Dexmedetomidine, Delirium, and Adverse Outcomes: Analysis of the STS Adult Cardiac Surgery Database

2021 ◽  
Author(s):  
Nirvik Pal ◽  
James H. Abernathy ◽  
Mark A. Taylor ◽  
Bruce A. Bollen ◽  
Ashish S. Shah ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Adverse Outcomes ◽  
Outcomes Analysis ◽  
Adult Cardiac Surgery

Processed EEG Use During Anesthesia and Outcomes: Analysis of the STS Adult Cardiac Surgery Database

2021 ◽  
Author(s):  
Frederick W. Lombard ◽  
Sounak Roy ◽  
Ashish S. Shah ◽  
Xiaoke Feng ◽  
Matthew S. Shotwell ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Outcomes Analysis ◽  
Processed Eeg ◽  
Adult Cardiac Surgery

scholarly journals Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clément Aguerreche ◽  
Gaspard Cadier ◽  
Antoine Beurton ◽  
Julien Imbault ◽  
Sébastien Leuillet ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Retrospective Study ◽  
Elective Surgery ◽  
Adverse Outcomes ◽  
Smoking History ◽  
Opioid Sparing ◽  
Intravenous Morphine ◽  
Sparing Effect ◽  
Pain At Rest ◽  
Adult Cardiac Surgery

Abstract Background No previous study investigated the dexmedetomidine-based opioid-free anesthesia (OFA) protocol in cardiac surgery. The main objective of this study was to evaluate the feasibility and the postoperative opioid-sparing effect of dexmedetomidine-based OFA in adult cardiac surgery patients. Methods We conducted a single-centre and retrospective study including 80 patients above 18 years old who underwent on-pump cardiac surgery between November 2018 and February 2020. Patients were divided into two groups: OFA (lidocaine, ketamine, dexmedetomidine, MgSO4) or opioid-based anaesthesia (remifentanil and anti-hyperalgesic medications such as ketamine and/or MgSO4 and/or lidocaine at the discretion of the anesthesiologist). The primary endpoint was the total amount of opioid consumed in its equivalent of intravenous morphine during the first 48 postoperative hours. Secondary outcomes included perioperative hemodynamics, post-operative maximal pain at rest and during coughing and adverse outcomes. Data are expressed as median [interquartile range]. Results Patients in the OFA-group had a higher EuroSCORE II, with more diabetes, more dyslipidemia and more non-elective surgery but fewer smoking history. In the OFA group, the median loading dose of dexmedetomidine was 0.6 [0.4–0.6] μg.kg− 1 while the median maintenance dose was 0.11 μg.kg− 1.h− 1 [0.05–0.20]. In 10 (25%) patients, dexmedetomidine was discontinued for a drop of mean arterial pressure below 55 mmHg. The median total amount of opioid consumed in its equivalent of intravenous morphine during the first 48 postoperative hours was lower in the OFA group (15.0 mg [8.5–23.5] versus 30.0 mg [17.3–44.3], p < 0.001). While no differences were seen with rest pain (2.0 [0.0–3.0] versus 0.5 [0.0–5.0], p = 0.60), the maximal pain score during coughing was lower in OFA group (3.5 [2.0–5.0] versus 5.5 [3.0–7.0], p = 0.04). In OFA group the incidence of atrial fibrillation (18% versus 40%, p = 0.03) and non-invasive ventilation use (25% versus 48%, p = 0.04) were lower. The incidence of bradycardia and the intraoperative use of norepinephrine were similar between both groups. Conclusion Dexmedetomidine-based OFA in cardiac surgery patients is feasible and could be associated with a lower postoperative morphine consumption and better postoperative outcomes. Further randomized studies are required to confirm these promising results and determine the optimal associations, dosages, and infusion protocols during cardiac surgery. Graphical abstract

scholarly journals Red blood cell transfusion induces abnormal HIF-1α response to cytokine storm after adult cardiac surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Emma Viikinkoski ◽  
Juho Jalkanen ◽  
Jarmo Gunn ◽  
Tuija Vasankari ◽  
Joonas Lehto ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Transfusion ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Adverse Outcomes ◽  
Red Blood Cell Transfusion ◽  
Clinical Trial Registration ◽  
Packed Red Blood Cells ◽  
The Impact ◽  
Adult Cardiac Surgery

AbstractPatients undergoing cardiac surgery develop a marked postoperative systemic inflammatory response. Blood transfusion may contribute to disruption of homeostasis in these patients. We sought to evaluate the impact of blood transfusion on serum interleukin-6 (IL-6), hypoxia induced factor-1 alpha (HIF-1α) levels as well as adverse outcomes in patients undergoing adult cardiac surgery. We prospectively enrolled 282 patients undergoing adult cardiac surgery. Serum IL-6 and HIF-1α levels were measured preoperatively and on the first postoperative day. Packed red blood cells were transfused in 26.3% of patients (mean 2.93 ± 3.05 units) by the time of postoperative sampling. Postoperative IL-6 levels increased over 30-fold and were similar in both groups (p = 0.115), whilst HIF-1α levels (0.377 pg/mL vs. 0.784 pg/mL, p = 0.002) decreased significantly in patients who received red blood cell transfusion. Moreover, greater decrease in HIF-1α levels predicted worse in-hospital and 3mo adverse outcome. Red blood cell transfusion was associated with higher risk of major adverse outcomes (stroke, pneumonia, all-cause mortality) during the index hospitalization. Red blood cell transfusion induces blunting of postoperative HIF-1 α response and is associated with higher risk of adverse thrombotic and pulmonary adverse events after cardiac surgery. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03444259.

scholarly journals The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Research: Outcomes Analysis, Quality Improvement, and Patient Safety

2018 ◽  
Vol 106 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Vinay Badhwar ◽  
J. Scott Rankin ◽  
Vinod H. Thourani ◽  
Richard S. D’Agostino ◽  
Robert H. Habib ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cardiac Surgery ◽  
Quality Improvement ◽  
Outcomes Analysis ◽  
Research Outcomes ◽  
Analysis Quality ◽  
Adult Cardiac Surgery

Comparison of 56 Hours versus 32 Hours of Perioperative Antibiotic Prophylaxis in Adult Cardiac Surgery

2015 ◽  
Vol 63 (S 01) ◽  
Author(s):  
C. Schimmer ◽  
K. Hamouda ◽  
M. Oezkur ◽  
S. Sommer ◽  
M. Leistner ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Antibiotic Prophylaxis ◽  
Perioperative Antibiotic Prophylaxis ◽  
Adult Cardiac Surgery

Adult Cardiac Surgery During Covid-19 Pandemic

2020 ◽  
Vol 2 (4) ◽  
pp. 276-287
Author(s):  
Gerardo AK Laksono ◽  
◽  
Andreas MS Hutama ◽  
Paul L Tahalele ◽  
◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Adult Cardiac Surgery
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