Effects of enoximone in the postoperative treatment in cardiac surgery

Heparin-induced thrombocytopenia (HIT) might be lifethreatening in patients undergoing open heart surgery, due to thromboembolic events, thrombocytopenia and bleeding. If cardiac surgery with cardiopulmonary bypass (CPB) is necessary, anticoagulation therapy will be based on usage of danaparoid or direct thrombin inhibitors. Female patient was switched from per oral anticoagulant therapy to low molecular heparin therapy preparing for reredo mitral valve replacement due to endocarditis and artificial valve thrombosis. In next 10 days, thrombocytopenia was obvious (Tr 302 000 mm3 to 11 000 mm3) , and diagnoses of HIT were done. Anticoagulant therapy was continued with danaparoid, 750 IU/12 h sc. During the surgery, reredo mitral valve replacement and aortocoronary bypass on anterior descending coronary artery, blood salvage technique with rhirudin( intravenous bolus 0,4 mg/kg, in CPB prajming solution 0,4mg/kg and continuous infusion during CPB 0,15 mg/kg/h ) during cardiopulmonary bypass was used. Active coagulation time and +++ were monitored, without any sign of micro thrombosis in circuit. Postoperatively, per oral anticoagulation therapy was initiated with prolonged postoperative treatment due to basic disease, endocarditis. Patient was discharged from hospital on 21-st postoperative day without any complication.

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Tranexamic Acid Administration after Cardiac Surgery

Anesthesiology ◽

10.1097/00000542-200101000-00007 ◽

2001 ◽

Vol 94 (1) ◽

pp. 8-14 ◽

Cited By ~ 40

Author(s):

Valter Casati ◽

Ferdinando Bellotti ◽

Chiara Gerli ◽

Annalisa Franco ◽

Michele Oppizzi ◽

...

Keyword(s):

Cardiac Surgery ◽

Tranexamic Acid ◽

Postoperative Period ◽

Postoperative Bleeding ◽

Postoperative Treatment ◽

Outcome Variable ◽

Double Blind ◽

Excessive Bleeding ◽

Elective Cardiac Surgery ◽

Increased Risk

Background Many different doses and administration schemes have been proposed for the use of the antifibrinolytic drug tranexamic acid during cardiac surgery. This study evaluated the effects of the treatment using tranexamic acid during the intraoperative period only and compared the results with the effects of the treatment continued into the postoperative period. Methods Patients undergoing elective cardiac surgery with use of cardiopulmonary bypass (N = 510) were treated intraoperatively with tranexamic acid and then were randomized in a double-blind fashion to one of three postoperative treatment groups: group A: 169 patients, infusion of saline for 12 h; group B: 171 patients, infusion of tranexamic acid, 1 mg x kg(-1) x h(-1) for 12 h; group C: 170 patients, infusion of tranexamic acid, 2 mg x kg(-1) x h(-1) for 12 h. Bleeding was considered to be a primary outcome variable. Hematologic data, allogeneic transfusions, thrombotic complications, intubation time, and intensive care unit and hospital stay duration also were evaluated. Results No differences were found among groups regarding postoperative bleeding and outcomes; however, the group treated with 1 mg x kg(-1) x h(-1) tranexamic acid required more units of packed red blood cells because of a significantly lower basal value of hematocrit, as shown by multivariate analysis. Conclusions Prolongation of treatment with tranexamic acid after cardiac surgery is not advantageous with respect to intraoperative administration alone in reducing bleeding and number of allogeneic transfusions. Although the prevalence of postoperative complications was similar among groups, there is an increased risk of procoagulant response because of antifibrinolytic treatment. Therefore, the use of tranexamic acid during the postoperative period should be limited to patients with excessive bleeding as a result of primary fibrinolysis.

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Epileptic seizure discharges in patients after open chamber cardiac surgery – A prospective prevalence study using continuous electroencephalography

10.21203/rs.2.20961/v1 ◽

2020 ◽

Author(s):

Marlene Tschernatsch ◽

Martin Juenemann ◽

Fouad Alhaidar ◽

Jasmin El Shazly ◽

Marius Butz ◽

...

Keyword(s):

Cardiac Surgery ◽

Pilot Study ◽

Mitral Valve ◽

Early Postoperative Period ◽

Postoperative Treatment ◽

Eeg Monitoring ◽

Mitral Valve Reconstruction ◽

Treatment And Prevention ◽

Continuous Electroencephalography ◽

Valve Reconstruction

Abstract Background Patients undergoing cardiac surgery often develop delirium and postoperative cognitive deficits (POCD), which lead to a higher postoperative morbidity, mortality and a reduced quality of life. Retrospective studies show a higher incidence of delirium, stroke and mortality in patients with convulsive and non-convulsive seizures after cardiac surgery. However, these studies do not systematically detect subclinical seizures in the early postoperative period; so, the incidence of seizures after cardiac surgery remains speculative. To investigate the real frequency of seizures, we conducted this prospective pilot study on patients with open-chamber cardiac surgery using continuous electroencephalography (EEG) monitoring utilizing widely distributed electrodes and 10-channel registration. The main objective of the study is to determine the prevalence of seizure-specific patterns in EEG after elective open-chamber cardiac surgery. Methods The prospective, blinded, monocentric, observational study investigated patients scheduled for elective open-chamber aortic or mitral valve reconstruction or replacement. The anaesthetic, surgical and postoperative treatment was standardized and not influenced by the presented observation. After surgery, all patients arrived at the ICU, and EEG monitoring started within the first hour after admission to the ICU (10 channel registration: Fp1,Fp2,C3,C4,P3,P4,T3,T4,Fz,Cz). EEG recording was continuously performed for up to 24 hours, and the EEG results were independently analysed with a focus on epileptic discharges and seizure activity by two blinded EEG board-certified physicians Results One hundred patients were included, 76% of whom underwent aortic valve replacement, 24% of whom endured mitral valve reconstruction or replacement. Early postoperative EEG recording lasted 12.9±7.2 hours. Epileptic EEG patterns were present in 38% of patients and seizure-specific EEG patterns were present in 22% of patients. Main EEG activity at the beginning of recording was suppressed or showed a burst-suppression pattern, and at the end of recording, all patients had an alpha/theta-rhythm. Conclusion This pilot study reveals a surprisingly high prevalence of seizure-specific EEG patterns (22%) in patients undergoing open-chamber cardiac surgery. As seizures potentially induce delirium and POCD, this finding is a relevant phenomenon in the post-cardiac surgery population, representing a promising target for the treatment and prevention of postoperative delirium and POCD.

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Efficacy of Short-Term Oral Prednisolone Treatment in the Management of Pericardial Effusion Following Pediatric Cardiac Surgery

Pediatric Cardiology ◽

10.1007/s00246-021-02783-y ◽

2021 ◽

Author(s):

Masahiro Mizumoto ◽

Naoki Masaki ◽

Sadahiro Sai

Keyword(s):

Cardiac Surgery ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Oral Prednisolone ◽

Pediatric Cardiac Surgery ◽

Postoperative Treatment ◽

Maximum Diameter ◽

Short Term ◽

Pericardial Drainage ◽

Prednisolone Treatment

AbstractA standard treatment for pericardial effusion without cardiac tamponade after pediatric cardiac surgery has not been established. We evaluated the efficacy of short-term oral prednisolone administration, which is the initial treatment for postoperative pericardial effusion without cardiac tamponade at our institution. Between October 2008 and March 2020, 1429 pediatric cardiac surgeries were performed at our institution. 91 patients required postoperative treatment for pericardial effusion. 81 were treated with short-term oral prednisolone. Pericardial effusion was evaluated using serial echocardiography during diastole. Pericardial drainage was performed for patients with circumferential pericardial effusion with a maximum diameter of ≥ 10 mm or signs of cardiac tamponade. Short-term oral prednisolone treatment was administered to patients with circumferential pericardial effusion with a maximum diameter of < 10 mm or localized pericardial effusion with a maximum diameter of ≥ 5 mm. Patients with localized pericardial effusion with a maximum diameter of < 5 mm were observed. Prednisolone (2 mg/kg/day) was administered orally for 3 days, added as needed. Short-term oral prednisolone treatment was effective in 71 cases and 90% of patients were regarded as responders. The remaining patients were deemed non-responders who required pericardial drainage. Overall, 55 responders were deemed early responders whose pericardial effusion disappeared within 3 days. There were no cases of deaths, infections, or recurrence of pericardial effusion. The amount of drainage fluid on the day of surgery was higher in the non-responders. In conclusion, short-term oral prednisolone treatment is effective and safe for treating pericardial effusion without cardiac tamponade after pediatric cardiac surgery.

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