Results Generated From:
Embase <1980 to 2013 Week 25>
Embase (updates since 2013-06-14)
<1>
Accession Number
2013368292
Authors
Takano H. Ohba T. Yamamoto E. Miyachi H. Inui K. Kawanaka H. Kamiya M.
Kikuchi A. Takahashi Y. Tanabe J. Inami S. Takagi G. Asai K. Yasutake M.
Ibuki C. Tanaka K. Kusama Y. Seino Y. Munakata K. Mizuno K.
Institution
(Takano, Inami, Takagi, Asai, Yasutake, Mizuno) Department of
Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
(Ohba, Ibuki, Seino) Department of Cardiology, Nippon Medical School,
Chiba-Hokuso Hospital, Insei, Japan
(Yamamoto, Kikuchi, Munakata) Department of Medicine, Nippon Medical
School, Musashi-Kosugi Hospital, Kawasaki, Japan
(Miyachi, Kusama) Department of Medicine, Nippon Medical School,
Tama-Nagayama Hospital, Tama, Japan
(Inui, Tanaka) Department of Cardiology, Hakujikai Memorial Hospital,
Tokyo, Japan
(Kawanaka, Tanabe) Department of Cardiology, Shizuoka National Medical
Center, Sunto, Japan
(Kamiya, Takahashi) Department of Cardiology, Fraternity Memorial
Hospital, Tokyo, Japan
Title
Usefulness of rosuvastatin to prevent periprocedural myocardial injury in
patients undergoing elective coronary intervention.
Source
American Journal of Cardiology. 111 (12) (pp 1688-1693), 2013. Date of
Publication: 15 Jun 2013.
Publisher
Elsevier Inc. (360 Park Avenue South, New York NY 10010, United States)
Abstract
The aim of the present study was to investigate whether percutaneous
coronary intervention-related periprocedural myocardial infarction (MI)
can be suppressed more significantly with high- compared with low-dose
rosuvastatin. A total of 232 patients scheduled to undergo elective
percutaneous coronary intervention within 5 to 7 days were assigned to
groups that would receive either 2.5 or 20 mg/day of rosuvastatin (n = 116
each). The incidence of periprocedural MI did not significantly differ
between the high and low-dose groups (8.7% vs 18.7%, p = 0.052). In
patients who were not taking statins at the time of enrollment, high-dose
rosuvastatin significantly suppressed periprocedural MI compared with the
low dose (10.5% vs 30.0%, p = 0.037). The difference was not significant
in patients who were already taking statins (high vs low dose 7.6% vs
10.6%, p = 0.582). In conclusion, the incidence of percutaneous coronary
intervention-related periprocedural MI was reduced more effectively by
high-dose than by low-dose rosuvastatin in statin-naive patients. However,
low-dose rosuvastatin is sufficient for patients who are already taking
statins. 2013 Elsevier Inc. All rights reserved.
<2>
Accession Number
2013369030
Authors
Callus E. Quadri E. Ricci C. Passerini C. Tovo A. Pelissero G. Chessa M.
Institution
(Callus, Quadri, Passerini, Tovo, Pelissero, Chessa) IRCCS Policlinico San
Donato, Scientific Directorate, Italy
(Ricci) Fondazione Don C.Gnocchi, Italy, Italy
Title
Update on psychological functioning in adults with congenital heart
disease: A systematic review.
Source
Expert Review of Cardiovascular Therapy. 11 (6) (pp 785-791), 2013. Date
of Publication: June 2013.
Publisher
Expert Reviews Ltd. (2 Albert Place, London N3 1QB, United Kingdom)
Abstract
The population of adults with congenital heart disease is increasing due
to advancements in cardiology and cardiac surgery. Many patients face
medical complications and psychosocial difficulties; however, it is not
yet clear whether there is a direct relationship between medical status
and the psychological functioning of these patients. This systematic
review of the relevant literature is an attempt to: provide a comparison
between the population of adults with congenital heart disease, the
healthy reference population and similar cardiac populations when it comes
to psychological functioning; explore the relationship between medical
status/cardiac condition and psychological functioning; and identify the
predictors of psychological distress in this population. 2013 2013 Expert
Reviews Ltd.
<3>
Accession Number
2013254652
Authors
Hwang J.J. Kim D.H. Hong Y.J. Lee D.Y.
Institution
(Hwang, Kim) Department of Thoracic and Cardiovascular Surgery, Eulji
University Hospital, Daejeon, South Korea
(Hong) Department of Thoracic and Cardiovascular Surgery, Eulji General
Hospital, 280-1, Hagye-dong, Nowon-gu, Seoul 139-711, South Korea
(Lee) Department of Thoracic and Cardiovascular Surgery, GangNam
Severenace Hospital, Seoul, South Korea
Title
A comparison between two types of limited sympathetic surgery for palmar
hyperhidrosis.
Source
Surgery Today. 43 (4) (pp 397-402), 2013. Date of Publication: April 2013.
Publisher
Springer Japan (1-11-11 Kudan-kita, Chiyoda-ku, No. 2 Funato Bldg., Tokyo
102-0073, Japan)
Abstract
Purpose: Endoscopic thoracic sympathetic surgery is effective for treating
palmar hyperhidrosis, although compensatory sweating (CS) is a significant
and annoying side effect. The purpose of this study was to compare the
results of limited resection at two different locations. Methods: From May
2004 to June 2009, T3 sympathicotomy (group I) was performed in 46
patients and T3,4 ramicotomy (group II) was performed in 43 patients
during the same period. T3 sympathicotomy (group I) and T3,4 ramicotomy
(group II) were performed during the same period. Using questionnaires,
completed by the patients, the satisfaction rates and grades of CS were
analyzed. Results: No significant differences in age distribution or sex
ratios were observed between the two groups. The satisfaction rate was
91.3 % in group I and 79.1 % in group II. The operation time was 19.8
(+/-6.6) min in group I, and 51.6 (+/-18.8) min in group II, showing a
statistically significant difference (p < 0.002). The incidence of
persistent hand sweating in group II (16.3 %) was higher than that
observed in group I (2.2 %). The incidence of compensatory sweating on the
lower extremities was higher in group II (37.2 %) than in group I (10.9
%). Conclusions: Although ramicotomy is considered to be an effective
method for treating hyperhidrosis and has a theoretical advantage of
allowing greater anatomical resection, it requires longer operation time
and induces more severe compensatory sweating in the lower limbs resulting
in reduced satisfaction rates. 2012 The Author(s).
<4>
Accession Number
2013340226
Authors
Wang J. Ma H.P. Zheng H.
Institution
(Wang, Ma, Zheng) Departments of Anaesthesiology, Hospital of Xinjiang,
Medical University, Urumqi, China
Title
Blood loss after cardiopulmonary bypass, standard vs titrated protamine: A
meta-analysis.
Source
Netherlands Journal of Medicine. 71 (3) (pp 123-127), 2013. Date of
Publication: April 2013.
Publisher
Van Zuiden Communications BV (Postbus 2122, Alphen aan de Rijn 2400 CC,
Netherlands)
Abstract
Background: The aim of this meta-analysis was to determine whether
standard or titrated dosing of protamine is more effective in facilitating
haemostasis after cardiac surgery with cardiopulmonary bypass (CPB).
Methods: We searched MEDLINE, and Biomedical Central using the terms
"cardiopulmonary bypass and heparin and protamine". Studies were included
in the meta-analysis if they were randomised controlled trials (RCTs),
controlled clinical studies, or cohort studies with designs comparing the
postoperative volume of bleeding between the study group (titrated dose)
and the control group (standard dose) for protamine reversal of surgical
anticoagulation in CPB procedures. The primary outcome of interest was
postoperative blood loss. Results: There were 219 studies identified in
the initial search; four of these were included in the meta-analysis. All
studies were RCTs, involving a total of 507 patients. Postoperative blood
loss was lower in the study group (range: 625-839 ml) compared with the
control group (range: 765-995 ml) in all four studies. Transfusion of
packed red blood cells was also lower in the study group compared with the
control group in all four studies. There was no evidence of significant
heterogeneity in postoperative blood loss among the four studies (Q=4.224,
I<sup>2</sup>=28.98%, p=0.238); hence, a fixed-effects model of analysis
was used. The overall/combined standardised difference in means of
postoperative blood loss volume significantly favoured study treatment
over control treatment (-0.562+/-0.322, p<0.001). Conclusion: These
findings suggest that titrated protamine dosing is more effective than
standard protamine dosing for reducing postoperative bleeding after CPB.
Van Zuiden Communications B.V. All rights reserved.
<5>
Accession Number
2013341734
Authors
Birnie D.H. Healey J.S. Wells G.A. Verma A. Tang A.S. Krahn A.D. Simpson
C.S. Ayala-Paredes F. Coutu B. Leiria T.L.L. Essebag V.
Institution
(Birnie, Wells, Tang) University of Ottawa Heart Institute, 40 Ruskin St.,
Ottawa, ON K1Y 4W7, Canada
(Healey) Population Health Research Institute, Hamilton, ON, Canada
(Verma) Southlake Regional Health Centre, Newmarket, ON, Canada
(Tang) Island Medical Program, University of British Columbia, Vancouver,
BC, Canada
(Krahn) University of British Columbia, Vancouver, BC, Canada
(Simpson) Queen's University, Kingston General Hospital, Kingston, ON,
Canada
(Ayala-Paredes) Universite de Sherbrooke, Sherbrooke, QC, Canada
(Coutu) Hopital Hotel-Dieu Centre Hospitalier de l'Universite de Montreal,
Montreal, QC, Canada
(Essebag) McGill University Health Centre, Hopital du Sacre-Coeur de
Montreal, Montreal, QC, Canada
(Leiria) Instituto de Cardiologia Fundacao Universitaria Cardiologia,
Porto Alegre, Brazil
Title
Pacemaker or defibrillator surgery without interruption of
anticoagulation.
Source
New England Journal of Medicine. 368 (22) (pp 2084-2093), 2013. Date of
Publication: 30 May 2013.
Publisher
Massachussetts Medical Society (860 Winter Street, Waltham MA 02451-1413,
United States)
Abstract
BACKGROUND: Many patients requiring pacemaker or implantable
cardioverter-defibrillator (ICD) surgery are taking warfarin. For patients
at high risk for thromboembolic events, guidelines recommend bridging
therapy with heparin; however, case series suggest that it may be safe to
perform surgery without interrupting warfarin treatment. There have been
few results from clinical trials to support the safety and efficacy of
this approach. METHODS: We randomly assigned patients with an annual risk
of thromboembolic events of 5% or more to continued warfarin treatment or
to bridging therapy with heparin. The primary outcome was clinically
significant device-pocket hematoma, which was defined as device-pocket
hematoma that necessitated prolonged hospitalization, interruption of
anticoagulation therapy, or further surgery (e.g., hematoma evacuation).
RESULTS: The data and safety monitoring board recommended termination of
the trial after the second prespecified interim analysis. Clinically
significant device-pocket hematoma occurred in 12 of 343 patients (3.5%)
in the continued-warfarin group, as compared with 54 of 338 (16.0%) in the
heparin-bridging group (relative risk, 0.19; 95% confidence interval, 0.10
to 0.36; P<0.001). Major surgical and thromboembolic complications were
rare and did not differ significantly between the study groups. They
included one episode of cardiac tamponade and one myocardial infarction in
the heparin-bridging group and one stroke and one transient ischemic
attack in the continued-warfarin group. CONCLUSIONS: As compared with
bridging therapy with heparin, a strategy of continued warfarin treatment
at the time of pacemaker or ICD surgery markedly reduced the incidence of
clinically significant device-pocket hematoma. (Funded by the Canadian
Institutes of Health Research and the Ministry of Health and Long-Term
Care of Ontario; BRUISE CONTROL ClinicalTrials.gov number, NCT00800137.)
Copyright 2013 Massachusetts Medical Society.
<6>
Accession Number
2013339603
Authors
Rakowski T. Dudek D. Dziewierz A. Yu J. Witzenbichler B. Guagliumi G.
Kornowski R. Hartmann F. Lansky A.J. Brener S.J. Mehran R. Stone G.W.
Institution
(Rakowski, Dudek, Dziewierz) Department of Interventional Cardiology,
Jagiellonian University Medical College, Krakow, Poland
(Yu, Mehran) Mount Sinai Medical Center, New York, NY, United States
(Witzenbichler) Charite University Medicine Campus Benjamin Franklin,
Berlin, Germany
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Kornowski) Rabin Medical Center, Petach Tikva, Israel
(Hartmann) Universitatsklinikum Schleswig-Holstein, Lubeck, Germany
(Lansky) Yale University School of Medicine, New Haven, CT, United States
(Brener) New York Methodist Hospital, Brooklyn, NY, United States
(Brener, Mehran, Stone) Cardiovascular Research Foundation, New York, NY,
United States
(Stone) Columbia University Medical Center, New York, NY, United States
Title
Impact of infarct-related artery patency before primary PCI on outcome in
patients with ST-segment elevation myocardial infarction: The HORIZONS-AMI
trial.
Source
EuroIntervention. 8 (11) (pp 1307-1314), 2013. Date of Publication: March
2013.
Publisher
EuroPCR (5 Rue Saint-Pantaleon, Toulouse 31015, France)
Abstract
Aims: We assessed the impact of early infarct-related artery (IRA)
recanalisation on the outcomes of patients in the recently conducted,
large-scale, multicentre HORIZONS-AMI trial. Methods and results: Of the
3,602 patients enrolled in the HORIZONS-AMI trial, 3,093 patients (85.9%)
were treated with percutaneous coronary intervention (PCI) to a single
artery. We analysed one-year outcomes in these patients according to the
presence or absence of early IRA patency, defined as Thrombolysis in
Myocardial Infarction (TIMI) 2 or 3 flow in the IRA. Baseline coronary
angiography showed early IRA patency in 1,121 patients (36.2%), while
1,972 patients (63.8%) had TIMI 0 or 1 flow. The presence compared with
the absence of early IRA patency was associated with better angiographic
results after primary PCI with more TIMI 3 flow after PCI (93.2% vs.
82.9%, p<0.0001) and myocardial blush grade 2 or 3 (84.4% vs. 71.1%,
p<0.0001). Early IRA patency was associated with lower rates of one-year
mortality (2.5% vs. 3.9%, p=0.04) and definite or probable stent
thrombosis (2.0% vs. 4.0%, p=0.002). In multivariable analysis, early IRA
patency at baseline angiography was an independent predictor of reduced
mortality at one year (HR 0.58, 95% CI: 0.36-0.98, p=0.02). Conclusions:
Early IRA patency in patients with STEMI undergoing primary PCI is
associated with better TIMI flow and myocardial blush post PCI and is an
independent predictor of lower one-year mortality. ClinicalTrials.gov
identifier NCT00433966.
<7>
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Accession Number
2013343880
Authors
Feltracco P. Barbieri S. Rizzi S. Ori C. Groppa F. De Rosa G. Frigo A.C.
Padrini R.
Institution
(Feltracco, Barbieri, Rizzi, Ori) Department of Anesthesia and Intensive
Care, University Hospital of Padova, via Cesare Battisti 256, 35121
Padova, Italy
(Groppa, De Rosa, Padrini) Clinical Pharmacology Unit, Department of
Medicine DMED, Padova, Italy
(Frigo) Department of Cardiac, Thoracic and Vascular Sciences, University
of Padova, Padova, Italy
Title
Perioperative analgesic efficacy and plasma concentrations of
S(+)-ketamine in continuous epidural infusion during thoracic surgery.
Source
Anesthesia and Analgesia. 116 (6) (pp 1371-1375), 2013. Date of
Publication: June 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: In our study, we evaluated the analgesic effect and plasma
level time course of subanesthetic doses of intraoperative S(+)-ketamine
administered by continuous epidural infusion for postthoracotomic pain.
Methods: A study population of 140 patients undergoing thoracic surgery
was randomly assigned to either S(+)-ketamine or ropivacaine by continuous
epidural infusion. The outcome measures were as follows: (a)
intraoperative fentanyl requirements; (b) postoperative pain intensity;
and (c) postoperative rescue analgesics. RESULTS: Intraoperative fentanyl
consumption was significantly lower (median of difference: -58.6 mug; 95%
confidence interval [CI], -97.2 to -19.6 mug; P = 0.0032) in patients in
the ketamine group than those in the ropivacaine group. Postoperative
visual analog scale scores were significantly lower in the ketamine group
than in controls (Wilcoxon-Mann-Whitney odds at 24 hours = 6.25; 95% CI,
4.07 to 1.97; P < 0.0001). Rescue analgesics were required more frequently
in controls than in the ketamine group (percentage difference: 58.6%; 95%
CI, 43.3% to 69.6%; P < 0.0001). The mean plasma level of ketamine
declined rapidly during continuous epidural infusion and decayed slowly
after it had stopped. CONCLUSIONS: Our data show that epidural infusion of
subanesthetic doses of S(+)-ketamine during thoracic surgery provides
better postoperative analgesia than epidural ropivacaine. 2013
International Anesthesia Research Society.
<8>
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Accession Number
2013343861
Authors
Dietrich W. Busley R. Spannagl M. Braun S. Schuster T. Lison S.
Institution
(Dietrich, Spannagl, Lison) Department of Anaesthesiology, Working Group
of Perioperative Hemostasis, University of Munich, Winthirstr. 4, 80639
Munich, Germany
(Busley) Department of Anaesthesiology, Klinik fuer Anaesthesie und
Intensivmedizin Am Krankenhaus Vilsbiburg, Vilsbiburg, Germany
(Braun) Department of Clinical Chemistry, Deutsches Herzzentrum Muenchen,
Munich, Germany
(Schuster) Department of Medical Statistics and Epidemiology, Klinikum
Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
Title
The influence of antithrombin substitution on heparin sensitivity and
activation of hemostasis during coronary artery bypass graft surgery: A
dose-finding study.
Source
Anesthesia and Analgesia. 116 (6) (pp 1223-1230), 2013. Date of
Publication: June 2013.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
Background: Cardiopulmonary bypass is associated with a high degree of
hemostatic system activation. Supplementation of antithrombin (AT) may
attenuate this activation and increase a patient's susceptibility to
heparin. However, the appropriate dosage of AT has not been defined. We
sought to determine the dosage of AT concentrate necessary to achieve
>100% AT activity at the end of cardiac surgery and the influence of AT on
heparin sensitivity. Methods: Forty-one patients were included. Thirty
consecutive patients undergoing primary coronary artery bypass graft
surgery with cardiopulmonary bypass were assigned to 3 groups of
increasing dosages of AT concentrate. Eleven additional patients served as
controls. AT activity and molecular markers of thrombin generation were
determined, and heparin sensitivity was calculated. RESULTS: A median
amount of 36.5 U (19.0; 42.8), 47.0 U (41.3; 61.6), and 50.0 U (47.4;
66.6) AT concentrate/kilogram body weight in the low, medium, and high AT
group, respectively, was administered. At the end of surgery, AT activity
with substitution was 84% (77; 111), 110% (92; 120), and 104% (97; 120)
(median [25th; 75th percentile]), respectively, compared with 63% (49; 79)
in controls (P < 0.05 all substitution groups versus control). Heparin
sensitivity increased from 1.29 (1.17; 1.66) s/U heparin/kg in the control
group to 2.02 (1.43; 3.65), 2.56 (1.52; 3.64), 1.72 (1.24; 2.66) s/U
heparin/kg in the groups with substitution (P < 0.05 all substitution
groups versus control). Compared with preoperative values, AT activity
decreased during the postoperative period in all patients with a nadir on
postoperative day 3 (P < 0.05 compared with baseline except for the medium
AT group). Corresponding to this decrease, an increase in prothrombin
fragment 1+2 and D-dimer could be observed postoperatively. Discussion:
High dosages of AT were required to preserve physiologic AT activity
during coronary artery bypass graft surgery and to significantly enhance
heparin sensitivity, respectively. However, a significant decrease in AT
activity, accompanied by high levels of thrombin generation, was
encountered up to 5 days postoperatively. 2013 International Anesthesia
Research Society.
<9>
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Accession Number
71084578
Authors
Tani M. Morimatsu H. Morita K.
Institution
(Tani, Morimatsu, Morita) Okayama University Hopital, Department of
Anesthesiology and Resuscitology, Okayama, Japan
Title
Atrial natriuretic peptide for management of acute kidney injury:
Systematic review.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2012 Paris France. Conference Start: 20120609
Conference End: 20120612. Conference Publication: (var.pagings). 29 (pp
177-178), 2012. Date of Publication: June 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Atrial natriuretic peptide (ANP) had been
used to manage acute kidney injury (AKI) without rigorous clinical
evidence. After a systematic review was reported in 2009, some RCTs have
been published. We aimed to review trials systematically including those
new RCTs as to effectiveness and risks of ANP in preventing and treating
AKI. Materials and Methods: We searched MEDLINE, Japan Medical Abstracts,
Clinical Trials.gov and reference lists of retrieved articles available
until December 2010. We included RCTs comparing ANP with placebo or
standard treatment or no treatment in adult patients at risk or with AKI.
Outcomes were mortality and need for renal replacement therapy (RRT), and
they were analyzed separately for low and high dose ANP for preventing and
treating AKI. The incidences of hypotension and arrhythmia were also
analyzed. We performed subgroup analyses to evaluate the effects of ANP
after cardiovascular surgery (CVS). Dichotomous data were analyzed by
Mantel-Haenszel model to calculate relative risks with 95% confidence
intervals. Results and Discussion: 24 trials were eligible and included
1321 patients in ANP group and 1148 patients in control group. Five new
studies (606 patients) were added to our review; three of them (562
patients) were prevention study using low dose ANP after CVS. Regardless
of dose and purpose of administration, ANP did not show any effectiveness
in mortality. Low dose ANP significantly reduced need for RRT (RR 0.38,
95%CI 0.18 - 0.81) for preventing AKI. As for adverse events, incidence of
arrhythmia was lower in low dose ANP group for preventing AKI; however
incidence of hypotension was not estimable. Subgroup analysis to study the
role of ANP in patients undergoing CVS showed that low dose ANP was
associated with reduction of RRT. We evaluated this effect separately
according the dose of ANP and first showed a finding which previous
studies did not reveal; low dose ANP was associated with reduction of RRT
need after CVS not only for preventing AKI (RR 0.21, 95%CI 0.05 - 0.82)
but also for treating AKI (RR 0.23, 95%CI 0.06 - 0.89). Conclusion: Low
dose ANP was associated with reduction of RRT requirement for preventing
AKI. Limited to post CVS, low dose ANP might have effectiveness on
reduction of RRT need not only for preventing AKI but also treating AKI.
<10>
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Accession Number
71084373
Authors
Wuethrich P.Y. Metzger T. Mordasini L. Curatolo M. Burkhard F.C.
Institution
(Wuethrich, Metzger, Mordasini, Curatolo, Burkhard) University Hospital
Bern, Department of Anaesthesiology and Pain Medicine, Bern, Switzerland
Title
Thoracic epidurally administrated bupivacaine significantly impairs
voiding function and adding fentanyl enhances this effect: A randomized
controlled trial.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2012 Paris France. Conference Start: 20120609
Conference End: 20120612. Conference Publication: (var.pagings). 29 (pp
117), 2012. Date of Publication: June 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background & Goal of the Study: In a previous study we found, contrary to
our hypothesis, that thoracic epidural analgesia (TEA) after open renal
surgery impairs voiding function1. The goal of this study is to exclude
surgery itself as a cause and determine which epidurally administered
drugs (bupivacaine or bupivacaine/fentanyl) are behind the changes in
lower urinary tract function. Material and Methods: In a randomized,
controlled, double blinded study, 40 patients with no pre-existing lower
urinary tract symptoms were equally randomized to receive an epidural
regimen with bupivacaine 0.125% or bupivacaine 0.125% with fentanyl
2mcg/ml. All patients underwent urodynamic investigations before placement
of the epidural catheter at level T8/9, after activating the TEA before
surgery and 2 days after open renal surgery under TEA with a segmental
blockade from T4 to T12. Primary outcome was the difference in postvoid
residual between the bupivacaine group and bupivacaine-fentanyl group
after surgery. All urodynamic parameters of storage and voiding phases
were assessed according to the guidelines of the International Continence
Society. Results and Discussion: In both group a significant increase in
postvoid residuals from 15ml [range: 0-95] to 200ml [0-695], P< 0.001 in
the bupivacaine group and from 20ml [0-90] to 450ml [70-850], P< 0.001 in
the bupivacaine/fentanyl group was observed after activation of the TEA.
This was more pronounced in the group receiving fentanyl (P=0.041). These
changes did not differ significantly before and after surgery. Maximum
detrusor pressure, detrusor pressure at maximum flow rate and maximum flow
rate were significantly reduced in both groups but did not worsen after
surgery. Conclusions: Thoracic epidurally administered bupivacaine 0.125%
with a segmental blockade T4 to T12 resulted in clinically relevant
postvoid residuals necessitating catheterization. The addition of fentanyl
seems to enhance this effect. Based on this observation removal of the
transurethral catheter in patients with TEA warrants close monitoring of
the postvoid residual.
<11>
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Accession Number
71084300
Authors
Cacheux C. Faraoni D. Van Aelbrouck C. Ickx B. Huybrechts I. Van Obbergh
L.
Institution
(Cacheux, Faraoni, Van Aelbrouck, Ickx, Huybrechts, Van Obbergh)
ULB-Hopital Erasme, Department of Anaesthesiology and Intensive Care,
Brussels, Belgium
Title
Effect of high versus low dose of tranexamic acid (TXA) on fibrinolysis
during cardiac surgery.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2012 Paris France. Conference Start: 20120609
Conference End: 20120612. Conference Publication: (var.pagings). 29 (pp
95), 2012. Date of Publication: June 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background: TXA is the antifibrinolytic of choice in Europe since the
withdrawal of aprotinin. The effect of different dose scheme on
fibrinolysis during cardiopulmonary bypass (CPB) has not yet been
evaluated by thromboelastography (TEG,Haemoscope). Materials and Methods:
46 adults scheduled for elective or semi-urgent cardiac surgery under CPB
were included in this double-blind, randomized, controlled trial (RCT)
approved by the local ethic committee. Exclusion criteria were: age < 18
years old, circulatory arrest, emergent procedure, preoperative
coagulopathy or anticoagulation with unfractioned heparin. Patients were
divided into 3 groups: BART (30 mg/kg, 16 mg/kg/h), Middle (5 mg/kg, 5
mg/kg/h), or Placebo (normal saline). A bolus was administered after
anesthesia induction followed by a continuous infusion until the end of
CPB. Anesthesia protocol was left to the discretion of the physicians.
Occurrence of fibrinolysis by TEG , characterized by an early maximum
amplitude reduction (LY30 time, MA) was defined as the primary objective.
Secondary outcomes were: CPB time, exposure and amount of blood product,
blood loss, eGFR(using Cockroft formula), incidence rate of seizure or
other adverse events. 5 TEG tests were performed during the study period
(baseline, post-bolus, per-CPB, end-CPB, after protamine). One or two way
ANOVA were used as statistical test when required , a p< 0.05 was
considered as significant. Results and Discussion: After informed consent,
40 adults were included in our study and 6 patients were excluded for
technical troubles. No fibrinolysis was observed in any group. Time
significantly influences each TEG variable (p < 0.001), however no
statistical difference between group and no interaction "Time x Group" was
found. When groups were compared, a statistically significant difference
was found for "r" at CPB time between BART and Placebo group (Mean diff
(95% CI) = 5.5mm (0.09-11) with p < 0.05). No difference was found
regarding the secondary outcomes, excepted for CPB (p= 0.04) and aortic
clamp (p= 0.02) times, longer for placebo. Conclusion: When evaluated by
TEG, we were unable to detect any fibrinolysis even in the placebo group.
Moreover no difference was found between high dose and low dose scheme of
TXA in term of fibrinolysis and secondary outcomes. Further well-powered
studies are needed to evaluate the best dosing scheme according to the
pharmacokinetic profile of TXA.
<12>
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Accession Number
71084017
Authors
Absenger C. Hadl M. Bornemann-Cimenti H. Szilagy S.I. Wejbora M.
Sandner-Kiesling A.
Institution
(Absenger, Hadl, Bornemann-Cimenti, Szilagy, Wejbora, Sandner-Kiesling)
Medical University of Graz, Department of Anaesthesiology and Intensive
Care, Graz, Austria
Title
The influence of preoperative hypnosis on perioperative anxiety-a
systematic review of the current literature.
Source
European Journal of Anaesthesiology. Conference: European Anaesthesiology
Congress, EUROANAESTHESIA 2012 Paris France. Conference Start: 20120609
Conference End: 20120612. Conference Publication: (var.pagings). 29 (pp
8), 2012. Date of Publication: June 2012.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and Goal of Study: Hypnosis is defined as a state of increased
receptivity to suggestion and direction, initially induced by the
influence of another person. It is suggested as a cheap, nonhazardous and
useful therapy for a range of psychosomatic as well somatic diseases. In
anesthesia, hypnosis was proposed as treatment for several indications,
including pain therapy, PONV and perioperative stress. In this systematic
review we aimed to evaluate the evidence for the application of
preoperative hypnosis in reducing perioperative anxiety. Material and
Methods: A systematic search was performed in PubMed and EMBASE. Keywords
were hypnosis and perioperative anxiety. Language was restricted to
English and German. Results and Discussion: Thirty-five abstracts were
screened, resulting in 8 studies to be included in this review. Six
studies had positive results, whereas two failed to show benefits. The
positive studies included preoperative anxiety prior major operations,
e.g. cardiac surgery, as well as intraoperative anxiety during local
anesthesia. Both, adult and pediatric patients were examined. A direct
comparison of different parameters is hindered by heterogeneous study
designs, especially in evaluating different time points, concepts and
methods of induction of hypnosis. Conclusion: In general, the current
literature supports the use of preoperative hypnosis for reducing
perioperative anxiety in a wide variety of operations and in different
groups of age. However, the inhomogeneous results should encourage more
engagement and research into this topic.
<13>
Accession Number
71079960
Authors
Pettit S. Japp A. Hawkins N. Gardner R. Haj-Yahia S. Mcmurray J. Petrie M.
Institution
(Pettit, Hawkins) Liverpool Heart and Chest Hospital, Liverpool, United
Kingdom
(Japp) Royal Infirmary of Edinburgh, Department of Cardiology, Edinburgh,
United Kingdom
(Gardner, Haj-Yahia, Petrie) Golden Jubilee National Hospital, Scottish
National Advanced Heart Failure Unit, Glasgow, United Kingdom
(Mcmurray) University of Glasgow, BHF Glasgow Cardiovascular Research
Centre, Glasgow, United Kingdom
Title
Systematic review of bridging to heart transplantation with long-term
continuous flow left ventricular assist devices.
Source
European Journal of Heart Failure. Conference: Heart Failure Congress 2013
Lisbon Portugal. Conference Start: 20130525 Conference End: 20130528.
Conference Publication: (var.pagings). 12 (pp S35), 2013. Date of
Publication: May 2013.
Publisher
Oxford University Press
Abstract
Background: The Interagency Registry for Mechanically Assisted Circulatory
Support (INTERMACS) has provided useful outcome data for consecutive
patients supported with a left ventricular assist device (LVAD), but
uncertainties remain regarding the strategy of bridging to heart
transplantation. Quality of life and continuing transplant eligibility for
patients with ongoing LVAD support are not described. Mortality is
censored at the point of transplantation and post-transplant outcomes are
not described. Methods: We performed a systematic review of studies of
long-term continuous flow LVAD support in patients without an absolute,
permanent contraindication to transplantation. For each study, we recorded
the number of patients who were transplanted from LVAD support, died
during LVAD support or recovered from LVAD support (LVAD explanted). In
most studies these were reported as competing outcomes. Where available,
the time to each outcome measure, post-transplant survival, ongoing
transplant eligibility, functional state and quality of life were
recorded. Results: Of 552 articles screened, 23 studies including 2088
patients were analyzed. Median duration of LVAD support ranged from 50 to
383 days. At close of follow-up, 19% of patients had died on LVAD support
and 42% of patients were transplanted. Median time to transplantation
ranged from 55 to 353 days (11 studies) and mean time to transplantation
from 51 to 532 days (6 studies), with longer periods of support in more
recent studies. Post-transplant survival was 89% at 1 year but was only
reported in 17% of studies and for 27% of transplant recipients. At close
of followup, transplant eligibility for those with ongoing LVAD support
was 90% but only reported in 26% of studies and for 18% of patients.
Functional state and quality of life improved during LVAD support but were
only reported in 17% and 22% of studies respectively and not for all
patients. Conclusions: Less than half of patients who receive a long-term
continuous flow LVAD as a bridge to transplantation actually undergo heart
transplantation during follow-up ranging from a median 50 to 383 days.
There is uncertainty about post-transplant survival and, for those with
ongoing LVAD support, functional state, quality of life and continuing
transplant eligibility. These data should be captured in a prospective
international registry of LVAD support.
<14>
Accession Number
71079006
Authors
Clive A.O.
Institution
(Clive) School of Clinical Sciences, University of Bristol, United Kingdom
Title
Surgical and large bore pleural interventions in malignant pleural
mesothelioma and radiotherapy trial (The SMART Trial).
Source
Lung Cancer. Conference: 11th Annual British Thoracic Oncology Group
Conference, BTOG 2013 Dublin Ireland. Conference Start: 20130123
Conference End: 20130125. Conference Publication: (var.pagings). 79 (pp
S33), 2013. Date of Publication: January 2013.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction: Malignant pleural mesothelioma is universally fatal tumour,
the incidence of which continues to rise. 'Procedure tract metastasis'
(PTM) may develop at the site of previous pleural interventions and
prophylactic radiotherapy has previously been used to minimise this
complication. However, three small trials already conducted in this area
showed conflicting results with regards to its efficacy. This has led to
significant variation in practice around the UK and confusion regarding
the optimal treatment strategy for these patients. The SMART trial is a
suitably powered, multi-centre study, designed to conclusively answer this
much debated research question. Methods: 203 patents with a
histo-cytologically proven diagnosis of malignant pleural mesothelioma,
who have undergone a large bore pleural intervention (thoracic surgical
procedure, large bore chest drain, indwelling pleural catheter or local
anaesthetic thoracoscopy) in the previous 35 days will be recruited to the
study. Written informed consent will be taken. Patients will be randomised
to either receive immediate radiotherapy (21 Gy in 3#s within 42 days of
the pleural intervention) or deferred radiotherapy (21 Gy in 3#s given in
the event of a PTM developing). Patients will be followed up for 12
months. Data regarding the incidence of PTM, quality of life data and
chest pain scores will be collected. Results: 23 UK centres are currently
open to recruitment and since the trial opened in December 2011, 60
patients have been recruited to the study. Conclusion: This randomised
controlled clinical trial is currently recruiting in centres around the UK
and 30% of the required patients have already been enrolled. We hope
recruitment will be complete by the end of 2013. This will allow
publication of the results in early 2015 when all patients have completed
12 months follow up.
<15>
Accession Number
71078977
Authors
Roy K. Slade M.
Institution
(Roy, Slade) Papworth Hospital, United Kingdom
Title
Therapeutic flexible bronchoscopy in lung malignancy results from a
prospective registry at Papworth Hospital.
Source
Lung Cancer. Conference: 11th Annual British Thoracic Oncology Group
Conference, BTOG 2013 Dublin Ireland. Conference Start: 20130123
Conference End: 20130125. Conference Publication: (var.pagings). 79 (pp
S23), 2013. Date of Publication: January 2013.
Publisher
Elsevier Ireland Ltd
Abstract
Introduction and Background: Interventional bronchoscopy (IB) can treat
airway complications, principally large airway obstruction in lung cancer.
Such procedures are usually performed by thoracic surgeons using rigid
bronchoscopy (RB). They can, however, be carried out via flexible
bronchoscopy under sedation as day-case, which is our usual practice. This
offers considerable cost savings, but some practitioners cite control of
the airway and safety considerations as reasons to prefer RB for
therapeutic interventions. We report the results of a prospective registry
of all therapeutic IB at Papworth Hospital 2008 2012. Aims: To report
outcomes of IB by improvement in: a. Lung physiology b. Performance status
(PS) and Borg scores c. To determine median survival and mortality.
Methods: We prospectively collected data from first IB procedures
performed 14/07/2008 to 31/07/2012. Spirometry, PS, Borg score, patient
location were compared before and after intervention by Wilcoxon
matched-pairs signed-ranks test at an average 31 days follow up. Kaplan
Meier survival analysis and 30-day mortality was recorded. Result: 93
patients were included. There was statistically significant improvement in
FEV1, FVC, PS and Borg scores post-procedure compared to pre-procedure
(Table 1). Over 50% were alive 12 months post IB and 30 day mortality was
16.1%. IB was carried out as outpatient in 67 (72%) patients and only one
was admitted post procedure. 22 were existing inpatients. Conscious
sedation was employed for 81 (87.1%) and general anesthetic in 12
patients. Conclusions: We demonstrate that therapeutic airway
interventions in patients with lung cancer can usually be carried out on
an outpatient basis, using flexible bronchoscopy and conscious sedation.
There are benefits in terms of lung function, PS, and BORG, and mortality
in advanced lung cancer is in line with international comparators. We
believe that randomised controlled trials, examining the potential
benefits of IB in lung cancer more rigorously, are warranted.
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