Patients Should be Extubated in the Operating Room After Routine Cardiac Surgery: An Inconvenient Truth

The operating room in a cardiothoracic surgical case is a complex environment, with multiple handoffs often required by staffing changes, and can be variable from program to program. This study was done to characterize what types of practitioners provide anesthesia during cardiac operations to determine the variability in this aspect of care. A survey was sent out via a list serve of members of the cardiac surgical team. Responses from 40 programs from a variety of countries showed variability across every dimension requested of the cardiac anesthesia team. Given that anesthesia is proven to have an influence on the outcome of cardiac procedures, this study indicates the opportunity to further study how this variability influences outcomes and to identify best practices.

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Is Extubating My Cardiac Surgery Patient Postoperatively in the Operating Room a Good Idea?

You’re Wrong, I’m Right ◽

10.1007/978-3-319-43169-7_19 ◽

2016 ◽

pp. 67-69

Author(s):

Joseph Kimmel ◽

Peter J. Neuburger

Keyword(s):

Cardiac Surgery ◽

Operating Room ◽

Cardiac Surgery Patient ◽

Surgery Patient

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Abstract 17362: A Multidisciplinary Heart Team Approach to High Risk Transvenous Pacemaker and Defibrillator Lead Extraction Improves Mortality

Circulation ◽

10.1161/circ.138.suppl_1.17362 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Ryan G Aleong ◽

Matthew Zipse ◽

Christine Tompkins ◽

Tamas Seres ◽

David Fullerton ◽

...

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Operating Room ◽

Cardiac Electrophysiology ◽

Lead Extraction ◽

Team Approach ◽

Heart Team ◽

Hybrid Operating Room ◽

Icd Leads ◽

The Creation

Introduction: There is a risk of serious complications with high-risk lead extraction (LE) that may increase mortality. Current guidelines do not provide definitive guidance on collaborative involvement of cardiac surgery as compared to other procedures such as TAVR procedures. We report a single center experience of the benefits of a collaborative approach between cardiac surgery and cardiac electrophysiology (EP). Hypothesis: MDHT will improve outcomes in LE Methods: High risk lead extractions had dwell times of at least 4 years for pacemaker leads and 2 years for ICD leads. A multidisciplinary heart team (MDHT) was created based on the TAVR model that includes a combined lead management clinic and a monthly multidisciplinary conference. Prior to MDHT creation, high risk lead extractions were performed either in the hybrid operating room (OR) and cardiology procedure lab with a surgeon on call as needed. After the MDHT creation all cases were performed in the hybrid operating room by a cardiac surgeon, cardiac anesthesiologist and EP together with an interventional radiologist readily available. Results: Prior to MDHT, 169 patients underwent 344 leads extractions. There were six major procedural complications (3.6%) that included 2 procedural deaths (1.2%) during that period (SVC tear, Tricuspid valve avulsion). Following the creation of MDHT, there have been 47 cases performed with 85 leads extracted. There have been two complications requiring surgical repair (one SVC laceration, one RV laceration), which were surgically repaired. With the creation of a MDHT, the rate of major complications was unchanged (Pre vs. Post MDHT 3.6% vs. 4.3%) but there was a lower mortality rate (Pre vs. Post MDHT 1.2% vs. 0%). Conclusions: High risk lead extraction had a fixed complication rate at our institution however a MDHT decreased mortality. A structured multidisciplinary approach, involving EP and cardiac surgery, decreased mortality in a medium sized lead extraction center and should be considered at all centers.

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New Members of Cardıac Surgery Operatıng Room “Plannıng of Operatıng Room Technıcıan's Educatıon Currıculum”

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.03.346 ◽

2018 ◽

Vol 121 (8) ◽

pp. e159-e160

Author(s):

Gül Özlem Yıldırım ◽

Gülseren Keskin ◽

Halil Yıldırım ◽

Elif Aktekin ◽

Nurcan Güzelay ◽

...

Keyword(s):

Cardiac Surgery ◽

Operating Room ◽

Education Curriculum ◽

New Members ◽

Operating Room Planning

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Reply to: reintubation in the ICU versus in the operating room in cardiac surgery patients

European Journal of Anaesthesiology ◽

10.1097/eja.0000000000001226 ◽

2020 ◽

Vol 37 (9) ◽

pp. 818-819

Author(s):

Manuel Taboada ◽

Laura Dos Santos ◽

Agustin Cariñena ◽

Valentin Caruezo

Keyword(s):

Cardiac Surgery ◽

Operating Room

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Improvement of Intraoperative Antibiotic Prophylaxis in Prolonged Cardiac Surgery by Automated Alerts in the Operating Room

Infection Control and Hospital Epidemiology ◽

10.1086/502109 ◽

2003 ◽

Vol 24 (1) ◽

pp. 13-16 ◽

Cited By ~ 45

Author(s):

Giorgio Zanetti ◽

Hugh L. Flanagan ◽

Lawrence H. Cohn ◽

Richard Giardina ◽

Richard Platt

Keyword(s):

Cardiac Surgery ◽

Antibiotic Prophylaxis ◽

Operating Room ◽

Spillover Effect ◽

Control Group ◽

Reminder System ◽

Preoperative Administration ◽

Group 5 ◽

The Impact

AbstractObjective:To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations.Design:Randomized, controlled, evaluator-blinded trial.Setting:University-affiliated hospital.Patients:Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery.Intervention:Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered.Results:Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02).Conclusion:The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis.

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Does Angiotensin Converting Enzyme Inhibitor Protect the Heart in Cardiac Surgery? From Laboratory to Operating Room: Clinical Application of Experimental Study

Current Pharmaceutical Design ◽

10.2174/138161206775474413 ◽

2006 ◽

Vol 12 (4) ◽

pp. 517-526 ◽

Cited By ~ 1

Author(s):

Yasuyuki Shimada

Keyword(s):

Experimental Study ◽

Cardiac Surgery ◽

Angiotensin Converting Enzyme ◽

Angiotensin Converting Enzyme Inhibitor ◽

Operating Room ◽

Clinical Application ◽

Enzyme Inhibitor ◽

Converting Enzyme ◽

Converting Enzyme Inhibitor

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Efficacy of a Simple Intraoperative Transfusion Algorithm for Nonerythrocyte Component Utilization after Cardiopulmonary Bypass

Anesthesiology ◽

10.1097/00000542-200105000-00014 ◽

2001 ◽

Vol 94 (5) ◽

pp. 773-781 ◽

Cited By ~ 210

Author(s):

Gregory A. Nuttall ◽

William C. Oliver ◽

Paula J. Santrach ◽

Sandra Bryant ◽

Joseph A. Dearani ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Blood Loss ◽

Operating Room ◽

Prospective Trial ◽

Median Number ◽

Control Group ◽

Coagulation Test ◽

Elective Cardiac Surgery ◽

Abnormal Bleeding

Background Abnormal bleeding after cardiopulmonary bypass (CPB) is a common complication of cardiac surgery, with important health and economic consequences. Coagulation test-based algorithms may reduce transfusion of non-erythrocyte allogeneic blood in patients with abnormal bleeding. Methods The authors performed a randomized prospective trial comparing allogeneic transfusion practices in 92 adult patients with abnormal bleeding after CPB. Patients with abnormal bleeding were randomized to one of two groups: a control group following individual anesthesiologist's transfusion practices and a protocol group using a transfusion algorithm guided by coagulation tests. Results Among 836 eligible patients having all types of elective cardiac surgery requiring CPB, 92 patients developed abnormal bleeding after CPB (incidence, 11%). The transfusion algorithm group received less allogeneic fresh frozen plasma in the operating room after CPB (median, 0 units; range, 0-7 units) than the control group (median, 3 units; range, 0-10 units) (P = 0.0002). The median number of platelet units transfused in the operating room after CPB was 4 (range, 0-12) in the algorithm group compared with 6 (range, 0-18) in the control group (P = 0.0001). Intensive care unit (ICU) mediastinal blood loss was significantly less in the algorithm group. Multivariate analysis demonstrated that transfusion algorithm use resulted in reduced ICU blood loss. The control group also had a significantly greater incidence of surgical reoperation of the mediastinum for bleeding (11.8% vs. 0%; P = 0.032). Conclusions Use of a coagulation test-based transfusion algorithm in cardiac surgery patients with abnormal bleeding after CPB reduced non-erythrocyte allogeneic transfusions in the operating room and ICU blood loss.

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