Clinical Effectiveness of Intravenous Exenatide Infusion in Perioperative Glycemic Control after Coronary Artery Bypass Graft Surgery

2017 ◽  
Vol 127 (5) ◽  
pp. 775-787 ◽  
Author(s):  
Guillaume Besch ◽  
Andrea Perrotti ◽  
Frederic Mauny ◽  
Marc Puyraveau ◽  
Maude Baltres ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Blood Glucose Control ◽  
Target Range ◽  
Control Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Abstract Background We aimed to assess the clinical effectiveness of intravenous exenatide compared to insulin in perioperative blood glucose control in coronary artery bypass grafting surgery patients. Methods Patients more than 18 yr old admitted for elective coronary artery bypass grafting were included in a phase II/III nonblinded randomized superiority trial. Current insulin use and creatinine clearance of less than 60 ml/min were exclusion criteria. Two groups were compared: the exenatide group, receiving exenatide (1-h bolus of 0.05 µg/min followed by a constant infusion of 0.025 µg/min), and the control group, receiving insulin therapy. The blood glucose target range was 100 to 139 mg/dl. The primary outcome was the proportion of patients who spent at least 50% of the study period within the target range. The consumption of insulin (Cinsulin) and the time to start insulin (Tinsulin) were compared between the two groups. Results In total, 53 and 51 patients were included and analyzed in the exenatide and control groups, respectively (age: 70 ± 9 vs. 68 ± 11 yr; diabetes mellitus: 12 [23%] vs. 10 [20%]). The primary outcome was observed in 38 (72%) patients in the exenatide group and in 41 (80%) patients in the control group (odds ratio [95% CI] = 0.85 [0.34 to 2.11]; P = 0.30). Cinsulin was significantly lower (60 [40 to 80] vs. 92 [63 to 121] U, P < 0.001), and Tinsulin was significantly longer (12 [7 to 16] vs. 7 [5 to 10] h, P = 0.02) in the exenatide group. Conclusions Exenatide alone at the dose used was not enough to achieve adequate blood glucose control in coronary artery bypass grafting patients, but it reduces overall consumption of insulin and increases the time to initiation of insulin.

scholarly journals Influence of multimodal low-opioid anesthesia on the dynamics of аnnexin V in blood plasma during cardiac surgery

2020 ◽  
pp. 20-28
Author(s):  
S.R. Maruniak ◽  
◽  
O.A. Loskutov ◽  
O.M. Druzhyna ◽  
I.R. Malish ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Interleukin 6 ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Control Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Standard Scheme

The aim – to analyze the effect of anesthesia on the dynamics of аnnexin V during coronary artery bypass grafting with сardiopulmonary bypass (CPB), and the dependence of direct clinical results on the expression of аnnexin V. Materials and methods. The study included 30 patients with coronary heart disease who underwent coronary artery bypass grafting with application of 2–3 aortocoronary anastomoses with CPB. According to the anesthetic management, all patients were divided into two groups: the first group (13 patients) – low opioid anesthetic scheme; control group (17 patients) – a standard scheme of anesthetic management. The determination of the level of аnnexin V in the blood was carried out before CPB and after bringing the sternum by enzyme-linked immunosorbent assay. Results. The low-opioid scheme of anesthetic management was associated with significantly (by 1.5 times) lower level of аnnexin V and by 28.38 % lower level of interleukin-6 at the end of the surgery as compared to the standard scheme. A significant negative correlation (r = –0.117, p = 0.523) was found between the levels of аnnexin V and interleukin-6. One-way analysis of variance showed that patients who had low cardiac output syndrome in the postoperative period had a significantly higher level of аnnexin V after CPB (p = 0.001). Conclusions. The use of multimodal low-opioid anesthesia is characterized by relative safety, a sufficient level of analgesia and lower level of аnnexin V compared to the control group. Key words: coronary artery bypass grafting, low-opioid anesthesia, apoptosis, аnnexin V, interleukin-6.

scholarly journals Effect of the Aortic Root Infusion of Sufentanil on Ischemia-Reperfusion Injury in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Trial

2019 ◽  
Author(s):  
Mohammad Bagher Khosravi ◽  
Mahdi Kahrom ◽  
Mahdi Tahari ◽  
Kambiz Alizadeh ◽  
Ghasem Soltani ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Aortic Root ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Control Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Background: Ischemic postconditioning is a novel strategy for attaining cardioprotection. Remarkable evidence from various in vitro and in vivo animal and human studies have shown significant opioid-induced cardioprotection against myocardial ischemia/reperfusion (I/R) injury. The purpose of this study was to assess the cardioprotective effect of sufentanil against I/R injury after on-pump coronary artery bypass grafting (CABG). Methods: Between June 2016 and July 2017, 80 consecutive patients with triple-vessel disease undergoing on-pump CABG were enrolled in this prospective randomized study. The patients assigned to the sufentanil group received a single dose of sufentanil (0.2 μg/kg diluted with 50 cc of saline) 5 minutes before the removal of the aorta cross-clamp, with the sufentanil injected via a cardioplegia needle into the aortic root. In the control group, the same volume of normal saline was injected as a placebo. Cardiac enzymes, the inotrope score, and the outcome data were compared between the 2 groups. Results: The mean age of the patients was 60.48±7.50 years (range=41–69 y), and men comprised 65.0% of the study population. The levels of CK-MB and cardiac troponin I were significantly lower in the sufentanil group (P<0.001). The amount of inotrope use (P<0.001), the incidence of atrial fibrillation (P=0.014), electrical shock (P=0.007), and the mechanical ventilation time (P<0.001) decreased in the sufentanil group compared with the control group. However, the use of intra-aortic balloon pumps (P=0.247) and the ICU length of stay (P=0.867) were not significantly different between the 2 groups. Conclusion: The injection of a single dose of sufentanil into the aortic root prior to aorta cross-clamp removal diminished cardiac injury during on-pump CABG in our patients.   J Teh Univ Heart Ctr 2019;14(4):177-182   This paper should be cited as: Bagher Khosravi M, Kahrom M, Tahari M, Alizadeh K, Soltani G, Ghanad MA. Effect of the Aortic Root Infusion of Sufentanil on Ischemia-Reperfusion Injury in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Trial. J Teh Univ Heart Ctr 2019;14(4):177-182.

scholarly journals Evaluation of the Risk Factors for Postoperative Neurocognitive Disorder in Elderly Patients Following Coronary Artery Bypass Grafting.

2020 ◽  
Author(s):  
Xiao Huang ◽  
Juxia Zhang ◽  
Ting Luo ◽  
Changwei Wei ◽  
Anshi Wu
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Interleukin 1 ◽  
Control Group ◽  
Neurocognitive Disorder ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Abstract Background The incidence and risk factors of postoperative neurocognitive disorder (PND) following coronary artery bypass grafting (CABG) is still controversial. Exploring an effective and reliable predictor of PND is essential to the prevention of PND. This prospective observational study aimed to find the incidence rate as well as possible risk factors of PND in CABG.Methods Patients who underwent CABG were included. A battery of neuropsychological tests was performed preoperatively and 7 days after surgery. We used the Z score to analyze and comprehensively evaluate PND. The clinical characteristics of the patients were recorded. The levels of TNF-α, IL-1 (interleukin-1), IL-6 (interleukin-6), S100β, MDA (malondialdehyde) and T-AOC (total antioxidant capacity) were measured at different time points.Results A total of 82 patients were enrolled in the study. The incidence of PND was 25.6% 7 days after surgery. Patients were divided into the control group (N = 61) and the PND group (N = 21). The average age of patients in the PND group was 68.1 years, which was 64 years in the control group (P < 0.05). The average years of education in the PND group were significantly shorter than those in the control group (P < 0.05). The serum levels of IL-6, MDA, Il-1, and S100β in the PND group were significantly lower than those in the control group 1 day after surgery, and the T-AOC level was higher than that in the control group (P < 0.05) 1 day after surgery. The concentration of S100β in the PND group significantly higher than that in the control group 3 days after surgery (P < 0.05). Age, years of education, IL6, TAOC, MDA, IL1, and S100B were included in the multiple regression to search for risk factors of PND. The results showed that higher age (95%CI = 0.776–0.984, P = 0.026), lower years of education (95%CI = 1.006–1.736, P = 0.045) and higher MDA level (95%CI = 0.304–0.964, P = 0.037) were risk factors for PND.Conclusions Older age, lower educational level and higher MDA might be risk factors for PND 7 days after surgery. More researches in the future on this field needs to be conducted to prevent PND effectively and timely.Trail registration: The trail has been registered to the Chinese Clinical Trail Registry (ID: ChiCTR1800015606) on April 11, 2018.

scholarly journals The Efficacy of Inpatient vs. Home-Based Physiotherapy Following Coronary Artery Bypass Grafting

2018 ◽  
Vol 15 (11) ◽  
pp. 2572
Author(s):  
Aleksandra Szylińska ◽  
Mariusz Listewnik ◽  
Iwona Rotter ◽  
Aleksandra Rył ◽  
Katarzyna Kotfis ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Control Group ◽  
Study Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Home Based

Background: Intensive post-operative physiotherapy after cardiac surgery helps to reduce the number of complications, accelerating convalescence and decreasing peri-operative mortality. Cardiac rehabilitation is aimed at regaining lost function and sustaining the effect of cardiac surgery. The aim of this study was to compare the efficacy of inpatient and home-based phase II physiotherapy following coronary artery bypass grafting, and inpatient phase II post-operative physiotherapy based on the analysis of the spirometry results. Methods: A prospective observational study included 104 adult patients of both sexes undergoing planned coronary artery bypass grafting and were randomized to one of the two groups—inpatients (InPhysio) and home-based (HomePhysio) at a 1:1 ratio. All patients had undergone spirometry testing prior to surgery (S1) and on the fifth day after the operation (S2), i.e., on the day of completion of the first phase (PI) of physiotherapy. Both the study group (InPhysio) and the control group (HomePhysio) performed the same set of exercises in the second phase (PII) of cardiac physiotherapy, either in the hospital or at home, respectively, according to the program obtained in the hospital. Both groups have undergone spirometry testing (S3) at 30 days after the operation. Results: The demographic and peri-operative data for both groups were comparable and showed no statistically significant differences. An analysis of gradients between the results of spirometry tests before surgery and at 30 days after the surgery showed a smaller decrease in forced vital capacity (FVC) in the study group than in the control group (p < 0.001). The results at five and 30 days after the surgery showed a greater increase in FVC in the study group than in the control group (680 mL vs. 450 mL, p = 0.009). There were no statistically significant differences in other parameters studied. Conclusions: The advantage of inpatient over home-based physiotherapy was evidenced by much smaller decreases in FVC between the initial and final tests, and greater increases between the fifth day after surgery and the final test. Our analysis showed greater efficacy of inpatient physiotherapy as compared with home-based exercises and raises concerns about patient adherence.

scholarly journals The Effect of Pulmonary Rehabilitation on Respiratory Functions, and the Quality of Life, following Coronary Artery Bypass Grafting: A Randomised Controlled Study

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Zümrüt Girgin ◽  
Yeliz Ciğerci ◽  
Fatıma Yaman
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Pulmonary Rehabilitation ◽  
Artery Bypass ◽  
Intervention Group ◽  
Controlled Study ◽  
Control Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Objective. Examining the effects of a pulmonary rehabilitation (PR) program applied to patients undergoing coronary artery bypass grafting (CABG) surgery with open heart technique on respiratory functions, functional capacity, and quality of life (QoL). Design. This randomised controlled study applied the Consolidated Standards of Reporting Trials statement. Methods. The study was conducted with two groups: the intervention group ( n = 25 ) and the control group ( n = 25 ). The control group received standard care after coronary artery bypass grafting. On the contrary, the experimental group participated in a PR program created by the researchers in addition to standard care. After coronary artery bypass grafting, the respiratory functions (on the 4th day of clinical care) and QoL (at the 6th week) of both groups were evaluated. The primary outcome measure was the respiratory function (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC). The secondary outcome measure of this study was the QoL. Results. When the average pulmonary function test values of the patients were examined, the mean FVC and FEV1 values of the patients in the intervention group on the 4th day of clinical care were significantly higher with a medium level size effect than the control group ( p = 0.027 ; effect size d = 0.643 ; p < 0.024 ; effect size d = 0.658 , respectively). At the postoperative 6th week measurement of QoL, a decrease was observed in all subdimensions of the scale, albeit less in the intervention group ( p < 0.05 ). There was a decrease in both the mental and physical component summary of QoL ( p < 0.05 ). Conclusion. The results of this study revealed that pulmonary rehabilitation applied to patients who have undergone coronary artery bypass graft recover their functional capacity faster.

Short-term outcomes of preoperative intra-aortic balloon pump use in patients undergoing adjunctive coronary endarterectomy: a retrospective observational study

Perfusion ◽  
2018 ◽  
Vol 33 (6) ◽  
pp. 426-432 ◽  
Author(s):  
Liangshan Wang ◽  
Xing Hao ◽  
Xiaomeng Wang ◽  
Chengxiong Gu ◽  
Hong Wang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Observational Study ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Control Group ◽  
Bypass Grafting ◽  
Coronary Endarterectomy ◽  
Artery Bypass Grafting ◽  
Iabp Support

Background: Coronary artery bypass grafting (CABG) combined with coronary endarterectomy (CE) can be associated with high operative mortality and morbidity. An intra-aortic balloon pump (IABP) has been the most widely used mechanical circulatory support device during perfusion treatment. However, the benefits of preoperative IABP in CABG combined with CE remain unknown. We conducted a retrospective observational study to evaluate the efficacy of preoperative IABP therapy in patients undergoing adjunctive right coronary artery (RCA) endarterectomy. Methods: Between May 2013 and May 2016, 120 patients undergoing off-pump coronary artery bypass grafting (OPCABG) with RCA endarterectomy who received preoperative IABP support (IABP group, n=56) or who did not receive preoperative IABP support (control group, n=64) were evaluated retrospectively. Results: Patients in the IABP group had a significantly lower mean preoperative ejection fraction and a significantly higher mean EuroSCORE (both <0.05). The incidence of inferior myocardial infarction (MI) was significantly lower in the IABP group than in the control group (3.6% vs 15.6%, RR = 0.23, 95% CI 0.05-1.00, p=0.03). Hospital mortality was similar in the two groups (3.6% vs 4.7%, RR= 0.76, 95% CI 0.13-4.40, p=0.76). There were no significant differences between the two groups with respect to the rates of prolonged ventilation, low cardiac output syndrome, renal failure requiring dialysis, re-operation for bleeding or IABP-related complications. Preoperative IABP may be a protective factor of inferior MI (HR = 0.031, 95% CI 0.004-0.211, p<0.001) Conclusions: The preoperative use of IABP could reduce the incidence of postoperative MI in patients undergoing CABG with CE and seemed to shift high-risk patients into a lower-risk category.

Early mobilization reduces delirium after coronary artery bypass graft surgery

2020 ◽  
Vol 28 (9) ◽  
pp. 566-571
Author(s):  
Fahimeh Shirvani ◽  
Seyed Ali Naji ◽  
Elham Davari ◽  
Mohsen Sedighi
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Postoperative Delirium ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
Control Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Background Postoperative delirium is common in patients undergoing coronary artery bypass grafting, characterized by cognitive decline. This study aimed to evaluate the effect of early planned mobilization on delirium after coronary artery bypass grafting. Methods This double-blind randomized clinical trial enrolled 92 consecutive patients who underwent coronary artery bypass grafting from September to December 2018. The patients were divided into two groups of 46: a mobilization protocol was applied in the intervention group in the first 2 days after surgery; the control group received routine nursing care only. Demographic data, medical records, and Neecham confusion scores were analyzed. Results Patients in the control group used cigarettes (31.1% vs. 11.1%, p = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, p = 0.002) more frequently, had longer intubation times (11.91 ± 3.87 vs. 10.23 ± 2.71 h, p = 0.020), and fewer blood components infused (15.6% vs. 33.3%, p = 0.05). More patients in the intervention group had normal function on the 2nd postoperative day compared to the control group (25 vs. 2, respectively, p = 0.001). The intervention group had significantly higher Neecham scores on postoperative day 2 (22.49 ± 2.03 vs. 26.82 ± 2.10, p = 0.001). Multivariable analysis showed significant associations between Neecham score and age ( p = 0.022), ejection fraction ( p = 0.015), myocardial infarction ( p = 0.016), systolic pressure ( p = 0.009), and diastolic pressure ( p = 0.008). Conclusions Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.

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