Impact of Aortic Manipulation on High Perioperative Cerebral Stroke Risk Undergoing Coronary Artery Bypass Grafting: Results from the E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting)

Background. Identification and management of risk factors for stroke following isolated coronary artery bypass grafting (CABG) could potentially lower the risk of such serious morbidity.Methods. We retrieved data for 30-day stroke incidence and perioperative variables for patients undergoing isolated CABG and used multivariate logistic regression to assess the adjusted effect of preoperative hematocrit concentration on stroke incidence.Results. In 2,313 patients (mean age 65.9 years, 73.6% men), 43 (1.9%, 95% CI: 1.4–2.5) developed stroke within 30 days following CABG (74.4% within 6 days). After adjustment for a priori defined potential confounders, each 1% drop in preoperative hematocrit concentration was associated with 1.07 (95% CI: 1.01–1.13) increased odds for stroke (men, OR: 1.08, 95% CI: 1.01–1.16; women, OR: 1.02, 95% CI: 0.91–1.16). The predicted probability of stroke for descending preoperative hematocrit concentration exceeded 2% for values <37% (<37% for men (adjusted OR: 2.39, 95% CI: 1.08–5.26) and <38% for women (adjusted OR: 2.52, 95% CI: 0.53–11.98), with a steeper probability increase noted in men). The association between lower preoperative hematocrit concentration and stroke was evident irrespective of intraoperative transfusion use.Conclusion. Screening and management of patients with low preoperative hematocrit concentration may alter postoperative stroke risk in patients undergoing isolated CABG.

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Acadesine: A new drug that may improve myocardial protection in coronary artery bypass grafting. Results of the first international multicenter study

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1016/s1053-0770(05)80028-x ◽

1996 ◽

Vol 10 (4) ◽

pp. 559

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Multicenter Study ◽

Myocardial Protection ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

International Multicenter Study ◽

International Multicenter

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Population Pharmacokinetics of Midazolam Administered by Target Controlled Infusion for Sedation following Coronary Artery Bypass Grafting

Anesthesiology ◽

10.1097/00000542-199812000-00020 ◽

1998 ◽

Vol 89 (6) ◽

pp. 1418-1429 ◽

Cited By ~ 39

Author(s):

Katayoun Zomorodi ◽

Andrew Donner ◽

Jacques Somma ◽

Juliana Barr ◽

Robert Sladen ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Multicenter Study ◽

Cross Validation ◽

Artery Bypass ◽

Pharmacokinetic Parameters ◽

Bypass Grafting ◽

Intersubject Variability ◽

Artery Bypass Grafting

Background Midazolam is commonly used for short-term postoperative sedation of patients undergoing cardiac surgery. The purpose of this multicenter study was to characterize the pharmacokinetics and intersubject variability of midazolam in patients undergoing coronary artery bypass grafting. Methods With institutional review board approval, 90 consenting patients undergoing coronary artery bypass grafting were enrolled at three study centers. All subjects received sufentanil and midazolam via target-controlled infusions. After operation, midazolam was titrated to maintain deep sedation for at least 2 h. It was then titrated downward to decrease sedation for a minimum of 4 h more and was discontinued before tracheal extubation. Arterial blood samples were taken throughout the study and were assayed for midazolam and 1-hydroxymidazolam. Midazolam population pharmacokinetic parameters were estimated using NONMEM. Cross-validation was used to estimate the performance of the model. Results The pharmacokinetics of midazolam were best described by a simple three-compartment mammillary model. Typical pharmacokinetic parameters were V1 = 32.2 l, V2 = 53 l, V3 = 245 l, Cl1 = 0.43 l/min, Cl2 = 0.56 l/min, and Cl3 = 0.39 l/min. The calculated elimination half-life was 15 h. The median absolute prediction error was 25%, with a bias of 1.4%. The performance in the cross-validation was similar. Midazolam metabolites were clinically insignificant in all patients. Conclusions The intersubject variability and predictability of the three-compartment pharmacokinetic model are similar to those of other intravenous anesthetic drugs. This multicenter study did not confirm previous studies of exceptionally large variability of midazolam pharmacokinetics when used for sedation in intensive care settings.

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