scholarly journals A randomized trial comparing the effects of sternal band and plate fixation of the sternum with that of figure-of-8 wires on sternal edge motion and quality of recovery after cardiac surgery

2020 ◽  
Vol 30 (6) ◽  
pp. 863-870
Author(s):  
Alistair G Royse ◽  
Doa El-Ansary ◽  
William Hoang ◽  
Elaine Lui ◽  
Mark McCusker ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Steel Wire ◽  
Plate Fixation ◽  
Open Label ◽  
Clinical Trial Registration ◽  
Quality Of Recovery ◽  
End Point ◽  
Wire Cerclage ◽  
Plate System

Abstract OBJECTIVES We sought to compare the effects of conventional wire cerclage with that of the band and plate fixation of the sternum. METHODS A parallel randomized open-label trial with 1:1 allocation ratio compared healing after adult cardiac surgery using ‘figure-of-8’ stainless steel wire cerclage or a band and plate system (plates). The primary end point was maximal sternal edge displacement during active coughing of ≥2 mm in ≥2 of 4 sites measured with ultrasound by 2 assessors blinded to the other at 6 weeks postoperatively. Secondary end points at 12 weeks included ultrasound assessment, computed tomography (CT) scan and multidimensional assessment of quality of recovery using the Postoperative Quality of Recovery Scale. RESULTS Of 50 patients, 26 received plates and 24 wires. Two patients died and 1 withdrew consent leaving 25 plates and 22 wires for primary end point analysis. Operations included 37 coronary, 5 valve and 8 combined coronary and valve procedures. At 6 weeks, less sternal movement was observed in patients with plates than those with wires, 4% (1/25) vs 32% (7/22), P = 0.018. Agreement between observers was high, kappa = 0.850. At 12 weeks, less ultrasound motion was seen in patients with plates, 0% (0/23) than those with wires, 25% (5/20), P = 0.014. Recovery from pain was higher for patients with plates 92% (22/24) than those with wires 67% (14/21), P = 0.004. CT bone edge separation was less for plates 38% (9/24) than wires 71% (15/21), P = 0.036. CT mild bone synthesis or greater was similar between patients with plates 21% (5/24) and wires 14% (3/21), P = 0.71. CONCLUSIONS Patients receiving the band and plate system had significantly less sternal edge motion than those receiving wires, 6 and 12 weeks after cardiac surgery and experienced less pain. Clinical trial registration clinicaltrials.gov NCT03282578.

Titanium Plate Fixation versus Conventional Closure for Sternal Dehiscence after Cardiac Surgery

2016 ◽  
Vol 65 (04) ◽  
pp. 338-342 ◽  
Author(s):  
Lisa Jongbloed ◽  
Uday Sonker ◽  
Geoffrey Kloppenburg ◽  
Roemer Vos
Keyword(s):  
Cardiac Surgery ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Steel Wire ◽  
Plate Fixation ◽  
Pectoral Muscle ◽  
Inhospital Mortality ◽  
Titanium Plate ◽  
Sternal Dehiscence ◽  
Sternal Stability

Background Postoperative sternal dehiscence with or without mediastinitis is a complication of cardiac surgery leading to considerable disability. Titanium plate fixation can provide sternal stability in patients with a dehiscent sternum. The aim of this study is to compare clinical outcomes of titanium plate fixation with conventional treatment methods such as steel wire cerclage and pectoralis muscle reconstruction. Patients and Methods A retrospective analysis was performed on 42 patients who underwent sternal refixation after dehiscence or secondary wound closure after poststernotomy mediastinitis. Clinical outcomes during hospital stay and follow-up were determined. Results Twenty patients were closed using sternal plates. Twenty-two patients were closed conventionally: 8 using pectoral muscle reconstruction and 14 using cerclage steel wires. There were no differences in baseline characteristics between the two groups. Indications of sternal closure were similar. Sternal stability at hospital discharge was achieved more often using sternal plating (90 vs. 50%, p = 0.005), mainly in patients closed after treatment of poststernotomy mediastinitis (100 vs. 22%, p = 0.002). Hospital stay was similar in both groups (10 [5–23] vs. 12 (5–21) days, p = 0.527). There was no inhospital mortality. Conclusion Titanium plate fixation is superior in stabilizing the sternal bone when compared with conventional refixation methods, especially in secondary closure after poststernotomy mediastinitis.

Thoracic Epidural versus  Intravenous Patient-controlled Analgesia after Cardiac Surgery

2006 ◽  
Vol 104 (1) ◽  
pp. 142-151 ◽  
Author(s):  
Vigdis Hansdottir ◽  
Julia Philip ◽  
Monika Fagevik Olsen ◽  
Christina Eduard ◽  
Erik Houltz ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Epidural Analgesia ◽  
General Anesthesia ◽  
Thoracic Epidural Analgesia ◽  
Patient Controlled Analgesia ◽  
Thoracic Epidural ◽  
Quality Of Recovery ◽  
Intravenous Morphine

Background Perioperative thoracic epidural analgesia reduces stress response and pain scores and may improve outcome after cardiac surgery. This prospective, randomized trial was designed to compare the effectiveness of patient-controlled thoracic epidural analgesia with patient-controlled analgesia with intravenous morphine on postoperative hospital length of stay and patients' perception of their quality of recovery after cardiac surgery. Methods One hundred thirteen patients undergoing elective cardiac surgery were randomly assigned to receive either combined thoracic epidural analgesia and general anesthesia followed by patient-controlled thoracic epidural analgesia or general anesthesia followed by to patient-controlled analgesia with intravenous morphine. Postoperative length of stay, time to eligibility for hospital discharge, pain and sedation scores, degree of ambulation, lung volumes, and organ morbidities were evaluated. A validated quality of recovery score was used to measure postoperative health status. Results Length of stay and time to eligibility for hospital discharge were similar between the groups. Study groups differed neither in postoperative global quality of recovery score nor in five dimensions of quality of recovery score. Time to extubation was shorter (P < 0.001) and consumption of anesthetics was lower in the patient-controlled thoracic epidural analgesia group. Pain relief, degree of sedation, ambulation, and lung volumes were similar between the study groups. There was a trend for lower incidences of pneumonia (P = 0.085) and confusion (P = 0.10) in the patient-controlled thoracic epidural analgesia group, whereas cardiac, renal, and neurologic outcomes were similar between the groups. Conclusions In elective cardiac surgery, thoracic epidural analgesia combined with general anesthesia followed by patient-controlled thoracic epidural analgesia offers no major advantage with respect to hospital length of stay, quality of recovery, or morbidity when compared with general anesthesia alone followed by to patient-controlled analgesia with intravenous morphine.

scholarly journals An Exploratory Analysis of the Association Between Catechol-O-Methyltransferase and Response to a Randomized Open-Label Placebo Treatment for Cancer-Related Fatigue

2021 ◽  
Vol 12 ◽  
Author(s):  
Teri W. Hoenemeyer ◽  
Navneet Kaur Baidwan ◽  
Kathryn Hall ◽  
Ted J. Kaptchuk ◽  
Kevin R. Fontaine ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Survivors ◽  
Placebo Response ◽  
Placebo Treatment ◽  
Open Label ◽  
Clinical Trial Registration ◽  
Treatment As Usual ◽  
Cancer Related Fatigue ◽  
Fatigue Severity

Previous studies have identified catechol-O-methyltransferase (COMT), as a key enzyme influencing sympathetic function. Although the COMT SNP rs4680 and rs4818, are well-studied, little is known about their influence on cancer-related fatigue (CrF) and placebo response. In this study, we examined whether genetic variation in COMT, at the functional SNP rs4680 and linked rs4818, influenced open-label placebo (OLP) responses found in cancer survivors reporting moderate to severe CrF. We randomized cancer survivors (N = 74) reporting moderate-to-severe CrF to receive OLP or to treatment-as-usual (TAU) and assessed if rs4680 and rs4818 were associated with changes in fatigue severity and fatigue-distressed quality of life. At the end of the initial 21 days, the treatments were crossed over and both groups were re-assessed. Participants with the rs4680 high-activity G-allele (G/G or G/A) or rs4818 C/G genotypes reported significant decreases in fatigue severity and improvements in fatigue-distressed quality of life. The COMT rs4818 findings replicated findings in a similar study of OLP in cancer fatigue.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02522988.

scholarly journals Intravenous versus inhalational maintenance of anesthesia for quality of recovery in adult patients undergoing non-cardiac surgery: A systematic review with meta-analysis and trial sequential analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254271
Author(s):  
Min Shui ◽  
Ziyi Xue ◽  
Xiaolei Miao ◽  
Changwei Wei ◽  
Anshi Wu
Keyword(s):  
Cardiac Surgery ◽  
Sequential Analysis ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Trial Sequential Analysis ◽  
Type I ◽  
Quality Of Recovery ◽  
Significant Difference

Background Intravenous and inhalational agents are commonly used in general anesthesia. However, it is still controversial which technique is superior for the quality of postoperative recovery. This meta-analysis aimed at comparing impact of total intravenous anesthesia (TIVA) versus inhalational maintenance of anesthesia on the quality of recovery in patients undergoing non-cardiac surgery. Methods We systematically searched EMBASE, PubMed, and Cochrane library for randomized controlled trials (RCTs), with no language or publication status restriction. Two authors independently performed data extraction and assessed risk of bias. The outcomes were expressed as mean difference (MD) with 95% confidence interval (CI) based on a random-effect model. We performed trial sequential analysis (TSA) for total QoR-40 scores and calculated the required information size (RIS) to correct the increased type I error. Results A total of 156 records were identified, and 9 RCTs consisting of 922 patients were reviewed and included in the meta-analysis. It revealed a significant increase in total QoR-40 score on the day of surgery with TIVA (MD, 5.91 points; 95% CI, 2.14 to 9.68 points; P = 0.002; I2 = 0.0%). The main improvement was in four dimensions, including “physical comfort”, “emotional status”, “psychological support” and “physical independence”. There was no significant difference between groups in total QoR-40 score (P = 0.120) or scores of each dimension on POD1. The TSA showed that the estimated required information size for total QoR-40 scores was not surpassed by recovered evidence in our meta-analysis. And the adjusted Z-curves did not cross the conventional boundary and the TSA monitoring boundary. Conclusion Low-certainty evidence suggests that propofol-based TIVA may improve the QoR-40 score on the day of surgery. But more evidence is needed for a firm conclusion and clinical significance.

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