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Postoperative care of cardiac surgery patient

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https://read.qxmd.com/read/30768933/thrombelastography-directed-transfusion-in-cardiac-surgery-impact-on-postoperative-outcomes
#1
Roberta E Redfern, Kevin Fleming, Rebekah L March, Nathan Bobulski, Michael Kuehne, John T Chen, Michael Moront
BACKGROUND: Transfusion of allogenic blood products is associated with significant morbidity and increased risk of mortality. Thrombelastography (TEG) to direct transfusion management during and immediately following cardiothoracic surgery reduced blood product usage in our institution. The goal of this study was to quantify the impact of TEG on postoperative outcomes. METHODS: All patients who underwent cardiac surgery before and after implementation of TEG were retrospectively analyzed...
February 12, 2019: Annals of Thoracic Surgery
https://read.qxmd.com/read/30765210/cardiac-prehabilitation
#2
REVIEW
Michael McCann, Nikki Stamp, Ann Ngui, Edward Litton
The care of patients undergoing cardiac surgery is becoming more complex, in part owing to the increasing burden of comorbid disease, frailty, and psychosocial issues. Many risk factors for postoperative morbidity and mortality are potentially modifiable if identified and treated in a timely fashion before surgery. Cardiac prehabilitation, draws from strategies currently undertaken in cardiac rehabilitation but implements them proactively rather than reactively. There is substantial evidence that in multiple domains, including aerobic conditioning, respiratory muscle training, lifestyle modification, diabetic control, sleep, and psychoeducation, selected interventions before cardiac surgery may improve outcomes...
January 12, 2019: Journal of Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/30760338/prevention-of-postoperative-pneumonia-in-noncardiac-surgical-patients-a-prospective-study-using-the-national-surgical-quality-improvement-program-database
#3
Michael L Caparelli, Alexander Shikhman, Abdullah Jalal, Sandra Oppelt, Cari Ogg, Shyam Allamaneni
Postoperative pneumonia increases morbidity, length of stay, and hospital readmission rates. Current data support the use of perioperative chlorhexidine gluconate in elective cardiac surgery patients to prevent postoperative pneumonia. The objectives of this study were to implement a resident-driven quality improvement project and determine the efficacy of an oral care bundle in preventing postoperative pneumonia among noncardiac surgical patients. A retrospective review of postoperative pneumonia occurrences at our hospital captured by the NSQIP database from 2014 to 2016 was conducted...
January 1, 2019: American Surgeon
https://read.qxmd.com/read/30756339/effect-of-iloprost-inhalation-on-postoperative-outcome-in-high-risk-cardiac-surgical-patients-a-prospective-randomized-controlled-multicentre-trial-ilocard
#4
Michael Winterhalter, Steffen Rex, Christian Stoppe, Peter Kienbaum, Hans-Helge Müller, Ines Kaufmann, Hermann Kuppe, Aristidis Dongas, Bernhard Zwissler
PURPOSE: Perioperative right ventricular (RV) failure due to pressure overload from pulmonary hypertension (PH) worsens postoperative outcomes after cardiac surgery. Inhaled iloprost is a potent pulmonary vasodilator improving RV performance, ameliorating myocardial and pulmonary ischemia-reperfusion injury and attenuating inflammation. We hypothesized that the prophylactic inhalation of iloprost would reduce postoperative ventilation times after cardiac surgery. METHODS: In this phase III, multicentre, randomized, double-blind, placebo-controlled trial, we randomly assigned 253 cardiac surgical patients at high risk of perioperative RV failure to the prophylactic inhalation of 20 µg iloprost or placebo before and during weaning from extracorporeal circulation...
February 12, 2019: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://read.qxmd.com/read/30742521/safety-of-deep-sedation-in-patients-undergoing-full-thickness-skin-graft-harvesting-and-skin-graft-reconstruction-for-limb-salvage-an-outcome-analysis
#5
Alice M Kai, Nalini Vadivelu, Feng Dai, Susan Dabu-Bondoc, Hosni Mikhael, Peter A Blume
BACKGROUND: Studies on obtaining donor skin graft using intravenous sedation for patients undergoing major foot surgeries in the same operating room visit have not previously been reported. The objective of this retrospective study is to demonstrate that intravenous sedation in this setting is both adequate and safe in patients undergoing skin graft reconstruction of the lower extremities in which donor skin graft is harvested from the same patient in one operating room visit. METHODS: Medical records of 79 patients who underwent skin graft reconstruction of the lower extremities by one surgeon at the Yale New Haven Health System between November 1, 2008, and July 31, 2014, were reviewed...
November 2018: Journal of the American Podiatric Medical Association
https://read.qxmd.com/read/30722696/the-effects-of-five-days-of-intensive-preoperative-inspiratory-muscle-training-on-postoperative-complications-and-outcome-in-patients-having-cardiac-surgery-a-randomized-controlled-trial
#6
Xiaoyu Chen, Lin Hou, Yuanyuan Zhang, Xiangjing Liu, Bohan Shao, Bo Yuan, Jing Li, Min Li, Hong Cheng, Lei Teng, Mingdi Guo, Zhengqing Wang, Tienan Chen, Jianjun Liu, Yaping Liu, Zhigang Liu, Xiaocheng Liu, Qi Guo
OBJECTIVE: To determine the prophylactic efficacy of short-term intensive preoperative inspiratory muscle training on the incidence of postoperative pulmonary complications in patients scheduled for cardiac surgery. DESIGN: Single-blind, randomized controlled pilot study. SETTING: TEDA International Cardiovascular Hospital, China. SUBJECTS: In total, 197 subjects aged ⩾50 years scheduled for cardiac surgery were selected...
February 6, 2019: Clinical Rehabilitation
https://read.qxmd.com/read/30721296/effect-of-electroencephalography-guided-anesthetic-administration-on-postoperative-delirium-among-older-adults-undergoing-major-surgery-the-engages-randomized-clinical-trial
#7
Troy S Wildes, Angela M Mickle, Arbi Ben Abdallah, Hannah R Maybrier, Jordan Oberhaus, Thaddeus P Budelier, Alex Kronzer, Sherry L McKinnon, Daniel Park, Brian A Torres, Thomas J Graetz, Daniel A Emmert, Ben J Palanca, Shreya Goswami, Katherine Jordan, Nan Lin, Bradley A Fritz, Tracey W Stevens, Eric Jacobsohn, Eva M Schmitt, Sharon K Inouye, Susan Stark, Eric J Lenze, Michael S Avidan
Importance: Intraoperative electroencephalogram (EEG) waveform suppression, often suggesting excessive general anesthesia, has been associated with postoperative delirium. Objective: To assess whether EEG-guided anesthetic administration decreases the incidence of postoperative delirium. Design, Setting, and Participants: Randomized clinical trial of 1232 adults aged 60 years and older undergoing major surgery and receiving general anesthesia at Barnes-Jewish Hospital in St Louis...
February 5, 2019: JAMA: the Journal of the American Medical Association
https://read.qxmd.com/read/30714327/strategy-of-treating-secundum-atrial-septal-defect-not-referred-to-percutaneous-closure
#8
Fei Zhang, Yifeng Yang, Qin Wu, Wancun Jin, Haisong Bu, Sijie Wu, Tianli Zhao, Shijun Hu
OBJECTIVE: To evaluate safety and effectiveness of intraoperative device closure for secundum atrial septal defect (ASD) not referred to percutaneous closure. DESIGN AND PATIENTS: From April 2010 to December 2018, 231 secundum ASD children (≤14 years) directly recommended to surgical repair were enrolled in this study. These patients were divided into two groups according to the parents' choice based on surgeons' recommendation. Follow-up evaluations were adopted at 2 weeks, 3 months, 6 months, and 12 months after the procedure and yearly thereafter...
February 4, 2019: Congenital Heart Disease
https://read.qxmd.com/read/30713052/elevated-pulse-pressure-in-anesthetized-subjects-before-cardiopulmonary-bypass-is-associated-strongly-with-postoperative-acute-kidney-injury-stage
#9
Ludmil Mitrev, Kelly G Speich, Spencer Ng, Albina Shapiro, Talia Ben-Jacob, Majid Khan, Vineeth Nagubandi, John Gaughan
OBJECTIVE: To investigate whether pulse pressure (PP) in anesthetized patients undergoing cardiac surgery before and after cardiopulmonary bypass (CPB) is associated with higher postoperative acute kidney injury (AKI) stage. DESIGN: Retrospective cohort of 597 patients undergoing cardiac surgery. SETTING: Single academic health care center. PARTICIPANTS: Adult patients undergoing cardiac surgery requiring CPB (coronary artery bypass grafting, valve, aortic, or combined surgery)...
January 7, 2019: Journal of Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/30707868/-sevoflurane-inhalation-sedation-could-shorten-the-duration-of-endotracheal-intubation-and-the-total-length-of-hospital-stay-of-critical-patients-after-surgery-as-compared-with-propofol-intravenous-sedation-a-meta-analysis-of-537-patients
#10
Yanqi Wu, Yahui Wang, Feng Shen, Bo Liu, Hong Qian, Huiling Yang, Yumei Cheng, Guixia Yang, Xiang Li, Xinghao Zheng
OBJECTIVE: To compare the influence of sevoflurane inhalation sedation and propofol intravenous sedation on duration of endotracheal intubation as well as the length of intensive care unit (ICU) stay and total length of hospital stay in postoperative critical patients. METHODS: Six databases including CNKI, Wanfang data, PubMed, Embase, Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs) about the influence of sevoflurane inhalation sedation or propofol intravenous sedation on the sedation time, the duration of endotracheal intubation, the length of ICU stay, the total length of hospital stay and the adverse effects rate in postoperative critical patients from the time of database establishment to July 2018...
January 2019: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://read.qxmd.com/read/30704887/the-impact-of-body-mass-index-on-complications-after-shoulder-arthroscopy-should-surgery-eligibility-be-determined-by-body-mass-index-cutoffs
#11
William J Rubenstein, Drew A Lansdown, Brian T Feeley, C Benjamin Ma, Alan L Zhang
PURPOSE: The goal of this study is to analyze postoperative complications after shoulder arthroscopy stratified by body mass index (BMI) and to quantify the trade-off in postsurgical complications and access to care that occurs with BMI eligibility cutoffs. METHODS: Patients who underwent shoulder arthroscopy in the National Surgical Quality Improvement Program database from 2015 to 2016 were identified. Patients were categorized on the basis of their BMI. χ2 tests were used to identify differences in complication rates between different BMI categories...
January 29, 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://read.qxmd.com/read/30696360/disparities-in-emergent-colectomy-for-colorectal-cancer-contribute-to-inequalities-in-postoperative-morbidity-and-mortality-in-the-us-health-care-system
#12
F Schlottmann, P D Strassle, A L Cairns, F A M Herbella, A Fichera, M G Patti
BACKGROUND AND AIMS: Colorectal cancer is the third most common cancer among both men and women in the United States. We aimed to determine racial and socioeconomic disparities in emergent colectomy rates for colorectal cancer in the US Health Care system. MATERIAL AND METHODS: We performed a retrospective analysis of the National Inpatient Sample including adult patients (⩾18 years) diagnosed with colorectal cancer, and who underwent colorectal resection while admitted between 2008 and 2015...
January 29, 2019: Scandinavian Journal of Surgery: SJS
https://read.qxmd.com/read/30694788/preoperative-exercise-rehabilitation-in-cardiac-and-vascular-interventions
#13
REVIEW
Laura M Drudi, Jimmy Tat, Matthew Ades, Juan Mata, Tara Landry, Kent S MacKenzie, Oren K Steinmetz, Heather L Gill
BACKGROUND: Exercise-based interventions have become part of the standard of care in rehabilitation programs for cardiovascular risk reduction and the promotion of a healthy lifestyle. The systematic review describes the current state of knowledge of the effects of preoperative exercise training (prehabilitation) on perioperative clinical outcomes in patients undergoing cardiac and vascular interventions. METHODS: Studies were systematically searched within 14 databases from inception to October 2016...
January 9, 2019: Journal of Surgical Research
https://read.qxmd.com/read/30683130/neurological-complications-after-cardiac-surgery-a-retrospective-case-control-study-of-risk-factors-and-outcome
#14
Giuseppe Maria Raffa, Francesco Agnello, Giovanna Occhipinti, Roberto Miraglia, Vincenzina Lo Re, Gianluca Marrone, Fabio Tuzzolino, Antonio Arcadipane, Michele Pilato, Angelo Luca
BACKGROUND: To evaluate incidence, risk factors, and outcomes of postoperative neurological complications in patients undergoing cardiac surgery. METHODS: A total of 2121 patients underwent cardiac surgery between August, 2008 and December, 2013; 91/2121 (4.3%) underwent brain computed tomography (70/91, 77%) or magnetic resonance imaging (21/91, 23%) scan because of major stroke (37/2121, 1.7%) and a spectrum of transient neurological episodes as well as transient ischemic attacks and delirium /psychosis/seizures (54/2121, 2...
January 25, 2019: Journal of Cardiothoracic Surgery
https://read.qxmd.com/read/30675675/comprehensive-risk-factor-evaluation-of-postoperative-delirium-following-major-surgery-clinical-data-warehouse-analysis
#15
Suk Yun Kang, Sang Won Seo, Joo Yong Kim
BACKGROUND: Postoperative delirium (POD) in older adults is a very serious complication. Due to the complexity of too many risk factors (RFs), an overall assessment of RFs may be needed. The aim of this study was to evaluate comprehensively the RFs of POD regardless of the organ undergoing operation, efficiently incorporating the concept of comprehensive big data using a smart clinical data warehouse (CDW). METHODS: We reviewed the electronic medical data of inpatients aged 65 years or older who underwent major surgery between January 2010 and June 2016 at Hallym University Sacred Heart Hospital...
January 24, 2019: Neurological Sciences
https://read.qxmd.com/read/30672972/comparisons-and-correlations-of-pain-intensity-and-respiratory-and-peripheral-muscle-strength-in-the-pre-and-postoperative-periods-of-cardiac-surgery
#16
Thayse Campos de Menezes, Daniela Bassi, Ricardo César Cavalcanti, Juliana Emanuelle Santos Luz Barros, Karolyne Soares Barbosa Granja, Ana Carolina do Nascimento Calles, Ana Luiza Exel
OBJECTIVE: To evaluate respiratory and peripheral muscle strength after cardiac surgery. Additionally, we compared the changes in these variables on the third and sixth postoperative days. METHODS: Forty-six patients were recruited, including 17 women and 29 men, with a mean age of 60.50 years (SD = 9.20). Myocardial revascularization surgery was performed in 36 patients, replacement of the aortic valve in 5 patients, and replacement of the mitral valve in 5 patients...
October 2018: Revista Brasileira de Terapia Intensiva
https://read.qxmd.com/read/30672840/reducing-exposure-to-opioid-and-benzodiazepine-medications-for-pediatric-cardiac-intensive-care-patients-a-quality-improvement-project
#17
Amy Donnellan, Jaclyn Sawyer, Anne Peach, Sandra Staveski, David P Nelson, J Nick Pratap
OBJECTIVES: To evaluate the effect of implementation of a comfort algorithm on infusion rates of opioids and benzodiazepines in postneonatal postoperative pediatric cardiac surgery patients. DESIGN: A quality improvement project, using statistical process control methodology. SETTING: Twenty-five-bed tertiary care pediatric cardiac ICU in an urban academic Children's hospital. PATIENTS: Postoperative pediatric cardiac surgery patients...
January 21, 2019: Pediatric Critical Care Medicine
https://read.qxmd.com/read/30665850/ultrasound-guided-continuous-thoracic-erector-spinae-plane-block-within-an-enhanced-recovery-program-is-associated-with-decreased-opioid-consumption-and-improved-patient-postoperative-rehabilitation-after-open-cardiac-surgery-a-patient-matched-controlled-before
#18
Philippe Macaire, Nga Ho, Tan Nguyen, Binh Nguyen, Viet Vu, Chinh Quach, Vicente Roques, Xavier Capdevila
OBJECTIVES: Open cardiac surgery may cause severe postoperative pain. The authors hypothesized that patients receiving a bundle of care using continuous erector spinae plane blocks (ESPB) would have decreased perioperative opioid consumption and improved early outcome parameters compared with standard perioperative management. DESIGN: A consecutive, patient-matched, controlled before-and-after study. SETTING: Two tertiary teaching hospitals...
November 19, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://read.qxmd.com/read/30665758/one-year-results-from-the-first-us-based-enhanced-recovery-after-cardiac-surgery-eras-cardiac-program
#19
Judson B Williams, Gina McConnell, J Erin Allender, Patricia Woltz, Kathy Kane, Peter K Smith, Daniel T Engelman, William T Bradford
OBJECTIVE: Our enhanced recovery after cardiac surgery (ERAS Cardiac) program is an evidence-based interdisciplinary process, which has not previously been systematically applied to cardiac surgery in the United States. METHODS: The Knowledge-to-Action Framework synthesized evidence-based enhanced recovery interventions and implementation of a designated ERAS Cardiac program. Standardized processes included (1) preoperative patient education, (2) carbohydrate loading 2 hours before general anesthesia, (3) multimodal opioid-sparing analgesia, (4) goal-directed perioperative insulin infusion, and (5) a rigorous bowel regimen...
December 8, 2018: Journal of Thoracic and Cardiovascular Surgery
https://read.qxmd.com/read/30664589/population-pharmacokinetics-and-dosing-of-milrinone-after-patent-ductus-arteriosus-ligation-in-preterm-infants
#20
Maarja Hallik, Mari-Liis Ilmoja, Tõnis Tasa, Joseph F Standing, Kalev Takkis, Rūta Veigure, Karin Kipper, Tiiu Jalas, Maila Raidmäe, Karin Uibo, Joel Starkopf, Tuuli Metsvaht
OBJECTIVES: The postoperative course of patent ductus arteriosus ligation is often complicated by postligation cardiac syndrome, occurring in 10-45% of operated infants. Milrinone might prevent profound hemodynamic instability and improve the recovery of cardiac function in this setting. The present study aimed to describe the population pharmacokinetics of milrinone in premature neonates at risk of postligation cardiac syndrome and give dosing recommendations. DESIGN: A prospective single group open-label pharmacokinetics study...
January 18, 2019: Pediatric Critical Care Medicine
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