I (18G catheter) or Group II (23G catheter). After induction
of general anesthesia a pre-determined length of catheter was inserted.
Successful catheter placement was defined as the catheter tip within two
segment of surgical incision in radio-contrast study. Intra-operative
analgesia was provided by epidural bupivacaine and intravenous morphine.
Post-operative analgesia was provided with epidural infusion of 0.1%
bupivacaine+1mcg/ml fentanyl. Observations and Results: Catheter
advancement was successful in 3 cases in Group I and 2 cases in Group II.
Five different types of catheter positions were found on X-ray. Negative
correlation was found between age and catheter advancement [significance
(2-tailed) =0.03]. However, satisfactory post-operative analgesia was
obtained in 35 cases. Positive correlation was found between infusion
rate, the number of segment of gap between desired level and the level
reached [significance (2-tailed) =0.00]. 23G catheter use was associated
with more technical complications. Conclusion: Advancement of epidural
catheter from lumbar to thoracic level was successful in only 10-15% cases
but satisfactory analgesia could be provided by increasing the infusion
rates.
<7>
Accession Number
2012117131
Authors
Wang Y. Zhang H.-B. Xia B. Wang G.-M. Zhang M.-Y.
Institution
(Wang) Department of Cardiac Surgery, Provincial Hospital Affiliated to
Shandong University, Jinan, Shandong 250021, China
(Zhang, Xia, Wang, Zhang) Department of Anesthesiology, Provincial
Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China
Title
Preemptive analgesic effects of flurbiprofen axetil in patients undergoing
radical resection of esophageal carcinoma via the left thoracic approach.
Source
Chinese Medical Journal. 125 (4) (pp 579-582), 2012. Date of
Publication: 20120220.
Publisher
Chinese Medical Association (42 Dongsi Xidajie, Beijing 100710, China)
Abstract
Background Systemic non-steroidal anti-inflammatory drugs have been
evaluated for their possible preemptive analgesic effects. The efficacy of
flurbiprofen axetil for preemptive analgesia in patients undergoing
radical resection of esophageal carcinoma via the left thoracic approach
needs further investigation. The aim of this study was to research the
preemptive analgesic effects of flurbiprofen axetil in thoracic surgery,
and the influence of preoperative administration on postoperative
respiratory function. Methods This randomized, double-blind, controlled
trial enrolled 60 patients undergoing radical resection of esophageal
carcinoma via the left thoracic approach. Anesthesia management was
standardized. Each patient was randomly assigned to receive either 100 mg
flurbiprofen axetil intravenously 15 minutes before incision (PA group) or
intravenous normal saline as a control (C group). Postoperative analgesia
was with sufentanil delivered by patient-controlled analgesia pump.
Postoperative sufentanil consumption, visual analog scale pain scores,
plasma levels of interleukin-8, and oxygenation index were measured.
Results Compared with the preoperative baseline, postoperative patients in
the PA group had no obvious increase in pain scores (P >0.05), but
patients in the C group had significantly increased pain scores (P <0.05).
Pain scores in the C group were significantly higher at 24 hours
postoperatively than preoperatively. Intergroup comparisons showed lower
visual analog scale scores at 2-24 hours postoperatively in the PA group
than the C group (P <0.05). Sufentanil consumption and plasma
interleukin-8 levels at 2 and 12 hours postoperatively were significantly
lower in the PA group than the C group (P <0.05). The oxygenation index at
2 and 12 hours postoperatively was significantly higher in the PA group
than the C group (P <0.05). Conclusions Intravenous flurbiprofen axetil
appears to have a preemptive analgesic effect in patients undergoing
radical resection of esophageal carcinoma via the left thoracic approach,
and appears to contribute to recovery of respiratory function and to
reduction of the postoperative inflammatory reaction.
<8>
Accession Number
2012115754
Authors
Polito A. Ricci Z. Fragasso T. Cogo P.E.
Institution
(Polito, Ricci, Fragasso, Cogo) Department of Cardiology, Bambino Gesu
Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy
Title
Balloon atrial septostomy and pre-operative brain injury in neonates with
transposition of the great arteries: A systematic review and a
meta-analysis.
Source
Cardiology in the Young. 22 (1) (pp 1-7), 2012. Date of Publication:
February 2012.
Publisher
Cambridge University Press (Shaftesbury Road, Cambridge CB2 2RU, United
Kingdom)
Abstract
Objective: To perform a systematic review and a meta-analysis of the
effects of balloon atrial septostomy on peri-operative brain injury in
neonates with transposition of the great arteries. Data source: We conduct
a systematic review of the literature to identify all observational
studies that included neonates born with transposition of the great
arteries who had peri-operative evidence of brain injury. Study selection
and data extraction: The search strategy produced three prospective and
two retrospective cohort studies investigating the association between
balloon atrial septostomy and brain injury totalling 10,108 patients. In
two studies, the outcome was represented by the presence of a coded
diagnosis of a clinically evident stroke at discharge, whereas in three
studies the outcome was represented by the finding of pre-operative brain
injury identified by magnetic resonance scans. Data synthesis: The overall
brain injury rate for neonates who underwent balloon atrial septostomy
versus control patients was 60 of 2273 (2.6%) versus 45 of 7835 (0.5%;
pooled odds ratio, 1.90; 95% confidence intervals, 0.93-3.89; p = 0.08). A
subgroup analysis of the three studies that used pre-operative brain
injury as the primary outcome found no significant association between
balloon atrial septostomy and brain injury (pooled odds ratio, 2.70; 95%
confidence intervals, 0.64-11.33; p = 0.17). Balloon atrial septostomy
frequency was 22.4% (2273 of 10,108), with reported rates ranging from 20%
to 75%. Conclusion: Our analysis shows that balloon atrial septostomy is
not associated with increased odds for peri-operative brain injury.
Balloon atrial septostomy should still be used for those patients with
significant hypoxaemia, haemodynamic instability, or both. Copyright
Cambridge University Press 2011.
<9>
Accession Number
2012125534
Authors
Oh S.-Y. Kim J.C. Choi Y.S. Lee W.K. Lee Y.-K. Kwak Y.L.
Institution
(Oh, Kim, Lee, Lee, Kwak) Department of Anesthesiology and Pain Medicine,
Yonsei University College of Medicine, Seoul, South Korea
(Choi) Department of Anesthesiology and Pain Medicine, Kyungpook National
University Hospital, 250, Seongsanno, Seodaemun-gu, Seoul 120-752, South
Korea
Title
Effects of ulinastatin treatment on myocardial and renal injury in
patients undergoing aortic valve replacement with cardiopulmonary bypass.
Source
Korean Journal of Anesthesiology. 62 (2) (pp 148-153), 2012. Date of
Publication: February 2012.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: We determined the protective effects of a high dose of
ulinastatin on myocardial and renal function in patients undergoing aortic
valve replacement with cardiopulmonary bypass (CPB). Methods: Sixty
patients were assigned randomly to either the ulinastatin group (n = 30)
or the control group (n = 30). In the ulinastatin group, ulinastatin
(300,000 U) was given after the induction of anesthesia, ulinastatin
(400,000 U) was added to the CPB pump prime, and then ulinastatin (300,000
U) was administered after weaning from CPB. In the control group, the same
volume of saline was administered at the same time points. Creatine
kinase-MB levels were assessed 1 day before surgery, and on the first and
second postoperative day (POD 1 and 2). Serum creatinine and cystatin C
levels were assessed 1 day before surgery, upon intensive care unit
arrival, and on POD 1 and 2. The level of plasma neutrophil
gelatinase-associated lipocalin was assessed before induction of
anesthesia, upon ICU arrival, and on POD 1. Results: No significant
differences were observed in serum levels of creatine kinase-MB and
biomarkers of renal injury between the two groups at any point during the
study period. Conclusions: Ulinastatin showed no cardiac or renal
protective effects after CPB in patients undergoing aortic valve
replacement. the Korean Society of Anesthesiologists, 2012.
<10>
Accession Number
2012125533
Authors
Min T.J. Kim W.Y. Jeong W.J. Choi J.H. Lee Y.S. Kim J.H. Park Y.C.
Institution
(Min, Kim, Jeong, Choi, Lee, Kim, Park) Department of Anesthesiology and
Pain Medicine, Korea University Ansan Hospital, Ansan, South Korea
Title
Effect of ketamine on intravenous patient-controlled analgesia using
hydromorphone and ketorolac after the Nuss surgery in pediatric patients.
Source
Korean Journal of Anesthesiology. 62 (2) (pp 142-147), 2012. Date of
Publication: February 2012.
Publisher
Korean Society of Anesthesiologists (314-1,2-Ga Hangangro, Yongsan-gu,
Seoul 140-871, South Korea)
Abstract
Background: Nuss surgery is preferred in pectus excavatum repair because
this procedure produces excellent cosmetic results and prevents
postoperative distressed pulmonary function. However, the procedure causes
severe pain due to thoracic expansion. This study was designed to
investigate the analgesic effect of small doses of ketamine on an
intravenous patient-controlled analgesia (IV-PCA) using hydromorphone and
ketorolac for pain control after Nuss surgery. Methods: Forty-four
patients undergoing elective Nuss surgery were randomly assigned to
receive hydromorphone 3 mug/kg/hr, ketorolac 0.05 mg/kg/hr and ondansetron
0.1 mg/kg/day (Group HO, n = 22) or hydromorphone 3 mug/kg/ hr, ketorolac
0.05 mg/kg/hr, ondansetron 0.1 mg/kg/day and ketamine 0.15 mg/kg/hr (Group
HK, n = 22) via an IVPCA pump after surgery. A blind observer evaluated
each patient using the Modified Children's Hospital of Eastern Ontario
Pain Scale (CHEOPS) for the assessment of pain control. The total
administered PCA volume, side effects and parents satisfaction with pain
control were assessed at postoperative 1, 4, 8, 12, 24, and 48 hours.
Results: There were no significant differences in Modified CHEOPS between
the groups during postoperative 48 hours. The total PCA volume in group HK
was significantly lower than that in group HO (P < 0.05). The side effects
in both groups did not significantly differ except for pruritus. The
levels of satisfaction from the parents were not significantly different
between the groups. Conclusions: A small dose of ketamine on IV-PCA
reduced the total administered dose of IV-PCA with hydromorphone and
ketorolac and reduced the incidence of pruritus after the Nuss procedure
in pediatric patients. the Korean Society of Anesthesiologists, 2012.
<11>
Accession Number
2012122711
Authors
Slany J. Nirnberger G. Pittrow L.A.
Institution
(Nirnberger) Bioconsult GmbH, Breitenfurt, Austria
(Pittrow) Takeda Pharma Ges.m.b.H., Seidengasse 33-35, 1070 Vienna,
Austria
Title
Cardiovascular risk stratification and antihypertensive therapy according
to guidelines in the outpatient setting.
Source
Wiener Medizinische Wochenschrift. 161 (23-24) (pp 557-564), 2011. Date
of Publication: December 2011.
Publisher
Springer Wien (Sachsenplatz 4-6, P.O. Box 89, Vienna A-1201, Austria)
Abstract
Basic concepts and methodology: Acceptance of the ESH/ESC 2007
hypertension guidelines and their reappraisal 2009 are not known by
Austrian practitioners. Therefore, within the frame of a noninterventional
trial we investigated 3,488 ambulatory hypertensive patients. Primary goal
was the evaluation of the assignment to cardiovascular risk categories
according to the ESH/ESC charts by office-based physicians compared to an
independent risk adjudication using the same data and method. Further
goals were assessment of compliance with the recommendation to start
combination treatment in grade 2 and 3 hypertension and efficacy and
tolerability of treatment with candesartan. Results: The comparison
revealed incorrect physicians? risk assessment for approximately 60% of
the patients with a strong tendency for underestimation. Despite
guidelines recommending an initial combination therapy for hypertension
>=160/90 mmHg, 15.4% of these patients still received candesartan as a
monotherapy. Target blood pressure <=140/90mmHg could be well achieved (in
81.6%) with candesartan as monotherapy or combined with
hydrochlorothiazide (HCTZ) for hypertension grade 1-3. Conclusions:
Guidelines for assessment of individual risk and derived therapy
algorithms should be better communicated in the outpatient setting.
Candesartan alone or combined with HCTZ is an effective and well tolerated
therapeutic option to control blood pressure in the majority of patients.
Springer-Verlag 2011.
<12>
Accession Number
70682482
Authors
Ravven S. Bader C. Azar A.R. Rudolph J.L.
Institution
(Ravven) Cambridge Health Alliance, Harvard Medical School, Cambridge, MA,
United States
(Bader) Albert Einstein College of Medicine, Bronx, NY, United States
(Azar) Geriatrics and Extended Care, Povidence VA Medical Center,
Providence, RI, United States
(Rudolph) Geriatric Research, Education and Clinical Center, VA Boston
Healthcare System, Boston, MA, United States
Title
Depression after CABG surgery: A meta-analysis.
Source
American Journal of Geriatric Psychiatry. Conference: AAGP Annual Meeting
2012 Washington, DC United States. Conference Start: 20120316 Conference
End: 20120319. Conference Publication: (var.pagings). 20 (3 SUPPL. 1)
(pp S84), 2012. Date of Publication: March 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Introduction: Coronary Artery Bypass Graft (CABG) surgery is a common
surgical procedure. Preoperative and postoperative depression can impair
the recovery process. The objective of this meta-analysis was to determine
the course of depressive symptoms after CABG surgery. Methods: Scientific
databases were searched for studies assessing depression before and after
CABG. Studies that reported depression and/or depressive symptoms before
and after CABG were included in meta-analyses Meta-analyses were performed
for early (1-2 weeks), recovery (>2 weeks - 2 months), mid (>2 months - 6
months), and late (>6 months) time points. Analysis of studies reporting
dichotomous outcomes were included. Heterogeneity and publication bias
were analyzed. Results: 21 studies reporting dichotomous outcomes were
included in the meta analysis. While there was a nonsignificant increased
risk of depression early after CABG (RR 95%CI), there was a significantly
decreased risk of depression at recovery (RR 0.78, 95% CI 0.67-0.90), mid
(RR 0.64, 95% CI 0.58-0.70) and late (RR 0.68, 95% CI 0.58- 0.79) time
points without heterogeneity. Conclusions: Risk of depression decreased
post-CABG. While depression improves overall after CABG, not all patients
will experience improvement and preoperative and postoperative depression
monitoring is important.
<13>
[Use Link to view the full text]
Accession Number
70681601
Authors
Blaudszun G. Lysakowski C. Elia N. Tramer M.R.
Institution
(Blaudszun, Lysakowski, Elia, Tramer) Uinversity Hospitals of Geneva,
Department of Anaesthesiology, Geneve, Switzerland
Title
Effect of perioperative systemic alpha2-agonists on postoperative morphine
consumption and pain intensity - Systematic review of randomized
controlled trials.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2011 Amsterdam Netherlands. Conference Start:
20110611 Conference End: 20110614. Conference Publication: (var.pagings).
28 (pp 196), 2011. Date of Publication: June 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Perioperative systemic alpha2-agonists are
expected to reduce postoperative opioid requirements and pain intensity.
Materials and Methods: We searched Medline, Embase, Central, and
bibliographies (to 4.2010), without language restriction, for randomized
trials testing any systemic alpha2-agonist (versus placebo or no
treatment), administrated before, during or after surgery, in adults
undergoing non-cardiac surgery under general anesthesia, and that reported
on postoperative cumulative opioid consumption or pain intensity. Opioid
doses were converted to morphine equivalents. We estimated weighted mean
differences (WMD) and numbers-needed-to-treat/harm (NNT/H) with 95%
confidence intervals (CI) when data from at least five studies or 100
patients could be combined. Results and Discussion: Thirty studies (1,792
patients, 933 received clonidine or dexmedetomidine) were included.
Alpha2-agonists regimens varied widely across trials. Their opioid-sparing
effect consistently increased over time: WMD at 2 h -0.4 mg, at 6 h -4.7
mg, at 12 h and 24h -8.5 mg, and at 36h -17.6 mg. Alpha2-agonists
significantly decreased pain intensity at 30 min (-1 cm on the 10 cm VAS)
and at 2 h (-0.7 cm), but not at 24 h. They also significantly decreased
nausea at 8 and 48 h (NNT 8.4 and 6.2, respectively), and vomiting at 48 h
(NNT 18), but increased the risk of postoperative bradycardia (NNH 12),
and of intraoperative and postoperative arterial hypotension (NNH 11 and
16, respectively). Recovery times were not prolonged. Conclusion(s):
Peri-operative systemic alpha2-agonists have only a weak postoperative
opioid-sparing effect and a short lasting effect on pain intensity. Their
impact on nausea and vomiting is clinically not relevant while hemodynamic
adverse effects may limit their routine usage.
<14>
[Use Link to view the full text]
Accession Number
70681222
Authors
Candela-Toha A.M. Elias-Martin E. Martinez-Perez A. Prada P. Parise-Roux
D.
Institution
(Candela-Toha, Elias-Martin, Martinez-Perez, Prada, Parise-Roux) Hospital
Universitario Ramon y Cajal, Department of Anaesthesiology, Madrid, Spain
Title
Efficacy and safety of intraoperative cell saver use in cardiac surgery
with cardiopulmonary bypass: A propensity score analysis.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2011 Amsterdam Netherlands. Conference Start:
20110611 Conference End: 20110614. Conference Publication: (var.pagings).
28 (pp 80), 2011. Date of Publication: June 2011.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Controversy exists about the effect of
intraoperative cell saver (ICS) use during cardiac surgery. While earlier
trials showed a reduction in blood components utilization, recent studies
show no effect or an increase in fresh frozen plasma use. A recent
meta-analysis of 31 randomized clinical trials (RCT) found a decrease in
exposure to allogenic blood products (OR 0.63) without increase in
morbidity or mortality (1). Because RCTs rarely reflect clinical practice,
the aim of our study was to determine the efficacy and safety of ICS in
routine clinical practice. Materials and Methods: Retrospective analysis
of prospectively collected data recorded in our Cardiac Anaesthesia
database. For the purpose of the present study patients operated of mayor
cardiac surgery with cardiopulmonary bypass (CPB) between September 1st
2004 and December 31<sup>st</sup> 2007 were included. We excluded patients
with ICS contraindication (i.e. endocardits) and early (< 24 h) deaths. We
first developed a propensity score (PS) model with ICS use as the
dependent variable. Baseline variables included were demographic: age,
sex, weight, height, body surface; analytical: preoperative hemoglobin,
hematocrit, platelet count, INR, aPTT, serum creatinine, preoperative
antiplatelet medication, and surgical variables: type, priority,
complexity, previous cardiac surgery and intraoperative use of
antifibrinolytics. We then performed matching without replacement based on
the PS model. Efficacy variables considered were: intraoperative
transfusion (IT), postoperative ICU transfusion (PT) and transfusion
during the first 48h (T48). Safety evaluation was assessed wtih
postoperative bleeding (PB) at 6h, 12h and 24h and bleeding needing
reintervention (BNR). Results and Discussion: During this period 986
surgeries were performed. ICS was used in 270 cases (27.4%) and 238 of
them could be matched by PS. ICS use decreased IT (OR, 95% confidence
interval [CI]) (0.57 [0.40-0.81]), PT 0.52 [0.35-0.77) and T48 0.38
[0.25-0.56]. PB at 6 and 12h, but not at 24h, was significantly higher in
patients with ICS use (mean difference in mL [CI]) at 6h: 76 [3-149], at
12h: 105 [10 - 200] and at 24h 101 [-14 - 215]. BNR was nonsignificantly
more frequent in the ICS group (OR [CI]) 1.9 [0.9 - 4.1]. Conclusion(s):
ICS use in cardiac surgery with CPB decreases intraoperative and
postoperative transfusion despite small non relevant increases in PB.
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