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A History of Alcohol Dependence Increases the Incidence and Severity of Postoperative Cognitive Dysfunction in Cardiac Surgical Patients  [PDF]
Judith A. Hudetz,Kathleen M. Patterson,Alison J. Byrne,Zafar Iqbal,Sweeta D. Gandhi,David C. Warltier,Paul S. Pagel
International Journal of Environmental Research and Public Health , 2009, DOI: 10.3390/ijerph6112725
Abstract: Postoperative cognitive dysfunction (POCD) commonly occurs after cardiac surgery. We tested the hypothesis that a history of alcohol dependence is associated with an increased incidence and severity of POCD in male patients undergoing cardiac surgery using cardiopulmonary bypass. Recent verbal and nonverbal memory and executive functions were assessed before and one week after surgery in patients with or without a history of alcohol dependence. Cognitive function was significantly reduced after cardiac surgery in patients with versus without a history of alcohol dependence. The results suggest that a history of alcohol dependence increases the incidence and severity of POCD after cardiac surgery.
Bioresorbable adhesion barrier for reducing the severity of postoperative cardiac adhesions: Focus on REPEL-CV
Martin Haensig, Friedrich Wilhelm Mohr, Ardawan Julian Rastan
Medical Devices: Evidence and Research , 2011, DOI: http://dx.doi.org/10.2147/MDER.S7957
Abstract: ioresorbable adhesion barrier for reducing the severity of postoperative cardiac adhesions: Focus on REPEL-CV Review (4118) Total Article Views Authors: Martin Haensig, Friedrich Wilhelm Mohr, Ardawan Julian Rastan Published Date January 2011 Volume 2011:4 Pages 17 - 25 DOI: http://dx.doi.org/10.2147/MDER.S7957 Martin Haensig, Friedrich Wilhelm Mohr, Ardawan Julian Rastan Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany Abstract: Treatment of a number of congenital heart defects often necessitates staged surgical intervention. In addition, substantial improvements in postoperative cardiac care and more liberal use of biological valve substitutes have resulted in many adult patients surviving to become potential candidates for reoperations to repair or replace valves or to undergo additional revascularization procedures. In all these scenarios, surgeons are confronted with cardiac adhesions, leading to an increased surgical risk. Thus, bioresorbable adhesion barriers had become of increasing interest because they are easy to use, and safe and effective. This review focuses on the mechanisms by which REPEL-CV prevents adhesive processes, as well as the development, design, and materials used, and also summarizes efficacy studies, clinical data, safety, and current role in therapy.
Postoperative Hypoxia and Length of Intensive Care Unit Stay after Cardiac Surgery: The Underweight Paradox?  [PDF]
Marco Ranucci, Andrea Ballotta, Maria Teresa La Rovere, Serenella Castelvecchio, for the Surgical and Clinical Outcome Research (SCORE) Group
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0093992
Abstract: Objective Cardiac operations with cardiopulmonary bypass can be associated with postoperative lung dysfunction. The present study investigates the incidence of postoperative hypoxia after cardiac surgery, its relationship with the length of intensive care unit stay, and the role of body mass index in determining postoperative hypoxia and intensive care unit length of stay. Design Single-center, retrospective study. Setting University Hospital. Patients. Adult patients (N = 5,023) who underwent cardiac surgery with CPB. Interventions None. Measurements and main results According to the body mass index, patients were attributed to six classes, and obesity was defined as a body mass index >30. POH was defined as a PaO2/FiO2 ratio <200 at the arrival in the intensive care unit. Postoperative hypoxia was detected in 1,536 patients (30.6%). Obesity was an independent risk factor for postoperative hypoxia (odds ratio 2.4, 95% confidence interval 2.05–2.78, P = 0.001) and postoperative hypoxia was a determinant of intensive care unit length of stay. There is a significant inverse correlation between body mass index and PaO2/FiO2 ratio, with the risk of postoperative hypoxia increasing by 1.7 folds per each incremental body mass index class. The relationship between body mass index and intensive care unit length of stay is U-shaped, with longer intensive care unit stay in underweight patients and moderate-morbid obese patients. Conclusions Obese patients are at higher risk for postoperative hypoxia, but this leads to a prolonged intensive care unit stay only for moderate-morbid obese patients. Obese patients are partially protected against the deleterious effects of hemodilution and transfusions. Underweight patients present the “paradox” of a better lung gas exchange but a longer intensive care unit stay. This is probably due to a higher severity of their cardiac disease.
Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial
Julika Schoen, Joscha Meyerrose, Hauke Paarmann, Matthias Heringlake, Michael Hueppe, Klaus-Ulrich Berger
Critical Care , 2011, DOI: 10.1186/cc10454
Abstract: After approval of the local ethical committee and written informed consent, N = 231 patients scheduled for elective/urgent cardiac surgery were enrolled. Delirium was assessed by the confusion-assessment-method for the intensive care unit (CAM-ICU) on the first three days after surgery. ScO2 was obtained on the day before surgery, immediately before surgery and throughout the surgical procedure. Preoperative cognitive function, demographic, surgery related, and intra- and post-operative physiological data were registered.Patients with delirium had lower pre- and intra-operative ScO2 readings, were older, had lower mini-mental-status-examination(MMSE) scores, higher additive EuroScore and lower preoperative haemoglobin-levels. The binary logistic regression identified older age, lower MMSE, neurological or psychiatric disease and lower preoperative ScO2 as independent predictors of postoperative delirium.The presented study shows that a low preoperative ScO2 is associated with postoperative delirium after on-pump cardiac surgery.Delirium is a common and serious problem in critically ill patients [1] and occurs in up to 41% [2] of cardiac surgical patients. Several preoperative risk factors for delirium after cardiac surgery have been identified: age, cognitive status, the severity of illness (that is, cardiogenic or septic shock), anemia, and certain medications like sedatives, anti-cholinergics, or hypnotics [2-6].Whereas the hyperactive form of delirium is easily recognized, the much more frequent hypoactive form is often missed by nurses and intensive care physicians [7,8]. As both the hyperactive and the hypoactive form of delirium have been shown to be associated with prolonged hospital stay, increased mortality, functional decline, and long-term cognitive impairment [1,9-12], specific diagnostic algorithms need to be implemented and prevention of delirium should be the focus of perioperative cardiac surgery care [13].Near-infrared spectroscopy offers the possib
Aplica??o do sistema de pontua??o de interven??es terapêuticas (TISS 28) em unidade de terapia intensiva para avalia??o da gravidade do paciente
Elias, Adriana Cristina Galbiatti Parminondi;Tiemi, Matsuo;Cardoso, Lucienne Tibery Queiroz;Grion, Cíntia Magalh?es Carvalho;
Revista Latino-Americana de Enfermagem , 2006, DOI: 10.1590/S0104-11692006000300004
Abstract: prospective cohort study realized in the adult intensive care unit (icu) of a university hospital to evaluate the utility of the tiss 28 score, using a protocol applied to 1641 patients from january 2000 to december 2002, based on the direct observation of patients and medical and nurse registers of therapeutic procedures and monitoring. the chi-square test, student's t test and kruskal-wallis were used to compare the tiss 28 score and some characteristics of survivors and no survivors patients. the results showed that the tiss 28 score stratified the patients by severity level and evidenced the relation between high scores and mortality of the analyzed patients.
Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome
Marco Ranucci, Barbara De Toffol, Giuseppe Isgrò, Federica Romitti, Daniela Conti, Maira Vicentini
Critical Care , 2006, DOI: 10.1186/cc5113
Abstract: Five hundred consecutive patients undergoing cardiac surgery with cardiopulmonary bypass were admitted to this prospective observational study. During cardiopulmonary bypass, serial arterial blood gas analyses with blood lactate and glucose determinations were obtained. Hyperlactatemia was defined as a peak arterial blood lactate concentration exceeding 3 mmol/l. Pre- and intraoperative factors were tested for independent association with the peak arterial lactate concentration and hyperlactatemia. The postoperative outcome of patients with or without hyperlactatemia was compared.Factors independently associated with hyperlactatemia were the preoperative serum creatinine value, the presence of active endocarditis, the cardiopulmonary bypass duration, the lowest oxygen delivery during cardiopulmonary bypass, and the peak blood glucose level. Once corrected for other explanatory variables, hyperlactatemia during cardiopulmonary bypass remained significantly associated with an increased morbidity, related mainly to a postoperative low cardiac output syndrome, but not to mortality.Hyperlactatemia during cardiopulmonary bypass appears to be related mainly to a condition of insufficient oxygen delivery (type A hyperlactatemia). During cardiopulmonary bypass, a careful coupling of pump flow and arterial oxygen content therefore seems mandatory to guarantee a sufficient oxygen supply to the peripheral tissues.Hyperlactatemia (HL) is a well-recognized marker of circulatory failure, and its severity has been associated with mortality in different clinical conditions [1,2]. After cardiac surgery, HL is relatively common [3,4] and is associated with morbidity and mortality [4]. During cardiac surgery with cardiopulmonary bypass (CPB) in adult patients, HL is detectable at a considerable (10% to 20%) rate [5,6] and is associated with postoperative morbidity and mortality [5]. At present, the nature of HL during and after cardiac operations is not totally clear, but the majority
Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. II. Evaluation of the Postoperative Period Risk based on Data from the Pre- and Intraoperative Period  [PDF]
Maria Milanova,Mikhail Matveev
Bioautomation , 2008,
Abstract: A classification of intraoperative (IO) and postoperative (PO) cardio-vascular complications (CVC) was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA in CVC for non-cardiac surgery. There were 370 intra and 405 postoperative (IO; PO) CVC registered, distributed as follows: groups with low risk (IO: 148; PO: 87), moderate risk (IO: 200; PO: 225), and high risk (IO: 22; PO: 93). Patient groups were formed, according to the CVC risk level, during the intra- and postoperative periods, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardio-vascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. The trend toward increase or decrease of the CVC risk was studied during the transition from intra- to the postoperative period. On the basis of these indices, a new distribution of the patients was implemented, into groups with different levels of risk of CVC during intra- and postoperative. This result is a solid argument, substantiating the proposal to introduce these adjustments to the ACC/AHA criteria for determining the severity of CVC in the specific conditions of emergency abdominal surgery.
Bioresorbable adhesion barrier for reducing the severity of postoperative cardiac adhesions: Focus on REPEL-CV®
Martin Haensig,Friedrich Wilhelm Mohr,Ardawan Julian Rastan
Medical Devices: Evidence and Research , 2011,
Abstract: Martin Haensig, Friedrich Wilhelm Mohr, Ardawan Julian RastanDepartment of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, GermanyAbstract: Treatment of a number of congenital heart defects often necessitates staged surgical intervention. In addition, substantial improvements in postoperative cardiac care and more liberal use of biological valve substitutes have resulted in many adult patients surviving to become potential candidates for reoperations to repair or replace valves or to undergo additional revascularization procedures. In all these scenarios, surgeons are confronted with cardiac adhesions, leading to an increased surgical risk. Thus, bioresorbable adhesion barriers had become of increasing interest because they are easy to use, and safe and effective. This review focuses on the mechanisms by which REPEL-CV prevents adhesive processes, as well as the development, design, and materials used, and also summarizes efficacy studies, clinical data, safety, and current role in therapy.Keywords: adhesion prevention, bioresorbable copolymer, cardiac reoperation
Comparison of granisetron, metoclopramide and gastric decompression for prevention of postoperative nausea and vomiting after fast track cardiac anesthesia  [cached]
Omid Aghadavoudi,Elahe Amiri
Journal of Research in Medical Sciences , 2008,
Abstract: BACKGROUND: Different methods have been suggested to prevent postoperative nausea and vomiting (PONV), but the efficacy of these methods has not been fully studied in fast track cardiac anesthesia (FTCA). METHODS: In a randomized double blind clinical trial study, 120 patients aged 18-70 years with ASA II or III, undergoing elective cardiac surgery, were selected. They were divided randomly into four groups. In group M, group G and group P, intravenous (IV) metoclopramide (0.1 mg/kg), granisetron (0.01 mg/kg), and normal saline were administered, respectively, about thirty minutes before extubation in the intensive care unit (ICU). In group N, a nasogastric (NG) tube was inserted after tracheal intubation in the operating room and removed about thirty minutes before extubation in the ICU. The incidence and severity of nausea and the episodes of vomiting were recorded by a blinded investigator at the time of extubation and performed regularly for a maximum of 24 hours. Assessment of severity of nausea was scored using a visual analogue scale (VAS) device. Data were analyzed by using ANOVA, chi-squared and Kruskal- Wallis and repeated measures tests. RESULTS: Overall the 24-h incidence of PONV was significantly lower in the G and M groups than in the P and N groups (10% and 16.7% vs. 33.3% and 40%, respectively; P < 0.02). Postoperative rescue medication was significantly less required in the G and M groups compared to the other two groups (P < 0.01). Less satisfaction, according to PONV status, was observed in the P and N groups (P < 0.01). CONCLUSIONS: According to this study, metoclopramide and granisetron, but not gastric decompression, are effective regimens for preventing PONV after FTCA. Given the economics and a considerable background incidence in patients exhibiting PONV, we suggest metoclopramide as a routine prophylactic antiemetic in FTCA. KEYWORDS: Cardiac surgical procedures, postoperative nausea and vomiting, granisetron, metoclopramide, gastrointestinal intubation.
Observations on a Giant Sigmoid Volvulus with Unusual Clinical Presentation and Challenging Postoperative Course: Case Report  [PDF]
Giuseppe Pisano, Pietro Giorgio Calò, Stefano Piras, Enrico Erdas
Surgical Science (SS) , 2015, DOI: 10.4236/ss.2015.611072
Abstract: Introduction: The present report describes a case of a giant sigmoid volvulus (SV) where acute respiratory distress was associated with toxic megacolon. Clinical features, surgical treatment and postoperative course deserved our attention and discussion. Presentation of Case: A 67-year-old man with psychiatric disturbances was admitted to our Department with severe respiratory distress due to an enormous abdominal distension caused by a sigmoid volvulus. Endoscopic derotation was unsuccessful and surgery immediately performed. After a wide colonic resection the patient underwent a prolonged treatment in the Intensive Care Unit. Death occurred 34 days after the operation for secondary infection of peritoneal effusion. Discussion: Main clinical features of SV pertain to abdominal compartment while in the present case acute respiratory distress was the prominent symptom; in the same time the severity of the case was due to the association of high abdominal pressure together with a toxic megacolon. Postoperative treatment consisted in ventilatory support, with a progressive shift from asssisted to spontaneous ventilation; repeated sessions of haemodialysis were necessary to manage renal failure up to recovery of the urine output. Bacterial trans location due to toxic megacolon was responsible of late infection of ascitic fluid. In spite of multiple antibiotic association according to bacterial cultures, intra-abdominal abscesses eventually developed causing fatal outcome 34 days after the first intervention. Conclusion: Severe clinical presentation required a prolonged and demanding postoperative course which was focused on the recovery of respiratory, cardiac and renal function even if fatal outcome was due to septic complications. Suspicion of late infection of ascitic fluid could arise from persistently high values of inflammation indexes and drive to an earlier drainage of the abdominal abscesses.
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