Denys Shaydenfish, Flora T Scheffenbichler, Barry J Kelly, Anne-Louise Lihn, Hao Deng, Anahita Nourmahnad, Xinling Xu, Timothy T Houle, Matthias Eikermann, Stuart A Forman
BACKGROUND: The anticholinesterase neostigmine and the muscarinic inhibitor glycopyrrolate are frequently coadministered for the reversal of neuromuscular blockade. This practice can precipitate severe bradycardia or tachycardia, but whether it affects the incidence of cardiovascular complications remains unclear. We hypothesized that anticholinesterase reversal with neostigmine and glycopyrrolate versus no anticholinesterase reversal increases the risk of postoperative cardiovascular complications among adult patients undergoing noncardiac surgery with general anesthesia...
March 14, 2019: Anesthesia and Analgesia
Daniela Kiski, Edward Malec, Christoph Schmidt
PURPOSE OF REVIEW: In recent years, ultrafast-track anesthesia with on-table extubation and concepts of accelerated postoperative care have gained increasing support in pediatric congenital cardiac surgery. It is believed that such approaches might ideally combine economic benefits with a striving for continuous improvement of patient outcomes. The present review summarizes the role of dexmedetomidine (DEX) in this setting. RECENT FINDINGS: DEX is a clinical multipurpose drug that mediates its diverse responses through the activation of α2-adrenoreceptors...
June 2019: Current Opinion in Anaesthesiology
Oguzhan Yeniay, Zeki Tuncel Tekgul, Onur Okur, Noyan Koroglu
PURPOSE: To measure the preoperative fasting durations with respect to time of the day and its effect on vital parameters and electrocardiogram in elderly patients undergoing surgery under spinal anesthesia. METHODS: This study investigated 211 patients older than 60 years undergoing elective surgery under spinal anesthesia. Patients scheduled for surgery in morning hours (AM) and afternoon hours (PM) were compared. Patients fasting hours and repeated measurements of mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (Sp02) and the type and number of ischemic electrocardiogram (ECG) signs were recorded and compared [preoperative, zeroth, 2nd,5th,15th,30th minutes following spinal anesthesia(SA)]...
March 18, 2019: Acta Cirúrgica Brasileira
Giovanni Landoni, Vladimir V Lomivorotov, Caetano Nigro Neto, Fabrizio Monaco, Vadim V Pasyuga, Nikola Bradic, Rosalba Lembo, Gordana Gazivoda, Valery V Likhvantsev, Chong Lei, Andrey Lozovskiy, Nora Di Tomasso, Nazar A R Bukamal, Fernanda S Silva, Andrey E Bautin, Jun Ma, Martina Crivellari, Ahmed M G A Farag, Nikolay S Uvaliev, Cristiana Carollo, Marina Pieri, Jan Kunstýř, Chew Yin Wang, Alessandro Belletti, Ludhmila A Hajjar, Evgeny V Grigoryev, Felice E Agrò, Hynek Riha, Mohamed R El-Tahan, A Mara Scandroglio, Abeer M Elnakera, Massimo Baiocchi, Paolo Navalesi, Vladimir A Shmyrev, Luca Severi, Mohammed A Hegazy, Giuseppe Crescenzi, Dmitry N Ponomarev, Luca Brazzi, Renato Arnoni, Dmitry G Tarasov, Miomir Jovic, Maria G Calabrò, Tiziana Bove, Rinaldo Bellomo, Alberto Zangrillo
BACKGROUND: Volatile (inhaled) anesthetic agents have cardioprotective effects, which might improve clinical outcomes in patients undergoing coronary-artery bypass grafting (CABG). METHODS: We conducted a pragmatic, multicenter, single-blind, controlled trial at 36 centers in 13 countries. Patients scheduled to undergo elective CABG were randomly assigned to an intraoperative anesthetic regimen that included a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or to total intravenous anesthesia...
March 28, 2019: New England Journal of Medicine
Jan Mracek, Jakub Kletecka, Jan Mork, David Stepanek, Jiri Dostal, Jolana Mrackova, Vladimir Priban
BACKGROUND AND STUDY AIMS:  Both general anesthesia (GA) and local anesthesia (LA) are used in our department for carotid endarterectomy. The decision of which anesthetic technique to use during surgery is made on an individual basis. The aim of our study was to analyze the reasons for using GA or LA. MATERIAL AND METHODS:  The reasons that led to the selection of either GA or LA were analyzed retrospectively in a group of 409 patients. RESULTS:  GA was used in 304 patients (74%) and LA in 105 patients (26%)...
July 2019: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Robert W Arnold, Aleah N Bond, Melissa McCall, Leif Lunoe
BACKGROUND: The oculocardiac reflex (OCR), bradycardia that occurs during strabismus surgery is a type of trigemino-cardiac reflex (TCR) is blocked by anticholinergics and enhanced by opioids and dexmedetomidine. Two recent studies suggest that deeper inhalational anesthesia monitored by BIS protects against OCR; we wondered if our data correlated similarly. METHODS: In an ongoing, prospective study of OCR/TCR elicited by 10-s, 200 g square-wave traction on extraocular muscles (EOM) from 2009 to 2013, anesthetic depth was estimated in cohorts using either BIS or Narcotrend monitors...
March 14, 2019: BMC Anesthesiology
Lisa Q Rong, Mohamed K Kamel, Mohamed Rahouma, Ajita Naik, Kritika Mehta, Ahmed A Abouarab, Antonino Di Franco, Michelle Demetres, Taylor L Mustapich, Meghann M Fitzgerald, Kane O Pryor, Mario Gaudino
STUDY OBJECTIVE: We performed a systematic comparison of high-dose and low-dose opioid anesthesia in cardiac surgery. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING: Operating room. PATIENTS: 1400 adult patients undergoing cardiac surgery using general anesthesia. INTERVENTIONS: All RCTs comparing the effects of various doses of intravenous opioids (morphine, fentanyl, sufentanil, and remifentanil) during adult cardiac surgery using general anesthesia published until May 2018 (full-text English articles reporting data from human subjects) were included...
November 2019: Journal of Clinical Anesthesia
Rebecca Y Klinger, Mary Cooter, Tiffany Bisanar, Niccolò Terrando, Miles Berger, Mihai V Podgoreanu, Mark Stafford-Smith, Mark F Newman, Joseph P Mathew
BACKGROUND: Cognitive decline after cardiac surgery occurs frequently and persists in a significant proportion of patients. Preclinical studies and human trials suggest that intravenous lidocaine may confer protection in the setting of neurologic injury. It was hypothesized that lidocaine administration would reduce cognitive decline after cardiac surgery compared to placebo. METHODS: After institutional review board approval, 478 patients undergoing cardiac surgery were enrolled into this multicenter, prospective, randomized, double-blinded, placebo-controlled, parallel group trial...
June 2019: Anesthesiology
Scott R Coleman, Ming Chen, Srikant Patel, Hong Yan, Alan D Kaye, Marcus Zebrower, Julie A Gayle, Henry Liu, Richard D Urman
PURPOSE OF REVIEW: Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years. The goals of ERAS are to improve patient outcomes and perioperative experience, reduce length of hospital stay, minimize complications, and reduce cost. Interventions and factors before, during, and after surgery all potentially play a role with the cumulative effect being superior quality of patient care. RECENT FINDINGS: Preoperatively, patient and family education, optimization of nutritional status, and antibiotic prophylaxis all improve outcomes...
March 14, 2019: Current Pain and Headache Reports
Magdolna Barra, Edit Remák, Dong Dong Liu, Li Xie, Lucy Abraham, Alesia B Sadosky
Purpose: The use of parecoxib plus opioids for postoperative analgesia in noncardiac surgical patients seems to be cost-saving in Europe due to a reduction in opioid use and opioid-related adverse events. Given the lack of information on postoperative analgesic use in Asia, this study assessed the economic consequences of the addition of parecoxib to opioids vs opioids alone to treat postsurgical pain in China. Methods: A cost-consequence economic evaluation assessed direct medical costs related to opioid-related clinically meaningful events (CMEs) utilizing dosing information and reported frequency of events from a Phase III, randomized, double-blind, global clinical trial (PARA-0505-069) of parecoxib plus opioids vs opioids alone for 3 days following major orthopedic, abdominal, gynecologic, or noncardiac thoracic surgery requiring general or regional anesthesia...
2019: ClinicoEconomics and Outcomes Research: CEOR
Naveen Raj
Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution, and duration of pain in these children have not been studied as extensively as in adults. Currently, there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response while minimizing their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimize opioid-related side effects, but this may not obtund the stress response in all children...
May 2019: Paediatric Anaesthesia
Kenji Watanabe, Nobuko Ito, Takuya Ohata, Taro Kariya, Hiroshi Inui, Yoshitsugu Yamada
RATIONALE: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease with a poor prognosis, characterized by chronic thromboembolic obstruction of the pulmonary arteries and pulmonary hypertension. Balloon pulmonary angioplasty (BPA) is a newly emergent treatment for CTEPH, which may substitute pulmonary endarterectomy, the standard but more invasive treatment for CTEPH. Here, we report the case of a CTEPH patient who underwent 2 noncardiac surgeries without complications after preoperative intervention of BPA...
March 2019: Medicine (Baltimore)
Aaron J Spooner, Christina M Faulkner, Richard J Novick, William D T Kent
OBJECTIVES: Simulation is a pivotal tool within cardiac surgery to facilitate learner growth and skill acquisition. There are many methods of simulation and it is possible to develop and implement new curricula incorporating these modalities. The objective of this paper is to describe the feasibility of a high-fidelity cardiac transplant simulation curriculum for surgical residents. METHODS: Our simulation setting was the Animal Resource Center at the University of Calgary...
February 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Teela Jones, José L Bracamonte, Barbara Ambros, Tanya Duke-Novakovski
OBJECTIVE: To evaluate effects of anesthesia induced with alfaxalone and maintained with alfaxalone, dexmedetomidine and remifentanil infusions in foals. STUDY DESIGN: Prospective, experimental study. ANIMALS: A group of six healthy foals [median (range) 11 (8-33) days] undergoing abdominal surgery. METHODS: Intravenous (IV) dexmedetomidine (3-7μgkg-1 ) provided sedation for insertion of a pulmonary artery catheter...
May 2019: Veterinary Anaesthesia and Analgesia
Ying-Hsuan Tai, Hsiang-Ling Wu, Fu-Wei Su, Kuang-Yi Chang, Cheng-Hsiung Huang, Mei-Yung Tsou, Chih-Cherng Lu
BACKGROUND: The aim of the study was to evaluate the effects of high-dose nitroglycerine administered during cardiopulmonary bypass on the intraoperative cerebral saturation and postoperative serum creatinine concentration in cardiac surgery. METHODS: In a retrospective cohort study, a total of 239 patients undergoing cardiac surgery with cardiopulmonary bypass at a tertiary medical center were included. General anesthesia consisted of volatile anesthetic and either intravenous loading of high-dose nitroglycerin (infusion rate 10 to 20 mg·h with a total dose of ≥0...
February 2019: Journal of the Chinese Medical Association: JCMA
Philip J Peyton, Mats Wallin, Magnus Hallbäck
BACKGROUND: There is continuing interest among clinicians in the potential for advanced hemodynamic monitoring and "goal directed" intravenous fluid administration guided by minimally-invasive cardiac output measurement to reduce complication rates in high risk patients undergoing major surgery. However, the adoption of the available technologies has been limited, due to cost, complexity and reliability of measurements provided. We review progress in the development of new generation methods for continuous non-invasive monitoring of cardiac output from measurement of carbon dioxide elimination in ventilated patients using the Differential Fick method...
February 26, 2019: BMC Anesthesiology
Ding Han, Ya-Guang Liu, Shou-Dong Pan, Yi Luo, Jia Li, Chuan Ou-Yang
Background Intravenous sufentanil-midazolam and inhalational sevoflurane are widely used for anesthetic induction in children undergoing cardiac surgery. However, knowledge about their effects on hemodynamics and cardiac efficiency remains limited due largely to the lack of direct monitoring method. We used minimally invasive technique pressure recording analytical method (PRAM) to directly monitor hemodynamics and cardiac efficiency and compared the effects of the two anesthetic regimens in children undergoing ventricular septal defect repair...
February 18, 2019: Heart Surgery Forum
Tasha L Welch, Luke A Law, Giuseppe Lanzino, William L Lanier
We describe two patients-both who underwent general anesthesia-in whom we theorize that hydraulic pressure on carotid artery baroreceptors resulted in transient asystolic cardiac arrest (TACA) during diagnostic or therapeutic procedures. Patient #1 was a 58-year-old female who experienced TACA in response to rapid injection of radiocontrast material into the carotid artery during diagnostic cerebral angiography. Her history was remarkable for aneurysmal subarachnoid hemorrhage at least 13 hr prior to angiography, radiographic evidence of intracranial hypertension, and baseline bradycardia, collectively suggestive of increases in baseline vagal tone...
February 21, 2019: Catheterization and Cardiovascular Interventions
C Sponholz, C Schuwirth, L Koenig, H Hoyer, S M Coldewey, C Schelenz, T Doenst, A Kortgen, M Bauer
Intraoperative vasopressor and fluid application are common strategies against hypotension. Use of processed electroencephalographic monitoring (pEEG) may reduce vasopressor application, a known risk factor for organ dysfunction, in elective cardiac surgery patients. Randomized single-centre clinical trial at Jena University Hospital. Adult patients operated on cardiopulmonary bypass or off-pump coronary artery bypass grafting were randomised to receive anesthesia with visible or blinded pEEG using Narcotrend™...
February 19, 2019: Journal of Clinical Monitoring and Computing
Yu-Hua Liu, Dong-Jie Qiu, Li Jia, Jun-Tao Tan, Jin-Meng Kang, Tian Xie, Hong-Meng Xu
INTRODUCTION: Whether anesthesia depth affects postoperative mortality remains uncertain. MEASUREMENTS: Several databases were systematically searched to identify all articles studying the relationship between depth of anesthesia and postoperative mortality. Post hoc subgroup analyses were conducted for follow-up period (30 days vs. longer than 90 days) and type of surgery. MAIN RESULTS: The analysis included 38,722 patients from nine studies...
September 2019: Journal of Clinical Anesthesia
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