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<1>
Accession Number
2014169774
Authors
De Amorim C.G. Malbouisson L.M.S. Da Silva Jr. F.C. Fiorelli A.I. Murakami
C.K.F. Carmona M.J.C.
Institution
(De Amorim, Malbouisson, Da Silva Jr., Fiorelli, Murakami, Carmona)
Discipline of Anesthesiology - Instituto Do Coracao, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
(De Amorim) Dom Almir Marques Ferreira, 644, Morada da Colina, Uberlandia,
Minas Gerais, Brazil
Title
Leukocyte depletion during CPB: Effects on inflammation and lung function.
Source
Inflammation. 37 (1) (pp 196-204), 2014. Date of Publication: February
2014.
Publisher
Springer New York (233 Spring Street, New York NY 10013-1578, United
States)
Abstract
Cardiopulmonary bypass (CPB) is related to inflammatory response and
pulmonary dysfunction. The aim of this study was to evaluate the effects
of CPB leukocyte filtration on inflammation and lung function after
coronary artery bypass grafting (CABG). A prospective randomized study was
performed to compare CABG patients undergoing CPB leukocyte filtration
(n=9) or standard CPB (n=11). Computed tomography, oxygenation, leukocyte
count, hemodynamic data, PaO ₂/FiO₂, shunt fraction,
interleukins, elastase, and myeloperoxidase were evaluated. Data were
analyzed using two-factor ANOVA for repeated measurements. The filtered
group showed lower neutrophil counts up to 50 min of CPB, lower shunt
fraction up to 6 h after surgery, and lower levels of IL-10 at the end of
surgery (p<0.05). There was no statistically significant difference
between groups related to other parameters. Leukodepletion during CPB
results in neutrophil sequestration by a short time, decreased IL-10 serum
levels, and lower worsening of lung function only temporarily. 2013 The
Author(s).

<2>
Accession Number
2014167796
Authors
Attar A.S. Tabari M. Rahnamazadeh M. Salehi M.
Institution
(Attar, Tabari, Rahnamazadeh) Department of Anesthesiology, Ghaem
Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, Islamic
Republic of
(Salehi) Department of Community Medicine, Mashhad University of Medical
Sciences, Mashhad, Iran, Islamic Republic of
Title
A comparison of effects of propofol and isoflurane on arterial oxygenation
pressure, mean arterial pressure and heart rate variations following
one-lung ventilation in thoracic surgeries.
Source
Iranian Red Crescent Medical Journal. 16 (2) , 2014. Article Number:
e15809. Date of Publication: February 2014.
Publisher
Iranian Red Crescent Society (PO Box: 2330, Dubai , UAE, United Arab
Emirates)
Abstract
Background: Hypoxia occurs during one-lung ventilation (OLV) due to the
arteriovenous shunt of unsaturated pulmonary venous blood. Hypoxic
pulmonary vasoconstriction (HPV) acts as a defense mechanism against
shunting. In thoracic surgery, anesthetics with minimal inhibitory effect
on HPV and minimal hemodynamic changes are preferred. Objectives: The
present study aimed to evaluate the Effects of propofol and isoflurane on
patients' arterial oxygen pressure following one-lung ventilation during
thoracic surgeries. Materials and Methods: In this randomized clinical
trial study which was conducted in Iran, sixty patients with ASA (The
American Society of Anesthesiologists) class I & II who were candidates
for right elective thoracotomy were divided in two groups. Induction of
anesthesia in the two groups was conducted using the same method, and left
double-lumen endotracheal tube was inserted. In the first group propofol
was used for the maintenance of anesthesia, and isoflurane for the second
group. During two-lung ventilation and at minutes 5 and 10 after OLV, ABG
(arterial blood gas) (for detecting the mean pressure of arterial oxygen),
mean arterial pressure and heart rate were recorded. Results: Sixty
patients (mean age = 4124.18 + 18.63 years) were divided into two groups.
The age and gender of the subjects were not statistically different
between the two groups. In the propofol group, the arterial oxygen
pressure during two-lung ventilation and at 5th and 10th minutes after OLV
was 263.14 + 136.19, 217.40 + 133.99 and 182.34 + 122.39; in the
isoflurane group, it was reported as 206.29 + 135.59, 164.78 + 118.90 and
155.35 + 109.21 mmHg, respectively. In the propofol group, mean arterial
pressure during two-lung ventilation, and 5th and 10th minutes after OLV,
was 84.01 + 20.67, 88.15 + 20.23 and 86.10 + 19.13, respectively;
regarding the isoflurane group, it was reported as 79.66 + 17.04, 84.78 +
20.19 and 86.50 + 17.07 mmHg, respectively. In the propofol group, heart
rate during two-lung ventilation, and 5th and 10th minutes after OLV was
92.77 + 17.20, 94.0 + 18.34 and 94.33 + 21.03, respectively; In the
isoflurane group, it was reported as 92.87 + 16.96, 91.8 + 18.75 and 91.05
+ 17.20 min, respectively. These values were statistically similar in the
two study groups. Conclusions: The Effects of propofol on hemodynamics and
arterial oxygen pressure during one- or two-lung ventilation were not
different from those of isoflurane. 2014, Iranian Red Crescent Medical
Journal; Published by Kowsar Corp.

<3>
Accession Number
2014178589
Authors
Efendijev I. Nurmi J. Castren M. Skrifvars M.B.
Institution
(Efendijev, Nurmi, Skrifvars) Department of Anesthesiology and Intensive
Care Medicine, Helsinki University Central Hospital, Finland
(Castren) Karolinska Institutet, Department of Clinical Science and
Education, Sodersjukhuset and Section of Emergency Medicine,
Sodersjukhuset, Stockholm, Sweden
(Castren) Department of Emergency Medicine, University of Turku, Finland
Title
Incidence and outcome from adult cardiac arrest occurring in the intensive
care unit: A systematic review of the literature.
Source
Resuscitation. 85 (4) (pp 472-479), 2014. Date of Publication: April 2014.
Publisher
Elsevier Ireland Ltd (P.O. Box 85, Limerick, Ireland)
Abstract
Background: Significant amount of data on the incidence and outcome of
out-of-hospital and in-hospital cardiac arrest have been published.
Cardiac arrest occurring in the intensive care unit has received less
attention. Aims: To evaluate and summarize current knowledge of intensive
care unit cardiac arrest including quality of data, and results focusing
on incidence and patient outcome. Sources and methods: We conducted a
literature search of the PubMed, CINAHL and Cochrane databases with the
following search terms (medical subheadings): heart arrest AND intensive
care unit OR critical care OR critical care nursing OR monitored bed OR
monitored ward OR monitored patient. We included articles published from
the 1st of January 1990 till 31st of December 2012. After exclusion of all
duplicates and irrelevant articles we evaluated quality of studies using a
predefined quality assessment score and summarized outcome data. Results:
The initial search yielded 794 articles of which 780 were excluded. Three
papers were added after a manual search of the eligible studies'
references. One paper was identified manually from the literature
published after our initial search was completed, thus the final sample
consisted of 18 papers. Of the studies included thirteen were
retrospective, two based on prospective registries and three were focused
prospective studies. All except two studies were from a single
institution. Six studies reported the incidence of intensive care unit
cardiac arrest, which varied from 5.6 to 78.1 cardiac arrests per 1000
intensive care unit admissions. The most frequently reported initial
cardiac arrest rhythms were non-shockable. Patient outcome was variable
with survival to hospital discharge being in the range of 0-79% and
long-term survival ranging from 1 to 69%. Nine studies reported
neurological status of survivors, which was mostly favorable, either no
neurological sequelae or cerebral performance score mostly of 1-2. Studies
focusing on post cardiac surgery patients reported the best long-term
survival rates of 45-69%. Conclusions: At present data on intensive care
unit cardiac arrest is quite limited and originates mostly from
retrospective single center studies. The quality of data overall seems to
be poor and thus focused prospective multi-center studies are needed.
2014 Elsevier Ireland Ltd.

<4>
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Accession Number
2014176643
Authors
Shih T. Nicholas L.H. Thumma J.R. Birkmeyer J.D. Dimick J.B.
Institution
(Shih, Nicholas, Thumma, Birkmeyer, Dimick) Center for Healthcare Outcomes
and Policy, University of Michigan, Office 100N-07, 2800 Plymouth Rd, Ann
Arbor, MI 48109, United States
Title
Does pay-for-performance improve surgical outcomes An evaluation of phase
2 of the premier hospital quality incentive demonstration.
Source
Annals of Surgery. 259 (4) (pp 677-681), 2014. Date of Publication: April
2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
OBJECTIVE:: We sought to determine whether the changes in incentive design
in phase 2 of MedicareEs flagship pay-for-performance program, the Premier
Hospital Quality Incentive Demonstration (HQID), reduced surgical
mortality or complication rates at participating hospitals. BACKGROUND::
The Premier HQID was initiated in 2003 to reward high-performing
hospitals. The program redesigned its incentive structure in 2006 to also
reward hospitals that achieved significant improvement. The impact of the
change in incentive structure on outcomes in surgical populations is
unknown. METHODS:: We examined discharge data for patients who underwent
coronary artery bypass (CABG), hip replacement, and knee replacement at
Premier hospitals and non-Premier hospitals in Hospital Compare from 2003
to 2009 in 12 states (n = 861,411). We assessed the impact of incentive
structural changes in 2006 on serious complications and 30-day mortality.
In these analyses, we adjusted for patient characteristics using multiple
logistic regression models. To account for improvement in outcomes over
time, we used difference-in-difference techniques that compare trends in
Premier versus non-Premier hospitals. We repeated our analyses after
stratifying hospitals into quintiles according to risk-adjusted mortality
and serious complication rates. RESULTS:: After restructuring incentives
in 2006 in Premier hospitals, there were lower risk-adjusted mortality and
complication rates for both cardiac and orthopedic patients. However,
after accounting for temporal trends in non-Premier hospitals, there were
no significant improvements in mortality for CABG [odds ratio (OR) = 1.09;
95% confidence interval (CI), 0.92-1.28] or joint replacement (OR = 0.81;
95% CI, 0.58-1.12). Similarly, there were no significant improvements in
serious complications for CABG (OR = 1.05; 95% CI, 0.97-1.14) or joint
replacement (OR = 1.12; 95% CI, 1.01-1.23). Analysis of the "worst"
quintile hospitals that were targeted in the incentive structural changes
also did not reveal a change in mortality [(OR = 1.01; 95% CI, 0.78-1.32)
for CABG and (OR = 0.96; 95% CI, 0.22-4.26) for joint replacement] or
serious complication rates [(OR = 1.08; 95% CI, 0.88-1.34) for CABG and
(OR = 0.92; 95% CI, 0.67-1.28) for joint replacement]. CONCLUSIONS::
Despite recent enhancements to incentive structures, the Premier HQID did
not improve surgical outcomes at participating hospitals. Unless
significantly redesigned, pay-for-performance may not be a successful
strategy to improve outcomes in surgery. 2013 by Lippincott Williams &
Wilkins.

<5>
Accession Number
2014097086
Authors
Tagarakis G.I. Aidonidis I. Daskalopoulou S.S. Simopoulos V. Liouras V.
Daskalopoulos M.E. Parisis C. Papageorgiou K. Skoularingis I. Triposkiadis
F. Molyvdas P.-A. Tsilimingas N.B.
Institution
(Tagarakis, Simopoulos, Liouras, Tsilimingas) Department of Cardiovascular
and Thoracic Surgery, University of Thessaly, Larissa, Greece
(Aidonidis, Papageorgiou, Molyvdas) Department of Physiology, University
of Thessaly, Larissa, Greece
(Daskalopoulou) Department of Medicine, McGill University, Montreal,
Canada
(Daskalopoulos) Vascular Surgery Unit, Thriassio General Hospital, Athens,
Greece
(Parisis, Skoularingis, Triposkiadis) Department of Cardiology, University
of Thessaly, Larissa, Greece
Title
Effect of ranolazine in preventing postoperative atrial fibrillation in
patients undergoing coronary revascularization surgery.
Source
Current Vascular Pharmacology. 11 (6) (pp 988-991), 2013. Date of
Publication: 2013.
Publisher
Bentham Science Publishers B.V. (P.O. Box 294, Bussum 1400 AG,
Netherlands)
Abstract
Background/Objective: Ranolazine is a new anti-ischemic agent approved for
chronic angina with additional electrophysiologic properties. The purpose
of the present trial was to investigate its effect in preventing
postoperative atrial fibrillation (POAF) after on-pump coronary artery
bypass graft (CABG) surgery. Methods: In the current prospective,
randomized, (1 active: 2 control), single-blind (outcome assessors),
single-centre clinical trial we recruited consecutive eligible patients
scheduled for elective on-pump CABG. Participants were assigned to receive
either oral ranolazine 375 mg twice daily for 3 days prior to surgery and
until discharge, or to receive usual care. Patients were monitored for the
development of POAF. Results: We enrolled 102 patients. Significantly
lower incidence of POAF was noted in the ranolazine group compared with
the control group (3 out of 34 patients, 8.8%, vs 21 out of 68 patients,
30.8%; p< 0.001). Mean values of left atrial diameter and left ventricular
ejection fraction between the control and the ranolazine group were not
significantly different. Conclusion: Our findings suggest a protective
role of oral ranolazine when administered in a moderate dose
preoperatively in patients undergoing on-pump CABG surgery. Future studies
based on a wider sample of patients will eventually support our
conclusions. 2013 Bentham Science Publishers.

<6>
Accession Number
2014165684
Authors
Guerra F. Shkoza M. Scappini L. Flori M. Capucci A.
Institution
(Guerra, Shkoza, Scappini, Flori, Capucci) Cardiology and Arrhythmology
Clinic, Marche Polytechnic University, Via Conca, 71, 60126 Ancona, Italy
Title
Role of electrical storm as a mortality and morbidity risk factor and its
clinical predictors: A meta-analysis.
Source
Europace. 16 (3) (pp 347-353), 2014. Date of Publication: March 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Aims: Electrical storm (ES) is a devastating and life-threatening event in
clinical practice, but its real weight as a risk factor and its clinical
predictors remain unclear. Our objective was to evaluate ES as a mortality
and morbidity risk factor and to define the clinical variables associated
with ES. Methods and results: The meta-analysis was performed according to
the PRISMA guidelines. At the end of the selection process, 13 studies
were collected and included in the quantitative analysis. Mortality and
morbidity due to ES were assessed. The most acknowledged ES predictors
were taken into account in separate sub-analyses. The whole cohort
included 5912 patients (857 with ES). Risk of death was increased in the
ES group [risk ratio (RR) 3.15; 95% confidence interval (CI) 2.22-4.48].
Electrical storm was also associated with increased composite risk of
all-cause death, cardiac transplantation, and hospitalization for acute
heart failure (RR 3.39; 95% CI 2.31-4.97). These results were confirmed by
comparing the ES group with patients with or without previous unclustered
episodes of ventricular arrhythmias. Moreover, implantable
cardioverter-defibrillator (ICD) for secondary prevention, lower ejection
fraction, monomorphic ventricular tachycardia as triggering arrhythmia,
and class I anti-arrhythmic drugs therapy were all associated with ES.
Conclusion: Electrical storm is a strong mortality risk factor and it is
associated with an increased combined risk of death, heart
transplantation, and hospitalization for heart failure. Implantable
cardioverter-defibrillator for secondary prevention, monomorphic
ventricular tachycardia as triggering arrhythmia, lower ejection fraction,
and class I anti-arrhythmic drugs therapy are all associated with ES and
could be used to define specific populations with higher risk to develop
ES. The Author 2013.

<7>
Accession Number
23317314
Authors
Sawatzky J.-A.V. Christie S. Singal R.K.
Institution
(Sawatzky) Associate Dean and Faculty Development Coordinator - Graduate
Programs, Faculty of Nursing, University of Manitoba, Winnipeg, Canada
(Christie, Singal) Cardiac Sciences Program, St. Boniface Hospital,
Winnipeg, Manitoba, Canada
Title
Exploring outcomes of a nurse practitioner-managed cardiac surgery
follow-up intervention: A randomized trial.
Source
Journal of Advanced Nursing. 69 (9) (pp 2076-2087), 2013. Date of
Publication: September 2013.
Publisher
Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United
Kingdom)
Abstract
Aims: To describe and compare the outcomes of a nurse practitioner-managed
cardiac surgery follow-up model of care with the standard model of primary
care provider follow-up for coronary artery bypass graft surgery patients.
Background: Advances in healthcare have had a favourable impact on length
of stay following cardiac surgery; however, the shorter length of stay has
not been accompanied by enhanced support to bridge the gap between acute
care and the community setting. Design: Prospective (2009-2010) randomized
study. Methods: Elective cardiac surgery patients (N = 200) were randomly
assigned to the nurse practitioner follow-up intervention or to the
standard model of follow-up care. The main outcomes were health-related
quality of life, patient satisfaction, symptoms, and health resource use.
Outcome data were elicited via telephone interviews at 2 and 6 weeks
postdischarge. Results: Baseline differences between the two groups were
non-significant; however, at 2 weeks postdischarge, the intervention group
reported significantly fewer symptoms and higher physical functioning
status. At 2 and 6 weeks postdischarge, the intervention group was
significantly more satisfied with the amount of help, as well as the
quality of the services received. Differences in healthcare resource use
were not statistically significant. Conclusion: This evidence suggests
that the nurse practitioner-managed model of follow-up care effectively
bridges the gap between institutional and primary care in the cardiac
surgery population. 2013 Blackwell Publishing Ltd.

<8>
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Accession Number
23644384
Authors
Naguib A.N. Tobias J.D. Hall M.W. Cismowski M.J. Miao Y. Barry N. Preston
T. Galantowicz M. Hoffman T.M.
Institution
(Naguib) Department of Anesthesiology and Pediatrics, The Ohio State
University, Columbus, OH, USA.
Title
The role of different anesthetic techniques in altering the stress
response during cardiac surgery in children: a prospective,
double-blinded, and randomized study.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 14 (5) (pp 481-490), 2013. Date of Publication: Jun 2013.
Abstract
Our goal was to evaluate the role of three anesthetic techniques in
altering the stress response in children undergoing surgery for repair of
congenital heart diseases utilizing cardiopulmonary bypass in the setting
of fast tracking or early tracheal extubation. Furthermore, we wanted to
evaluate the correlation between blunting the stress response and the
perioperative clinical outcomes. Prospective, randomized, double-blinded
study. Single center from December 2008 to May of 2011. Forty-eight
subjects (low-dose fentanyl plus placebo, n = 16; high-dose fentanyl plus
placebo, n = 17; low-dose fentanyl plus dexmedetomidine, n = 15) were
studied between ages 30 days to 3 years old who were scheduled to undergo
repair for a ventricular septal defect, atrioventricular septal defect, or
Tetralogy of Fallot. Children undergoing surgical repair of congenital
heart disease were randomized to receive low-dose fentanyl (10 mcg/kg;
low-dose fentanyl), high-dose fentanyl (25mcg/kg; high-dose fentanyl), or
low-dose fentanyl plus dexmedetomidine (as a 1 mcg/kg loading dose
followed by infusion at 0.5mcg/kg/hr until separation from cardiopulmonary
bypass. In addition, patients received a volatile anesthetic agent as
needed to maintain hemodynamic stability. Blood samples were tested for
metabolic, hormonal and cytokine markers at baseline, after sternotomy,
after the start of cardiopulmonary bypass, at the end of the procedure and
at 24 hours postoperatively. Forty-eight subjects (low-dose fentanyl plus
placebo, n = 16; high-dose fentanyl plus placebo, n = 17; low-dose
fentanyl plus dexmedetomidine, n = 15) were studied. Subjects in the
low-dose fentanyl plus placebo group had significantly higher levels of
adrenocorticotropic hormone, cortisol, glucose, lactate, and epinephrine
during the study period. The lowest levels of stress markers were seen in
the high-dose fentanyl plus placebo group both over time
(adrenocorticotropic hormone, p= 0.01; glucose, p = 0.007) and at
individual time points (cortisol and lactate at the end of surgery,
epinephrine poststernotomy; p < 0.05). Subjects in the low-dose fentanyl
plus dexmedetomidine group had lower lactate levels at the end of surgery
compared with the low-dose fentanyl plus placebo group (p < 0.05).
Although there were no statistically significant differences in plasma
cytokine levels between the three groups, the low-dose fentanyl plus
placebo group had significantly higher interleukin-6:interleukin-10 ratio
at 24 hours postoperatively (p < 0.0001). In addition, when compared with
the low-dose fentanyl plus placebo group, the low-dose fentanyl plus
dexmedetomidine group showed a lower norepinephrine level from baseline at
poststernotomy, after the start of cardiopulmonary bypass, and at the end
of surgery (p < 0.05). Subjects in the low-dose fentanyl plus placebo
group had more postoperative narcotic requirement (p = 0.004), higher
prothrombin time (p < 0.03), and more postoperative chest tube output (p <
0.05). Success of fast tracking was not significantly different between
groups (low-dose fentanyl plus placebo 75%, high-dose fentanyl plus
placebo 82%, low-dose fentanyl plus dexmedetomidine 93%; p = 0.39). The
use of low-dose fentanyl was associated with the greatest stress response,
most coagulopathy, and highest transfusion requirement among our cohorts.
Higher dose fentanyl demonstrated more favorable blunting of the stress
response. When compared with low-dose fentanyl alone, the addition of
dexmedetomidine improved the blunting of the stress response, while
achieving better postoperative pain control.

<9>
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Accession Number
23628835
Authors
Ishii S. Shime N. Shibasaki M. Sawa T.
Institution
(Ishii) Department of Anesthesiology and Intensive Care Medicine, Kyoto
Prefectural University of Medicine, Kyoto, Japan.
Title
Ultrasound-guided radial artery catheterization in infants and small
children.
Source
Pediatric critical care medicine : a journal of the Society of Critical
Care Medicine and the World Federation of Pediatric Intensive and Critical
Care Societies. 14 (5) (pp 471-473), 2013. Date of Publication: Jun 2013.
Abstract
To determine whether ultrasound guidance increases the success rates,
decreases the complication rates, and shortens the time to successful
radial artery catheterization in infants and small children. Randomized
study. Single university-affiliated hospital. Infants and children
weighing 3-20 kg, undergoing cardiac surgery for congenital heart disease.
We randomly assigned the right and left radial arteries of patients
undergoing arterial catheterization to ultrasound-guided technique versus
the usual palpation technique. The primary study endpoints were the rates
of successful cannulation at first and within three attempts. The
secondary endpoints were time to radial artery identification, number of
attempts for successful cannulation, and rate of complications. Compared
with palpation, ultrasound-guided radial artery catheterization was
successful in 76.3% versus 35.6% of first attempts and in 94.9% versus
50.8% of arteries after three attempts (both comparisons, p < 0.01). The
median time [interquartile range] to identification of the arteries (18.5
seconds [11.25-27.25] vs 30 seconds [17.75-39.5]) was significantly
shorter (p < 0.01), the number of attempts [interquartile range] at
successful cannulation (1 [1-1] vs 2 [1-2]) was significantly fewer (p <
0.01), and the proportion of hematomas (5.1% vs 25.4%) was significantly
lower (p < 0.01) in the ultrasound group than those in the palpation
group. In infants and small children, ultrasound-guided radial artery
catheterization was more successful and expeditious than the usual
palpation technique.

<10>
Accession Number
2014156927
Authors
Grygier M. Araszkiewicz A. Lesiak M. Grajek S.
Institution
(Grygier, Araszkiewicz, Lesiak, Grajek) First Department of Cardiology,
Poznan University of Medical Sciences, ul. Dluga 1/2, 61-848 Poznan,
Poland
Title
Intracoronary adenosine administered during aortocoronary vein graft
interventions may reduce the incidence of no-reflow phenomenon. A pilot
randomised trial.
Source
Kardiologia Polska. 72 (2) (pp 126-133), 2014. Date of Publication: 2014.
Publisher
Via Medica (Ul. Swietokrzyska 73, Gdansk 80-180, Poland)
Abstract
Background: The results of percutaneous coronary intervention (PCI) for
saphenous vein graft (SVG) disease are limited by distal embolisation and
no-reflow which occurs in 10-43% of cases.Aim: To examine the role of a
new protocol of adenosine administration during PCI in SVG on immediate
angiographic results and clinical course.Methods: A prospective,
single-centre, randomised placebo-controlled pilot trial in 32 consecutive
patients after coronary artery bypass graft (aged 71 + 12 years, 22 male)
with stable and unstable angina (CCS II-IV), who were admitted to our
hospital for SVG PCI, was conducted. Patients were randomised to two
groups. Group A (16 patients) received two times adenosine (2 mg + 2 mg)
to the SVG during PCI procedure, and Group B (16 patients) received a
placebo. Results: No reflow was observed in one (6.25%) patient in the
adenosine group and six (37.5%) patients in the placebo group (p =
0.0325). TIMI 3 flow (94% vs. 63%; p = 0.0322) and corrected TIMI frame
count < 28 (94% vs. 63%; p = 0.0322) at the end of the procedure were
better in patients who received adenosine. Myocardial blush grade 2 and 3
at the end of the procedure was observed in 15 patients in the adenosine
group and ten patients in the placebo group (p = 0.083). A trend toward a
lower rate of myocardial infarctions in the adenosine group was observed
(6% vs. 25%; p = 0.144). Conclusions: Adenosine injections may be
effective in preventing no-reflow in the setting of PCI of SVG. Adenosine
administration seems to be associated with a more favourable clinical
course. Polskie Towarzystwo Kardiologiczne.

<11>
Accession Number
2014162914
Authors
Deo S.V. Shah I.K. Dunlay S.M. Lim J.Y. Erwin P.J. Dillon J.J. Park S.J.
Institution
(Deo) Department of Cardiovascular Surgery, Adventist Wockhardt Heart
Institute, Surat, Gujarat 395001, India
(Shah) Department of Surgery, University of Minnesota, Minneapolis, MN,
United States
(Dunlay) Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN,
United States
(Lim) Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN,
United States
(Erwin) Mayo Clinic Libraries, Rochester, MN, United States
(Dillon) Division of Nephrology and Hypertension, Mayo Clinic, Rochester,
MN, United States
(Park) Division of Cardiovascular Surgery, University Hospitals, Case
Western Reserve University, Cleveland, OH, United States
Title
Coronary artery bypass grafting versus drug-eluting stents in patients
with end-stage renal disease.
Source
Journal of Cardiac Surgery. 29 (2) (pp 163-169), 2014. Date of
Publication: March 2014.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Background The optimal treatment for multivessel coronary artery disease
in patients with end-stage renal disease (ESRD) is unresolved. Aim of
Study Compare clinical adverse events after percutaneous intervention with
drug-eluting stents (DESs) and coronary artery bypass grafting (CABG) in
patients with ESRD. Methods MEDLINE, Web of Science, and Scopus were
searched for appropriate studies published in the English language
(between January 2000 and August 2013). The pooled odds ratio (OR) was
estimated by the Peto method with a random effect model. Data are
presented with 95% confidence interval; p < 0.05 is significant. Results
Five observational studies (12,035 DES patients; 6317 CABG) with a
follow-up period of 27.4 + 6.3 months were included. Early mortality (CABG
8% and DES 2.6%) was less in the DES cohort (OR 0.29 [0.14-0.59]; p =
0.0006; I² = 18%). Repeat intervention (DES 29% and CABG 12%)
was more likely in the DES cohort (OR 3.72 [2.24-6.18]: p < 0.0001). Late
mortality (27.4 + 7.3 months) was comparable in both cohorts (OR 0.72
[0.40-1.29]; p = 0.27). While DES cohort (32%) patients suffered a
slightly higher incidence of major adverse cardiac and cerebrovascular
events (MACCE) as compared to CABG (25%), this was not significant (1.35
[0.72-2.53]; p = 0.35; I² = 30%). Conclusion Data regarding
this topic are limited to small retrospective studies. Early mortality is
lower with DESs compared with coronary artery bypass in patients with
ESRD. Rate of reintervention is significantly higher in the DES cohort. At
a mean pooled follow-up of two years, both mortality and MACCE are
comparable in both cohorts. doi: 10.1111/jocs.12296 (J Card Surg
2014;29:163-169) 2014 Wiley Periodicals, Inc.

<12>
Accession Number
2014162896
Authors
Fitch Z.W. Whitman G.J.R.
Institution
(Fitch, Whitman) Division of Cardiac Surgery, Johns Hopkins Hospital,
Baltimore, MD, United States
Title
Incidence, risk, and prevention of ventilator-associated pneumonia in
adult cardiac surgical patients: A systematic review.
Source
Journal of Cardiac Surgery. 29 (2) (pp 196-203), 2014. Date of
Publication: March 2014.
Publisher
Blackwell Publishing Inc. (350 Main Street, Malden MA 02148, United
States)
Abstract
Ventilator-associated pneumonia remains a major cause of morbidity and
mortality in postoperative heart surgery patients. We present a systematic
review of the literature on the incidence, risk factors, and prevention of
this condition in a population at heightened risk. doi: 10.1111/jocs.12260
(J Card Surg 2014;29:196-203) 2013 Wiley Periodicals, Inc.

<13>
Accession Number
2014149752
Authors
Kikkert W.J. Claessen B.E. Stone G.W. Mehran R. Witzenbichler B. Brodie
B.R. Wohrle J. Witkowski A. Guagliumi G. Zmudka K. Henriques J.P.S.
Tijssen J.G.P. Sanidas E.A. Chantziara V. Xu K. Dangas G.D.
Institution
(Claessen, Stone, Mehran, Sanidas, Chantziara, Xu, Dangas) Cardiovascular
Research Foundation, New York, NY, United States
(Stone, Sanidas, Chantziara) Columbia University Medical Center, New York,
NY, United States
(Mehran, Dangas) Cardiovascular Institute, Mount Sinai Medical Center, One
Gustave L. Levy Place, New York, NY 10029, United States
(Kikkert, Claessen, Henriques, Tijssen) Academic Medical Center,
University of Amsterdam, Amsterdam, Netherlands
(Guagliumi) Ospedali Riuniti di Bergamo, Bergamo, Italy
(Witzenbichler) Charite Universitatsmedizin, Campus Benjamin Franklin,
Berlin, Germany
(Wohrle) University of Ulm, Ulm, Germany
(Brodie) LeBauer CV Research Foundation, Greensboro, NC, United States
(Witkowski) National Institute of Cardiology, Warsaw, Poland
(Zmudka) Szpital Jana Pawla II, Krakow, Poland
Title
D-dimer levels predict ischemic and hemorrhagic outcomes after acute
myocardial infarction: A HORIZONS-AMI biomarker substudy.
Source
Journal of Thrombosis and Thrombolysis. 37 (2) (pp 155-164), 2014. Date of
Publication: February 2014.
Publisher
Springer Netherlands (Van Godewijckstraat 30, Dordrecht 3311 GZ,
Netherlands)
Abstract
D-dimer is a product of cross linked fibrin degradation and is a measure
of the amount of fibrin turnover. As such, D-dimer might be of utility in
the prediction of both thrombotic and hemorrhagic events. Therefore, the
aim of the present study was to evaluate whether elevated D-dimer levels
on admission and at discharge could predict subsequent ischemic and
hemorrhagic events in patients with acute myocardial infarction (AMI).
D-dimer was measured on admission and at discharge in 461 out of a total
of 3,602 patients in the HORIZONS-AMI trial, as part of the formal
prespecified biomarker substudy. The predictive value for major adverse
cardiovascular events (MACE) and non-CABG major bleeding after 3 year
follow up was investigated by stratifying patients in groups of D-dimer
level and comparing event rates using Kaplan-Meier and calculating hazard
ratios using Cox proportional hazards models. D-dimer levels > 0.71 mug/mL
on admission were associated with an adjusted hazard ratio of 2.58 for
MACE (p = 0.0014) and 4.61 for major bleeding (p = 0.0018). A discharge
D-dimer level > 1.26 mug/mL was associated with a higher risk for MACE by
univariate analysis (HR 1.88, p = 0.037), but lost its significance after
multivariate adjustment (HR 1.77, p = 0.070). High D-dimer levels on
admission were associated with a higher risk of MACE and non-CABG major
bleeding in STEMI patients undergoing pPCI. 2013 Springer
Science+Business Media New York.

<14>
[Use Link to view the full text]
Accession Number
2014158032
Authors
Sigaut S. Tremey B. Ouattara A. Couturier R. Taberlet C. Grassin-Delyle S.
Dreyfus J.-F. Schlumberger S. Fischler M.
Institution
(Sigaut, Tremey, Schlumberger, Fischler) Department of Anesthesiology,
Hopital Foch, Suresnes, France
(Dreyfus) Clinical Research Unit, Hopital Foch, Suresnes, France
(Ouattara) Department of Anesthesiology and Critical Care 2, University
Hospital, Bordeaux, France
(Couturier) Department of Anesthesiology, Centre Chirurgical Marie
Lannelongue, Le Plessis-Robinson, France
(Taberlet) Department of Anesthesiology and Critical Care, University
Hospital, Besancon, France
(Grassin-Delyle) Laboratory of Pharmacology and Toxicology, Centre
Hospitalier Universitaire Raymond Poincare, Garches, France
Title
Comparison of two doses of tranexamic acid in adults undergoing cardiac
surgery with cardiopulmonary bypass.
Source
Anesthesiology. 120 (3) (pp 590-600), 2014. Date of Publication: March
2014.
Publisher
Lippincott Williams and Wilkins (530 Walnut Street,P O Box 327,
Philadelphia PA 19106-3621, United States)
Abstract
BACKGROUND:: The optimal dose of tranexamic acid (TA) is still an issue.
The authors compared two doses of TA during cardiac surgery in a
multicenter, double-blinded, randomized study. METHODS:: Patients were
stratified according to transfusion risk, then randomized to two TA doses:
10 mg/kg bolus followed by 1 mgkgh infusion (low dose) until the end of
surgery or 30 mg/kg bolus followed by 16 mgkgh infusion (high dose). The
primary endpoint was the incidence of blood product transfusion up to day
7. Secondary ones were incidences of transfusion for each type of blood
product and amounts transfused, blood loss, repeat surgery, TA-related
adverse events, and mortality. RESULTS:: The low-dose group comprised 284
patients and the high-dose one 285. The primary endpoint was not
significantly different between TA doses (63% for low dose vs. 60% for
high dose; P = 0.3). With the high dose, a lower incidence of frozen
plasma (18 vs. 26%; P = 0.03) and platelet concentrate (15 vs. 23%; P =
0.02) transfusions, lower amounts of blood products (2.5 + 0.38 vs. 4.1 +
0.39; P = 0.02), fresh frozen plasma (0.49 + 0.14 vs.1.07 + 0.14; P =
0.02), and platelet concentrates transfused (0.50 + 0.15 vs. 1.13 + 0.15;
P = 0.02), lower blood loss (590 + 50.4 vs. 820 + 50.7; P = 0.01), and
less repeat surgery (2.5 vs. 6%; P = 0.01) were observed. These results
are more marked in patients with a high risk for transfusion.
CONCLUSIONS:: A high dose of TA does not reduce incidence of blood product
transfusion up to day 7, but is more effective than a low dose to decrease
transfusion needs, blood loss, and repeat surgery. Copyright 2014, the
American Society of Anesthesiologists, Inc.

<15>
Accession Number
2014163166
Authors
Forti P.
Institution
(Forti) Department of Medical and Surgical Sciences, University of
Bologna, Via Massarenti 9, Bologna, 40138, Italy
Title
Atrial fibrillation is associated with an increased risk of cognitive
impairment and dementia with or without a history of clinical stroke.
Source
Evidence-Based Medicine. 19 (1) (pp e3), 2014. Date of Publication:
February 2014.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)

<16>
Accession Number
2014149153
Authors
Talwar S. Kumar M.V. Muthukkumaran S. Airan B.
Institution
(Talwar, Kumar, Muthukkumaran, Airan) Department of Cardiothoracic and
Vascular Surgery, Cardiothoracic Centre, All India Institute of Medical
Sciences, New Delhi 110029, India
Title
Is sternotomy superior to thoracotomy for modified Blalock-Taussig shunt?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (3) (pp 371-375),
2014. Date of Publication: March 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was: is sternotomy approach
superior to a thoracotomy approach for a modified Blalock-Taussig shunt
procedure? More than 58 papers were found using the search as described
below, of which 11 papers represented the best evidence to answer the
clinical question. The authors, journal, date and country of publication,
patient group studied, study type, relevant outcomes and results of these
papers are tabulated. Three of seven papers compared the sternotomy and
thoracotomy approaches. The operative approach was a significant predictor
of shunt failure. The criterion used to define early shunt failure was
either the complete occlusion during hospitalization or the need to return
to the operating room for a second shunt. The studies that compared the
thoracotomy and sternotomy approaches observed increased shunt failure
rates in the thoracotomy group. The sternotomy approach was associated
with advantages like less pulmonary artery distortion, ease of technical
performance, cosmetic advantage of a single sternotomy incision, ease of
ligation of patent ductus, less phrenic nerve injury, less collateral
formation in chest wall adhesions and less thoracotomy induced scoliosis.
However, other papers studied either the sternotomy approach only or the
thoracotomy approach and drew conclusions regarding risk factors for
operative morbidity and mortality. We conclude that the sternotomy
approach is beneficial to neonates and infants undergoing modified
Blalock-Taussig shunt when compared with the conventional thoracotomy
approach. 2013 The Author.

<17>
Accession Number
2014149151
Authors
Diaz A. Black E. Dunning J.
Institution
(Diaz, Black) Department of Cardiothoracic Surgery, John Radcliffe
Hospital, Oxford, United Kingdom
(Dunning) Department of Cardiothoracic Surgery, James Cook University
Hospital, Middlesbrough, United Kingdom
Title
Is thymectomy in non-thymomatous myasthenia gravis of any benefit?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (3) (pp 381-389),
2014. Date of Publication: March 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was if thymectomy in
non-thymomatous myasthenia gravis was of any benefit? Overall, 137 papers
were found using the reported search, of which 16 represented the best
evidence to answer the clinical question. The authors, journal, date and
country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. The outcome variables
were similar in all of the papers, including complete stable remission
(CSR), pharmacological remission, age at presentation, gender, duration of
symptoms, preoperative classification (Oosterhius, Osserman or myasthenia
gravis Foundation of America (MGFA)), thymic pathology, preoperative
medications (steroids, immunosuppressants), mortality and morbidity. We
conclude that evidence-based reviews have shown that relative rates of
thymectomy patients compared with non-thymectomy patients attaining
outcome indicate that the former group of patients is more likely to
achieve medication-free remission, become asymptomatic and clinically
improve (54%, P < 0.01), particularly patients with severe and generalized
symptoms (P = 0.007). Patients with generalized myasthenia gravis showed
11% stronger association with favourable outcomes after thymectomy. Some
studies show early remission rates (RRs), as early as 6 months
post-thymectomy, of 44%. Overall, the reported remission rate for
non-thymomatous myasthenia gravis is between 38 and 72% up to 10 years of
follow-up. Among these patients, those with thymic hyperplasia show the
best complete stable remission rates (42%, P < 0.04) in the majority of
studies. Age showed variability across the studies and the cut-off was
also different among them. Overall age < 45 years showed a higher
probability of achieving complete stable remission during follow-up (81%
benefit rate (BR), P < 0.02). Pharmacological improvement is reported
between 6 and 42%. However, the certainty of these benefits has not been
established due to factors such as the confounding differences between
myasthenia gravis patients receiving and not receiving thymectomy, the
non-randomized nature of class II studies and the lack of Class I evidence
to support its use. There is currently a randomized trial ongoing looking
at thymectomy by sternotomy vs controls and the results are eagerly
awaited. 2013 The Author.

<18>
Accession Number
2014149150
Authors
Li X. Kong M. Jiang D. Dong A.
Institution
(Li, Kong, Jiang, Dong) Department of Second Affiliated Hospital, School
of Medicine, Zhejiang University, Number 88, Jie Fang Road, Hangzhou
310009, Zhejiang Province, China
Title
Comparing coronary artery bypass grafting with drug-eluting stenting in
patients with diabetes mellitus and multivessel coronary artery disease: A
meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (3) (pp 347-354),
2014. Date of Publication: March 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: Although drug-eluting stents (DESs) reduce the rate of target
vessel revascularization compared with bare-metal stents, the results of
DESs for patients with diabetes and multivessel coronary artery disease
(CAD) in the DES era are inconsistent. This meta-analysis was undertaken
to assess the efficacy and safety of coronary artery bypass grafting
(CABG) compared with drug-eluting stent implantation in patients with
diabetes mellitus and multivessel coronary artery disease. Methods: We
conducted a search of Medline, EMBASE from January 2003 to July 2013 by
two reviewers independently, using the terms 'coronary artery bypass graft
surgery', 'drug-eluting stent', 'sirolimus-eluting stent',
'paclitaxel-eluting stent', 'diabetes mellitus' and 'multivessel disease',
according to established criteria. Studies comparing CABG with DES in
patients with diabetes and multivessel CAD with a minimum follow-up of 1
year were included. Results: Thirteen studies including 6653 patients with
diabetes (3237 who underwent CABG and 3416 who underwent DES implantation)
met the selection criteria. The mean follow-up period was 2.9 years (range
1-5). Compared with DES, CABG was associated with a lower risk for major
adverse cardiac events (odds ratio [OR] 0.51, 95% confidence interval [CI]
0.46-0.58), driven mainly by a lower risk for repeat revascularization (OR
0.29, 95% CI 0.23-0.35). There was no significant difference with regard
to death (OR 0.89, 95% CI 0.75-1.05). Patients in the CABG group had a
higher risk for stroke events (OR 2.09, 95% CI 1.45-3.02). Conclusions:
Percutaneous coronary intervention with DES in patients with diabetes and
multivessel CAD is safe, but has a high risk of long-term repeat
revascularization. CABG should remain the standard procedure for diabetic
patients with multivessel CAD. 2013 The Author.

<19>
Accession Number
2014149148
Authors
Gielen C. Dekkers O. Stijnen T. Schoones J. Brand A. Klautz R. Eikenboom
J.
Institution
(Gielen, Dekkers, Stijnen, Schoones, Brand, Klautz, Eikenboom) Department
of Thrombosis and Hemostasis, LUMC, Albinusdreef 2, PO Box 9600, 2300 RC
Leiden, Netherlands
Title
The effects of pre- and postoperative fibrinogen levels on blood loss
after cardiac surgery: A systematic review and meta-analysis.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (3) (pp 292-299),
2014. Date of Publication: March 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
Objectives: Fibrinogen concentrate is increasingly used in cardiac surgery
when bleeding is anticipated or ongoing. Since randomized clinical studies
to support this are lacking, it is relevant to know whether lower
fibrinogen levels are associated with excessive bleeding. We performed a
systematic review and meta-analysis to define the association between
fibrinogen levels and blood loss after cardiac surgery. Methods: A
database search (January 2013) was performed on publications assessing the
association between pre- and postoperative fibrinogen levels and
postoperative blood loss in adult patients undergoing cardiac surgery.
Cohort studies and case-control studies were eligible for inclusion. The
main outcome was the pooled correlation coefficient, calculated via
Fisher's Z transformation scale, in a random-effects meta-analysis model
stratified for the time point at which fibrinogen was measured. Results: A
total of 20 studies were included. The pooled correlation coefficient of
studies (n = 9) concerning preoperative fibrinogen levels and
postoperative blood loss was -0.40 (95% confidence interval: -0.58,
-0.18), pointing towards more blood loss in patients with lower
preoperative fibrinogen levels. Among papers (n = 16) reporting on
postoperative fibrinogen levels and postoperative blood loss, the pooled
correlation coefficient was -0.23 (95% confidence interval: -0.29, -0.16).
Conclusions: Our meta-analysis indicated a significant but
weak-to-moderate correlation between pre- and postoperative fibrinogen
levels and postoperative blood loss in cardiac surgery. This moderate
association calls for appropriate clinical studies on whether fibrinogen
supplementation will decrease postoperative blood loss. 2013 The Author.

<20>
Accession Number
2014149141
Authors
Ng J.K.Y. Ng C.S.H. Underwood M.J. Lau K.K.W.
Institution
(Ng) Sheffield University Medical School, University of Sheffield,
Sheffield, United Kingdom
(Ng, Underwood, Lau) Division of Cardiothoracic Surgery, Prince of Wales
Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
(Lau) St Bartholomew's Hospital, West-Smithfield, London, United Kingdom
Title
Does repeat thymectomy improve symptoms in patients with refractory
myasthenia gravis?.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (3) (pp 376-380),
2014. Date of Publication: March 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in thoracic surgery was written according to a
structured protocol. The question addressed was: Does repeat thymectomy
improve symptoms in patients with refractory myasthenia gravis after
thymectomy? A total of 189 papers were found using the reported search, of
which seven represented the best evidence to answer the clinical question.
The outcome measures included operative mortality and morbidity, as well
as long-term remission rate. The authors, journal, date and country of
publication, patient group studied, study type, relevant outcomes and
results of these papers are tabulated. All the studies were small (4-21
patients), retrospective, single institutional case series. There was
considerable heterogeneity in the studies. The interval between the first
and second operation ranged from less than a year to over 10 years. The
operative approach of the initial operation included transcervical,
trans-sternal and substernal approaches. The maximal medical therapy
received by the patients prior to reoperation varied from
anticholinesterase alone to cytotoxic therapy and regular plasmapheresis.
The severity of symptoms ranged from Osserman Class IIa to V. The
operative approach to re-thymectomy included resternotomy, thoracoscopy
and a combination of both. There was no perioperative mortality. One study
reported injury to the innominate vein at resternotomy in 3 (14.3%)
patients. One study reported myasthenic crisis in 2 patients in the
postoperative period. Only one study reported complete remission in 2
patients. In general, however, 52-95% of patients reported some
improvement. There was no consistent, objective measure of improvement in
these studies. We conclude that repeat thymectomy for patients with
refractory myasthenia gravis after previous thymectomy is safe especially
for patients whose first procedure was transcervical. Complete remissions
are rare but, in these small series, 60-70% of patients report
improvement. Clinical improvement appears to be associated with the
presence of residual thymic tissue at the second operation, but these
cannot be reliably identified on preoperative imaging. Patient selection
remains driven by symptoms. 2013 The Author.

<21>
Accession Number
2014149140
Authors
Wademan B.H. Galvin S.D.
Institution
(Wademan) Department of Cardiothoracic Surgery, Wellington Regional
Hospital, Private bag 7902, Wellington South, New Zealand
(Galvin) Department of Cardiac Surgery, Austin Hospital, Melbourne, VIC,
Australia
Title
Desmopressin for reducing postoperative blood loss and transfusion
requirements following cardiac surgery in adults.
Source
Interactive Cardiovascular and Thoracic Surgery. 18 (3) (pp 360-370),
2014. Date of Publication: March 2014.
Publisher
Oxford University Press (Great Clarendon Street, Oxford OX2 6DP, United
Kingdom)
Abstract
A best evidence topic in cardiac surgery was written according to a
structured protocol. The question addressed was, in adult patients
undergoing cardiac surgery requiring extracorporeal cardiopulmonary bypass
(CPB), does administration of desmopressin acetate (DDAVP) reduce
postoperative blood loss and transfusion requirements? Altogether 38
papers were found using the reported search, of which 19 represented the
best evidence to answer the clinical question. The authors, journal, date
and country of publication, patient group studied, study type, relevant
outcomes and results of these papers are tabulated. Perioperative
administration of DDAVP in adult patients undergoing cardiac surgery
requiring CPB may result in a small but significant reduction in
postoperative blood loss. However, this does not translate into a
reproducible, clinically significant reduction in exposure to transfusion
in unselected patients exposed to CPB. Several sub-groups of patients have
been identified in whom DDAVP reduces postoperative blood loss and
transfusion requirements. These sub-groups include patients who have
received preoperative aspirin within 7 days of surgery, patients with CPB
times in excess of 140 min and patients with demonstrable pre- or
perioperative platelet dysfunction as determined by TEG analysis or
platelet function assays. Platelet dysfunction at the time of surgery may
be secondary to preoperative administration of antiplatelet medications,
the result of pathological processes such as von Willebrands disease,
uraemia or aortic stenosis with its associated sheer stress, as well as
operative variables such as prolonged exposure to CPB. The evidence does
not support the routine use of DDAVP in all cardiac surgery; indeed, it is
clear that there is no significant reduction in postoperative blood loss
or transfusion requirements with the administration of DDAVP in patients
undergoing isolated coronary artery bypass grafting (CABG) in the absence
of the features noted above. Given the absence of a clinically significant
reduction in exposure to blood transfusion in unselected patients, we
cannot recommend the routine use of DDAVP in patients exposed to CPB.
However, DDAVP may reduce postoperative bleeding in patients who have
received preoperative aspirin within 7 days of surgery, patients with CPB
times in excess of 140 min and patients with demonstrable platelet
dysfunction and should be used selectively in these subgroups. 2013 The
Author.

<22>
Accession Number
2014159711
Authors
Simopoulos V. Tagarakis G.I. Daskalopoulou S.S. Daskalopoulos M.E. Lenos
A. Chryssagis K. Skoularingis I. Molyvdas P.-A. Tsilimingas N.B. Aidonidis
I.
Institution
(Simopoulos, Tagarakis, Tsilimingas) Department of Cardiovascular and
Thoracic Surgery, University of Thessaly, Larissa, Greece
(Daskalopoulou) Department of Medicine, McGill University, Montreal,
Canada
(Daskalopoulos) Vascular Surgery Unit, Thriassio General Hospital, Athens,
Greece
(Lenos, Chryssagis) Department of Cardiac Surgery, Heart and Vessels
Clinic Bad Neustadt, Bad Neustadt a.d. Saale, Germany
(Skoularingis) Department of Cardiology, University of Thessaly, Larissa,
Greece
(Molyvdas, Aidonidis) Department of Physiology, University of Thessaly,
Larissa, Greece
Title
Ranolazine enhances the antiarrhythmic activity of amiodarone by
accelerating conversion of New-Onset atrial fibrillation after cardiac
surgery.
Source
Angiology. 65 (4) (pp 294-297), 2014. Date of Publication: April 2014.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Ranolazine is a relatively novel antiischemic/antianginal compound with
antiarrhythmic properties. We investigated its ability to shorten the time
to conversion of postoperative atrial fibrillation (POAF) when added to
amiodarone after coronary artery bypass graft (CABG) surgery. In this
prospective, randomized, allocation-concealed, single-blind, single-site
clinical trial, we enrolled consecutive eligible patients who developed
POAF after elective on-pump CABG surgery. Participants were randomized to
receive either ranolazine 375 mg twice daily orally plus intravenous
amiodarone (active group) or intravenous amiodarone alone (control group).
We enrolled 41 patients; 20 in the active and 21 in the control group.
There were no significant differences between the groups in terms of age,
procedural duration, extracorporeal circulation time, and aortic
cross-clamp time. Mean time of conversion was significantly shorter in the
active group (19.9 + 3.2 vs 37.2 + 3.9 hours, P <.001), suggesting that
compared to amiodarone alone, the ranolazine-amiodarone combination had a
superior antiarrhythmic effect against POAF. The Author(s) 2013.

<23>
Accession Number
2014139423
Authors
Mohammadzadeh A. Jafari N. Hasanpour M. Sahandifar S. Ghafari M. Alaei V.
Institution
(Mohammadzadeh, Jafari, Hasanpour, Sahandifar, Ghafari, Alaei) Department
of Cardiothoracic, Imam Khomeini Hospital, Ardabil University of Medical
Sciences, Ardabil 56197, Iran, Islamic Republic of
Title
Effects of pulsatile perfusion during cardiopulmonary bypass on
biochemical markers and kidney function in patients undergoing cardiac
surgeries.
Source
American Journal of Cardiovascular Disease. 3 (3) (pp 158-162), 2013. Date
of Publication: 2013.
Publisher
E-Century Publishing Corporation (40 White Oaks Lane, Madison WI 53711,
United States)
Abstract
For several years there is no conclusive guideline on the effectiveness of
pulsatile or non-pulsatile perfusion during cardiopulmonary bypass (CPB)
in patients undergoing cardiac surgeries. In this study, we evaluated the
effect of pulsatile versus continuous perfusion on the myocardial release
of the cardiac biochemical markers including, creatine phosphokinase
(CPK), cardiac creatine kinase (CK-MB), and lactate dehydrogenase (LDH),
and also kidney function tests including: blood urea nitrogen test (BUN)
and creatinine test (Cr) in patients that underwent both pulsatile and
non-pulsatile methods before and after heart surgeries. A total of 80
patients were enrolled in this study, 40 patients in each pulsatile and
non-pulsatile group. Venous blood samples were drown from each patient in
two groups before operation and after operation at, 24, 48, and 72 h and
analyzed separately for CPK, its cardiac isoenzyme (CK-MB), LDH, BUN and
Cr. There were no significant differences between the two groups with
regard to preoperative parameters such as sex, age, and body surface area.
Our study shows that the effect of pulsatile perfusion on cardiac and
kidney function is better than the non-pulsatile method.

<24>
Accession Number
2014142899
Authors
Munkholm-Larsen S. Wan B. Tian D.H. Kearney K. Rahnavardi M. Dixen U.
Kober L. Alfieri O. Yan T.D.
Institution
(Munkholm-Larsen, Wan, Tian, Kearney, Rahnavardi, Yan) Systematic Review
Unit, Collaborative Research Group (CORE), Sydney, Australia
(Munkholm-Larsen, Dixen) Department of Cardiology, Hvidovre University
Hospital, Copenhagen, Denmark
(Kober) Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
(Alfieri) Division of Cardiac Surgery, Ospedale San Raffaele, Milan, Italy
(Yan) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital,
University of Sydney, Sydney, NSW 2050, Australia
Title
A systematic review on the safety and efficacy of percutaneous
edge-to-edge mitral valve repair with the MitraClip system for high
surgical risk candidates.
Source
Heart. 100 (6) (pp 473-478), 2014. Date of Publication: March 2014.
Publisher
BMJ Publishing Group (Tavistock Square, London WC1H 9JR, United Kingdom)
Abstract
Background MitraClip implantation has emerged as a viable option in high
surgical risk patients with severe mitral regurgitation (MR). We performed
the present systematic review to assess the safety and efficacy of the
MitraClip system for high surgical risk candidates with severe organic
and/or functional MR. Methods Six electronic databases were searched for
original published studies from January 2000 to March 2013. Two reviewers
independently appraised studies, using a standard form, and extracted data
on methodology, quality criteria, and outcome measures. All data were
extracted and tabulated from the relevant articles' texts, tables, and
figures and checked by another reviewer. Results Overall 111 publications
were identified. After applying selection criteria and removing serial
publications with accumulating number of patients or increased length of
follow-up, 12 publications with the most complete dataset were included
for quality appraisal and data extraction. All 12 studies were prospective
observational studies. Immediate procedural success ranged from 72-100%;
30 day mortality ranged from 0-7.8%. There was a significant improvement
in haemodynamic profile and functional status after implantation. One year
survival ranged from 75-90%. No long term outcomes have been reported for
high surgical risk patients. Conclusions MitraClip implantation is an
option in managing selected high surgical risk patients with severe MR.
The current evidence suggests that MitraClip can be implanted with
reproducible safety and feasibility profile in this subgroup of patients.
Further prospective trials with mid- to long-term follow-up are required.

<25>
Accession Number
2014152524
Authors
Tsivgoulis G. Sergentanis T.N. Chan A. Voumvourakis K. Triantafyllou N.
Psaltopoulou T. Gold R. Krogias C.
Institution
(Tsivgoulis, Voumvourakis) Second Department of Neurology, University of
Athens, Attikon Hospital, Iras 39, Gerakas Attikis, 15344, Athens, Greece
(Tsivgoulis) International Clinical Research Center, St Anne's University
Hospital Brno, Brno, Czech Republic
(Sergentanis, Psaltopoulou) Department of Hygiene, Epidemiology and
Medical Statistics, School of Medicine, University of Athens, Athens,
Greece
(Chan, Gold, Krogias) Department of Neurology, Ruhr University, St
Josef-Hospital, Bochum, Germany
(Triantafyllou) First Department of Neurology, University of Athens,
Eginition Hospital, Athens, Greece
Title
Chronic cerebrospinal venous insufficiency and multiple sclerosis: A
comprehensive meta-analysis of case-control studies.
Source
Therapeutic Advances in Neurological Disorders. 7 (2) (pp 114-136), 2014.
Date of Publication: March 2014.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
Objectives: Chronic cerebrospinal venous insufficiency (CCSVI) has
recently been implicated in the pathogenesis of multiple sclerosis (MS).
This comprehensive meta-analysis of case- control studies investigates the
association of CCSVI with MS. Methods: Through Medline, EMBASE and
Cochrane database searches, case-control ultrasound studies comparing
CCSVI frequency among patients with MS and healthy controls were
identified. Results: We identified 19 eligible studies including 1250
patients with MS and 899 healthy controls. The pooled analysis showed that
CCSVI was associated with MS [odds ratio (OR) 8.35; 95% confidence
interval (CI) 3.44-20.31; p < 0.001) with considerable heterogeneity
across studies (I2 = 80.1%). This association was substantially attenuated
in sensitivity analyses excluding studies that were carried out by the
group that originally described CCSVI, included investigators who had also
been involved in publications advocating endovascular procedures for CCSVI
treatment, or were conducted in Italy. Our most conservative sensitivity
analysis combining different exclusion criteria yielded no association of
CCSVI with MS (OR 1.35; 95% CI 0.62-2.93; p = 0.453) without any
heterogeneity (I2 = 0%). Conclusion: There is considerable heterogeneity
across different case-control studies evaluating the association of CCSVI
and MS. The greatest factor contributing to this heterogeneity appears to
be the involvement of investigators in other publications supporting
endovascular procedures as a novel MS treatment. The Author(s) 2013.

<26>
Accession Number
2014152504
Authors
Sirvinskas E. Usas E. Mankute A. Raliene L. Jakuska P. Lenkutis T. Benetis
R.
Institution
(Sirvinskas, Lenkutis, Benetis) Department of Cardiac, Thoracic and
Vascular Surgery, Hospital of Lithuanian University of Health Sciences,
Sukileliu str 17, Kaunas, LT - 50009, Lithuania
(Usas, Mankute) Hospital of Lithuanian University of Health Sciences,
Kaunas, Lithuania
(Sirvinskas, Raliene, Jakuska, Benetis) Institute of Cardiology,
Lithuanian University of Health Sciences, Kaunas, Lithuania
Title
Effects of intraoperative external head cooling on short-term cognitive
function in patients after coronary artery bypass graft surgery.
Source
Perfusion (United Kingdom). 29 (2) (pp 124-129), 2014. Date of
Publication: March 2014.
Publisher
SAGE Publications Ltd (55 City Road, London EC1Y 1SP, United Kingdom)
Abstract
The aim of study was to assess the effects of an intraoperative external
head-cooling technique on cognitive dysfunction in the early postoperative
period (at the 10th day) in patients after coronary artery bypass graft
(CABG) surgery. Patients in Group H (n=25) were cooled with CPB and the
intraoperative, external head-cooling technique, patients in Group C
(n=25) were cooled only with cardiopulmonary bypass (CPB) to achieve mild
hypothermia (33-34 C). Cognitive function was analyzed before the
operation and after the surgery using the Mini Mental State Examination
(MMSE), the Modified Visual Reproduction Test from the Wechsler Memory
Scale, Trail Making (A/B), WAIS - Digit Span (WDS) and WAIS Digit Symbol
Substitution Test (WDSST). The incidence of cognitive impairment at the
10th day after the surgery was 36% (n=9) in Group H and 64% (n=16) in
Group C (p=0.048). The temperature during the aortic cross-clamp period
was associated with a lower rate of cognitive dysfunction (p=0.05,
r2=0.09). The intraoperative, external head-cooling technique during the
aortic cross-clamp period has a neuroprotective effect and leads to less
short-term cognitive function impairment after CABG surgery. The
Author(s) 2013.

<27>
Accession Number
2014152732
Authors
Engelen M.A. Welp H.A. Gunia S. Amler S. Klarner M.P. Dell'Aquila A.M.
Stypmann J.
Institution
(Engelen, Gunia, Klarner, Stypmann) Department of Cardiovascular Medicine,
Division of Cardiology, University of Muenster, Muenster, Germany
(Welp, Dell'Aquila) Department of Cardiac Surgery, University of Muenster,
Muenster, Germany
(Amler) Institute of Biostatistics and Clinical Research, University of
Muenster, Muenster, Germany
Title
Prospective study of everolimus with calcineurin inhibitor-free
immunosuppression after heart transplantation: Results at four years.
Source
Annals of Thoracic Surgery. 97 (3) (pp 888-893), 2014. Date of
Publication: March 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
Background Immunosuppression is necessary after transplantation but it is
associated with distinct adverse side effects. These negative effects
could at least partially be overcome with the mammalian target of
Rapamycin (mTOR) inhibitor everolimus. Few studies have examined
everolimus therapy with calcineurin inhibitor (CNI) withdrawal in
maintenance heart transplant patients (HTx). Methods In this prospective,
single-arm, single-center study, maintenance patients after HTx were
converted from CNI to everolimus. They were followed for 48 months.
Primary endpoints were kidney-function and arterial hypertension. Results
Forty-eight patients were recruited (mean post-transplant time 5.4 + 3.5
years). Of these, 36 were followed for the entire 4-year period. Median
calculated glomerular filtration rate increased from 40.7 (32.4 to 59.1)
mL/minute at baseline to 48.9 (29.7 to 67)) mL/minute at month 48 (p = not
significant). Median systolic and diastolic blood pressure, triglycerides,
and high-density lipoprotein and low-density lipoprotein cholesterol, did
not change significantly in a comparison of the values at baseline and at
48 months. Early resolution of most non-renal CNI-related adverse events
was sustained. Due to adverse events, CNI therapy had to be reintroduced
in 6 patients (12.5%). No significant changes in cardiac function
parameters were observed. Conclusions Calcineurin inhibitor-free
immunosuppression with everolimus is an effective and safe option in
selected maintenance HTx patients. Most adverse effects under everolimus
occurred early after conversion and in most cases resolved without
intervention within a few weeks. Refining selection criteria may help both
in identifying patients who will profit most from switching and in
alleviating the need to reintroduce CNI therapy. 2014 by The Society of
Thoracic Surgeons.

<28>
Accession Number
2014152724
Authors
Uzzaman M.M. Robb J.D. Mhandu P.C.E. Khan H. Baig K. Chaubey S. Whitaker
D.C.
Institution
(Uzzaman, Robb, Mhandu, Khan, Baig, Chaubey, Whitaker) Department of
Cardiothoracic Surgery, King's College Hospital, Bessemer Rd., London
SE59RS, United Kingdom
Title
A meta-analysis comparing muscle-sparing and posterolateral thoracotomy.
Source
Annals of Thoracic Surgery. 97 (3) (pp 1093-1102), 2014. Date of
Publication: March 2014.
Publisher
Elsevier USA (6277 Sea Harbor Drive, Orlando FL 32862 8239, United States)
Abstract
We compared outcomes of posterolateral thoracotomy vs muscle-sparing
thoracotomy after open thoracic operations. Twelve trials were included,
comprising 571 patients in the muscle-sparing thoracotomy group and 512
patients in the posterolateral thoracotomy group. There was significantly
improved shoulder internal rotation (weighted mean difference, -1.28; 95%
confidence interval, -2.45 to -0.11; p = 0.03) and pain scores on day 7
(weighted mean difference, -0.76; 95% confidence interval, -1.26 to -0.27;
p = 0.002) but higher seroma rates (odds ratio, 8.26; 95% confidence
interval, 2.16 to 31.56; p = 0.002) in the muscle-sparing thoracotomy
group compared with the posterolateral thoracotomy group. We advocate
using muscle-sparing thoracotomy, especially on patients dependant on
quicker recovery of shoulder function. 2014 by The Society of Thoracic
Surgeons.

<29>
Accession Number
71367472
Authors
Wang D.X. Zhou C.H. Liu H. Yan L.R. Zhang X.X.
Institution
(Wang, Zhou, Liu, Yan, Zhang) Key Laboratory of Clinical Trial Research in
Cardiovascular Drugs, Fuwai Hospital, Peking Union Medical College, China
Title
Comparison of more than 3 years clinical outcomes between drug-eluting
stents and coronary artery bypass graft for unprotected left main disease.
Source
International Journal of Cardiology. Conference: ICC CUHK-Mayo Clinic-Asia
Cardiovascular Summit and 2nd Antithrombotic Pharmaceutical Symposium Hong
Kong Hong Kong. Conference Start: 20130413 Conference End: 20130414.
Conference Publication: (var.pagings). 164 (2 SUPPL. 1) (pp S8), 2013.
Date of Publication: April 2013.
Publisher
Elsevier Ireland Ltd
Abstract
Purpose: We sought to perform a meta analysis to combine the available
randomised and nonrandomised studies examine the clinical effect of
drug-eluting stents (DES) and coronary artery bypass graft (CABG) in
unprotected left main disease (UPLM) with more than 3 year follow-up.
Methods: A systemic research was carried out in Pubmed, Embase, Cochrane
library and scientific sessions of AHA, ACC and ESC (up to Oct 2012). All
randomised and nonrandomised studies after >3 years of follow-up comparing
DES and CABG in UPLM were included. In observational studies, risk
adjusted hazard ratio (HR) or odds ratio (OR) were extracted. Sensitivity
analyses and publication analyses were also performed to confirm the
reliability of results. Results: 11 eligible studies (2 randomised, 9
nonrandomised) with 6858 subjects were identified and selected. Mortality,
death/MI/stroke and target vessel revascularizaton (TVR) were focused.
Pooled analysis revealed that there was no statistical significant
difference between DES and CABG in mortality (OR=0.95, 95% confidential
interval [CI]: 0.81 to 1.13, P=0.586, heterogeniety test: 0.0%; Fig. 1)
and death/MI/stroke (OR=0.94, 95% CI: 0.80 to 1.11, P=0.473, heterogeniety
test: 0.0%). However, compared with CABG, DES had a significant increased
incidence of TVR (Random-effect model, OR=3.56, 95% CI: 2.66 to 4.71,
P<0.001, heterogeniety test: 45.9%). No evidence of significant
publication bias was observed in mortality (Begg's test, P=0.325; Egger's
test, P=0.407). Sensitivity analysis of mortality excluding each included
study at one time revealed that most individual study was consisted with
the direction and size of the overall effect (all P>0.1). (Figure
Presented).

<30>
Accession Number
71366677
Authors
Youssef I.I. Mohammed A. Asida S. Abd-Elrazik A.
Institution
(Youssef, Mohammed, Asida, Abd-Elrazik) Anaesthesia, Faculty of Medicine,
Minia, Egypt
Title
Thoracic paravertebral block versus systemic opioids in post thoracotomy
analgesia.
Source
Regional Anesthesia and Pain Medicine. Conference: 32nd Annual European
Society of Regional Anaesthesia and Pain Therapy, ESRA Congress 2013
Glasgow United Kingdom. Conference Start: 20130904 Conference End:
20130907. Conference Publication: (var.pagings). 38 (5 SUPPL. 1) (pp
E186-E187), 2013. Date of Publication: September-October 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Purpose/Objective: thoracic paravertebral block versus systemic opioids on
post-thoracotomy analgesia. Materials and Methods: Randomized controlled
trial included forty patients undergoing thoracotomy divided into 2
groups, 20 patients received 20 ml bupivacaine 0.05% incremental injection
via a catheter inserted in thoracic para vertebral space, 20 patients
received systemic. Visual analogue scale (VAS), total morphine consumption
,time to first analgesia request, changes in pulmonary function and side
effects were recorded postoperatively. Results: VAS at rest was lower in
paravertebral group at all measurements points except 16, 20 and 24 hs
postoperatively, pain on coughing showed significant difference at 8 and
16 hs, postoperative consumption of morphine was 36 (22-42mg) in morphine
group versus 9 (2-22mg) in para vertebral group. Total bupivacaine was
300-420mg in first 24hs. time of first analgesic request was significant
in morphine group. VAS at first analgesic request was not statistically
different between 2 groups, no significant difference in peak expiratory
flow rate preoperatively, after 12hs or 24hs. Conclusions: Continuous
thoracic para vertebral block with bupivacaine provides effective
analgesia after thoracic surgery compared to systemic analgesia with
significant less incidence of complications such as pulmonary
complications, PONV and pruritis.

<31>
Accession Number
71366422
Authors
Lavand'Homme P.
Institution
(Lavand'Homme) Anesthesiology Department, St Luc Hospital, University
Catholic of Louvain, Brussels, Belgium
Title
Ketamine-should everyone have a little?!.
Source
Regional Anesthesia and Pain Medicine. Conference: 32nd Annual European
Society of Regional Anaesthesia and Pain Therapy, ESRA Congress 2013
Glasgow United Kingdom. Conference Start: 20130904 Conference End:
20130907. Conference Publication: (var.pagings). 38 (5 SUPPL. 1) (pp
E76-E78), 2013. Date of Publication: September-October 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Since its introduction in clinical practice in the early 1960s as an
intravenous anesthetic agent, the interest in ketamine has continued to
grow, specifically with the use of low doses as antihyperalgesic agent
[1]. The recent developments regarding the anti-inflammatory properties of
ketamine have also contributed to a renewed interest in acute pain
medicine. However, because of well known psychomimetic side effects, the
administration of ketamine in awake patients remains unusual. Under those
conditions, ketamine is generally used in case of block failure to
supplement intraoperative anesthesia. As a matter of fact, publications
assessing the potential benefits of the addition of a low dose (i.e.
antihyperalgesic dose) of systemic ketamine to an effective locoregional
technique are scarce, if not inexistant, although such utilization
deserves some interest. The main mechanism of action of ketamine relies on
a noncompetitive antagonism of excitatory neurotransmission (NMDA
receptors). However, ketamine mechanisms of action are complex and the
drug may interact with opioid, monoaminergic, cholinergic, purinergic and
adenosine receptor systems [1]. These multiple interactions account for
the the various clinical effects such as anesthesia, analgesia,
antihyperalgesia, induction of psychiatric symptoms schizophrenia like or
positive effect on depression mood. Preemptive or preventive analgesic
effect: Various meta-analysis have demonstrated that the intraoperative
administration of a low dose of ketamine (median dose 0.4 mg/kg ; range
0.1 to 1.6 mg/kg), even a single bolus dose, in patients under general
anesthesia receiving opioids may reduce 24h- postoperative opioid
requirements [2,3]. Postoperative pain was also reduced in patients who
receive ketamine what implies an improved quality of pain control in
addition to the decrease in opioid consumption [4]. Particular benefit of
ketamine administration was observed in painful procedures, including
upper abdominal, thoracic and major orthopedic surgeries. The analgesic
effect of ketamine was independent of both timing and dose of ketamine
administration. Preemptive , preventive and also protective analgesia are
current concepts used in perioperative analgesia . The goal of preemptive
analgesia is to prevent nociceptive inputs from lesioned tissues to reach
and to sensitize the central nervous system, thereby to reduce the
expression of post-injury pain. Although extremely attractive, the concept
of preemptive analgesia has only brought deceiving results in the
perioperative setting [5]. In a meta-analysis analysing the postoperative
analgesic efficacy of a preemptive application of various analgesic
regimens versus the administration of the same analgesic regimens
initiated after the surgical incision, systemic NMDA antagonists including
ketamine were ineffective by comparison to epidural analgesia, intrawound
local anesthetics or NSAIDs [6]. In the light of experimental models of
incisional pain, the concept of preemptive analgesia has evolved to the
concept of preventive analgesia, a broader definition, which involves any
perioperative analgesic and antihyperalgesic treatments aimed to control
central nervous system sensitization. An other qualitative systematic
review focusing on the role of NMDA antagonists found 58% of included
clinical studies in favour of a preventive analgesic effect [7]. The
authors have defined "preventive drug" as a drug able to reduce central
sensitization caused by surgical injury, thereby able to decrease
postoperative pain beyond its clinical activity i.e. therapeutic half
life. However, the real definition of preventive analgesia also involves
longterm consequences of the modulation of central nervous system
sensitization as the development of persistent post-surgical pain [8].
Unfortunately, very few studies have assessed the impact of intraoperative
ketamine administration of chronic postsurgical pain. The combination of
intravenous ketamine with epidural analgesia has demonstrated some
efficacy in the context of major abdominal and thoracic procedures [9,10].
In preventive analgesia, both the duration and the efficacy of the
treatment are more important than the timing of administration of the
drugs [5]. Recent progresses made in the assessment of endogenous
mechanisms of pain processing should allow to improve preventive analgesia
by an individualization of analgesic and antihyperalgesic perioperative
treatments. Effectively, individual differences in pain sensitivity place
people at reduced or elevated risk for the development of acute and
chronic pain [11]. Recent interesting developments have focused on dynamic
test paradigms -in contrast with static tests like pain threshold-
designed to measure endogenous pain processing and to depict individual's
pain modulation capacity. Early promising results show that patients with
poor inhibitory systems (i.e. bad conditioned pain modulation) are more
susceptible to develop chronic postsurgical pain [11]. Moreover, patients
with enhanced excitatory processes (i.e. positive temporal summation, the
clinical correlate of experiment wind up phenomenon in animal) have higher
postoperative pain and are more prone to persistent post-surgical pain
[11]. Interestingly, low doses of ketamine reduce temporal summation both
in animal experimental models, in volunteers and in humans [12]. Further,
very recent data also suggest a role of endogenous inhibitory systems in
the analgesic efficacy of ketamine [13]. Ketamine and peripheral
inflammation: The inflammatory response to surgery appears to play a
prominent role in the patient's outcome. Ketamine influences the immune
system and is able to regulate very early the local inflammatory processes
as it reduces the release of pro-inflammatory cytokines without affecting
the production of anti-inflammatory ones [14]. Although the interactions
of ketamine with the inflammatory processes are complex, to summarize, one
can say that ketamine helps to avoid exacerbated pro-inflammatory reaction
[14,15]. Once again, whether several studies have linked the
administration of ketamine to lower levels of proinflammatory cytokines,
the impact on clinical outcome has not been assessed. Nevertheless, the
anti-inflammatory effects of ketamine might account for the benefits
observed in both early and delayed rehabilitation processes (i.e. improved
mobilization) after orthopaedic procedures like knee surgery (arthroscopy
and arthroplasty) or hip replacement [16-18]. Currently, there seems to
exist a potent link between clinical hyperalgesia, the expression of
central sensitization, and a perioperative exaggerated pro-inflammatory
reaction as central sensitization not only relies on NMDA receptors
activation but also on extended glial pro-inflammatory reaction [15]. Some
recent data even support the involvement of inflammatory mechanisms in
opioid-induced hyperalgesia as glia exhibits pro-inflammatory responses to
opioid administration. These findings reinforce the use of ketamine in
patients who are already treated by opioids analgesics e.g. chronic pain
patients and opioid-dependant patients [19]. Depression and postoperative
cognitive dysfunction: As part of the anti-inflammatory effects of
ketamine, the administration of the drug seems to reduce the risk for
postoperative major cognitive dysfunction as observed after cardiac
surgery [14]. An other interesting effect is the rapid action of the drug
on depressive states which has been recently highlighted. The mechanisms
are still unknown. It is worthing to note that an old study from Kudoh
[20,21] already pointed out the improvement of postoperative state of
depressed patients who received a small dose of intravenous ketamine.
Conclusion: Ketamine is a promizing drug which should be part of the
perioperative strategies to improve patient's outcome, specifically
outcome related to pathological pain i.e. rehabilitation and prevention of
persistent post-surgical pain. Regarding the potential side effects
(psychomimetic side effects) of the drug, the selection of patients is
mandatory. Patients who have impaired endogenous analgesic systems
including patients who suffer chronic pain and are under chronic opioid
treatment should be targeted. The postoperative benefits (short-term and
long-term) of the combination of low doses of ketamine with a
loco-regional technique deserve further studies.

<32>
Accession Number
71366406
Authors
Lavand'homme P.
Institution
(Lavand'homme) Anesthesiology Department, St Luc Hospital, University
Catholic of Louvain, Brussels, Belgium
Title
Pharmacological reduction of post-operative chronic pain.
Source
Regional Anesthesia and Pain Medicine. Conference: 32nd Annual European
Society of Regional Anaesthesia and Pain Therapy, ESRA Congress 2013
Glasgow United Kingdom. Conference Start: 20130904 Conference End:
20130907. Conference Publication: (var.pagings). 38 (5 SUPPL. 1) (pp
E56-E57), 2013. Date of Publication: September-October 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Since several years, the anesthesiologists are questioning the longterm
effects of perioperative management and seriously considering their role
in preventive medicine (De Kock 2009). The persistence of pain after
surgical procedure, trauma or ICU stay has become a major focus of
interest and its prevention now represents a challenge as an indice of the
quality of health cares. In Europe, the prevalence of chronic pain reaches
20% (Breivik et al. 2006) with trauma and surgery accounting for 15% of
the cases. The definition of Persistent Post-Surgical Pain (PPSP) involves
pain that develops after surgical intervention and lasts at least 2
months, other causes for the pain having been excluded (e.g. infection,
recurrence of malignancy) as well as pain from a condition preceeding the
surgery (Macrae 2008). The time frame of 2 months has been strongly
debated because the exact duration of postoperative inflammatory process
still remains undetermined. Actually, one may consider PPSP as pain
lasting more than 3 to 6 months (often beyond 6 months) after surgery
(Schug and Pogatzki-Zahn 2011). The first largest study aimed to assess
the prevalence of PPSP in a general population reports a prevalence of 6.2
to 18.3% moderate to severe pain in the area of surgery 3 to 36 months
after the procedure (Johansen et al. 2012). In this survey, 62% of
patients had local pain in the area of surgery before surgery. The
existence of PPSP in the pediatric population is also a recent concern.
The first studies reveal an incidence of 13 to 22% at one year after
surgery (Fortier et al. 2012; Page et al. 2013). Chronic pain is a complex
problem, with a multifactorial etiology. Several studies have analysed the
risk factors involved in the development of PPSP after various surgical
procedures (Kehlet et al. 2006; Schug and Pogatzki-Zahn 2011; Clarke et
al. 2012). Among the risk factors, the severity of acute postoperative
pain and both the severity and the duration of pre-operative pain at
surgical site or elsewhere (co-existing chronic pain condition) are the
most cited predictive factors. Recently, the role of psycho-social factors
has also been highlithted e.g. anxiety, hypervigilance, catastrophizing.
However, some patients presenting with severe acute pain will never
develop persistent pain what supports the fact that individuals are not
equal facing pain and that endogenous pain modulation may place peoples at
less or more risk for severe acute and chronic pain. The mechanisms
underlying the persistence of pain in some patients are not fully
understood although a better understanding of the transition period would
certainly help to better prevent PPSP (Katz and Seltzer 2009; Lavand'homme
2011). Central nervous system sensitization participates to the acute pain
experienced by the patient and is one of mechanisms underlying the
maintenance of pain. For these reasons, the control of central
sensitization has been and still remains a major target in the prevention
of PPSP. Accordingly, the concept of preventive analgesia, a broader
definition of preemptive analgesia, has been developed which involves any
perioperative analgesic and antihyperalgesic treatments aimed to control
central nervous system sensitization and to reduce the development of
PPSP. In preventive analgesia, both the duration and the efficacy of the
treatment are more important than the timing of administration of the
drugs. Recent clinical studies have highlighted the fact that an optimal
control of pre-operative, per-operative and post-operative pain is
mandatory to ensure the success of preventive analgesia. Furthermore,
progresses made in the assessment of endogenous mechanisms of pain
processing should allow to improve even more preventive analgesia by an
individualization of analgesic and antihyperalgesic perioperative
treatments. Peri-operative pharmacological strategies: Modern
perioperative anesthesia and analgesia relies on the use of multimodal or
balanced techniques which are aimed to reduce the intraoperative
administration of opioids. The concept of opioid-sparing anesthesia and
analgesia (even more, opioidfree anesthesia) is a major step in the
prevention of PPSP. Opioids induce endogenous pro-nociceptive systems
mainly through central NMDA receptors activation, a phenomenon well known
as opioid-induced hyperalgesia (OIH) (Lee et al. 2011). They are also able
to enhance the glial inflammation resulting from the incision, a state
which contributes to central nervous system sensitization. OIH is
dependent on the dose and the duration of opioid administration,
exacerbates postoperative pain (acute hyperalgesia and tolerance) and as
recently demonstrated by van Gulik (van Gulik et al. 2013) contributes to
chronic thoracic pain in a dependent manner after cardiac surgery. Several
pharmacological strategies besides their own effectiveness in reducing
central sensitization process also reduce the development of PPSP by
decreasing perioperative use of high doses of opioid, hence OIH, i.e.
antihyperalgesic drugs like ketamine and gabapentinoids, nitrous oxide,
locoregional analgesic techniques (Richebe et al. 2013). Some
meta-analysis and reviews support the view that perioperative
administration of ketamine and gabapentinoids are effective in reducing
PPSP (Clarke et al. 2012). Epidural anesthesia, and specifically its
intraoperative use, may reduce the risk of developing PPSP after
thoracotomy in 1 out every 4 patients (Andreae and Andreae 2012).
Paravertebral block may reduce the risk of chronic pain after breast
cancer surgery in one woman out of every 5 women (Andreae and Andreae
2012).

<33>
Accession Number
71366370
Authors
Bonnet F. Puscas A. Marret E.
Institution
(Bonnet, Puscas, Marret) Anaesthetics and intensive Care, Hopital Tenon
Assistance Publique Hopitaux de Paris, Paris, France
Title
Steroids as analgesics in postoperative pain.
Source
Regional Anesthesia and Pain Medicine. Conference: 32nd Annual European
Society of Regional Anaesthesia and Pain Therapy, ESRA Congress 2013
Glasgow United Kingdom. Conference Start: 20130904 Conference End:
20130907. Conference Publication: (var.pagings). 38 (5 SUPPL. 1) (pp
E2-E3), 2013. Date of Publication: September-October 2013.
Publisher
Lippincott Williams and Wilkins
Abstract
Steroids have long been considered to have more drawbacks than benefit in
the perioperative setting. Chronic treatments with steroids were committed
to be substituted during the perioperative period to avoid acute adrenal
insuffisiency. Otherwise the use of steroids was associated with the risk
of septic complication. More tan ten years ago, the postoperative
antiemetic preventive effect of dexamethasone, has been demonstrated
leading to more extensive administration in the perioperative period.
Other effects of steroids were then documented, leading to a routine
admnistration in patients scheduled for surgery. Steroids used for
intravenous administation are : hydrocortisone, prednisolone,
methylprednisolone and dexamethasone. The latest has the highest
glucosteroid activity compared to hydrocortisone. With regard to the
antiinflammatory effect, dexamethasone 0.75 mg is equivalent to cortisol
20 mg. Systematic review of the antimetic effect have documented that
dexamethasone prevents early and late nausea and vomiting in adults and
children [1]. The preventive antiemetic effect of dexamethasone is
equivalent to that of setrons with a relative risk reduction of 25%. The
combination of the two agents is more effective than each single drug used
separately. Since dexamethasone requires a certain delay of action it is
administered at the induction of anaetshesia. The number-needed-to-treat
to avoid early nausea and vomiting depends on the incidence of these side
effects but is commonly ranging between 4 and 10. The use of dexamethasone
depends consequently on the incidence of PONV, when more than two risk
factors are documented dexamethasone is administered separately or in
combination with droperidol and / or setrons [2]. Dexamethasone is not
only effective in a large population of patients and procedures, but also
in selective surgical procedures such as cholecystectomy or tonsillectomy
[3,4]. In ambulatory surgery, the prevention of PONV is an integral part
of patient'care allowing reducing the duration of hospital stay.
Consequently, patients feel more comfortable when receiving dexamethasone
preoperatively. Beside their antiemetic properties, dexamethsaone and
other steroids produce analgesia in postoperative patients. This effect is
related to the inhibition of prostaglandins synthesis due to blockade of
phospholipases and cyclo-oxygenases. In addition, steroids inhibit the
development of mechanical hyperalgesia in laboratoy animals. An exhaustive
systematic review has confirmed the analgesic effect of dexamethasone and
steroids in randomized clincal trials including various surgical
procedures [5]. The administration of dexamethasone (at least 8 mg in
adults) not only decreases pain intensity in the immediate postoperative
period and lately but also reduces by 40% postoperative opioid on demand
administration (NNT to avoid the use of opioid = 8). This effect is more
important when steroids are given before anaesthetic induction. The
analgesic effect of steroids hase been confirmed in several surical
procedures. A significant number of studies have been perfomed in patients
scheduled for tonsillectomy [6, 7]. In this setting, dexamethasone not
only reduces the incidence of nausea and vomting but also the intensity of
postoperative pain. Nevertheless, the administration of dexamethasone also
increases the risk of reintervention especially for local bleeding. A
single dose of steroid also improves postoperative pain control after
molar extraction and othognatic surgery and reduces postoperative oedema
and facial swelling. Dexamethasone is equally effective to NSAIDs in this
setting and the combination of the two is more effective than each drug
taken separately. Steroids have been used in local infiltration for spine
surgery with benefical effect on postoperative pain control. Steroids are
given in visceral surgery such as cholecystectomy as part of multimodal
anagesia. More recently, it has been documented that the combination of
dexamethasone to a local anaesthetic solution increased the duration of
the sensory and motor blocks while improving postoperative pain control.
This effect is however comparable when dexamethasone is administered
intravenously instead of perineurally [8]. Steroids also improve fatigue
in sick patients and postoperatively. This effect has been evaluated after
cholecystectomy, breast surgery, and cardiac surgery. The fact that
patient experience less frequent side effects, is likely to be part of an
explaination but not only. Among other beneficial effects of steroids
documented in the postoperative peroid one must report the reduction of
the severity of sorethroat after orotracheal intubation, earlier
deambulation after major surgery occasionally resulting in decreasing the
duration of hospital stay. In cardiac surgery a metaanalysis of RCTs have
pointed out that the administration of steroids may decrease the incidence
of postoperative atrial fibrillation likely due to their anti-inflammatory
[9]. The potential impact of steroids on healing, surgical anastomosis and
septic complications is a concern. Nevertheless, up to now, no clinical
trial or metaanalysis has demonstrated any deleterious effect of steroids
from this point of view. A careful survey of this issue is nevertheless
required.