Graphic reporting of diagnostic procedures in a cardiac catheterization unit

Background: Elderly patients are undergoing invasive cardiac diagnostic procedures more frequently. Preprocedural sedation is often prescribed, intraprocedural medications administered, and appropriate concern raised regarding post procedure delirium and adverse consequences in the elderly. The objective of this prospective randomized study was to investigate the effect of premeditation on new onset delirium and procedural care. Methods: Patients ≤ 70 years old and scheduled for elective cardiac catheterization were screened for enrollment. All patients underwent a mini mental status exam (MMSE) and delirium assessment using confusion assessment method (CAM) prior to the procedure and repeated at 4 hours and prior to discharge or the next morning. Patients were randomly assigned to receive either diphenhydramine and diazepam (25 mg / 5 mg po) or no premedication. Patient cooperation during the procedure and ease of post-procedure management by nursing staff was measured using Visual Analog Scale (VAS). The degree of alertness was assessed immediately on arrival to the floor, at one and two hours using Observer’s Assessment of Alertness/Sedation Scale (OAA/S). Results: Total of 93 patients enrolled in the study, of which 47 patients received premedication prior to the procedure. The mean age was 77 ± 4.2 years, 56% were male. The baseline mean MMES was similar in each group (27.6± 1.4 in premedication group versus 28.17±1.4 in patients without premedication). Patients with premedication were less alert immediately and at one hour after arrival on the floor (p<0.01), but no patient in either group developed delirium after the procedure as measured by CAM. The ease of procedure was greater, pain medication requirement lower and nursing reported an improvement with patient management after the procedure in the premedicated group (all p<0.05). Conclusion : Premedication did not cause delirium or confusion in elderly patients undergoing cardiac catheterization. The reduced pain medication requirement, perceived procedural ease and post procedure management favors premedication in elderly patients under going cardiac catheterization.

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Residual Lesion Diagnostics in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation and Its Outcomes

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211026594 ◽

2021 ◽

Vol 12 (5) ◽

pp. 605-613

Author(s):

Ilya A. Soynov ◽

Igor A. Kornilov ◽

Yuriy Y. Kulyabin ◽

Alexey V. Zubritskiy ◽

Dmitry N. Ponomarev ◽

...

Keyword(s):

Propensity Score ◽

Extracorporeal Membrane Oxygenation ◽

Propensity Score Matching ◽

Cardiac Catheterization ◽

Diagnostic Procedures ◽

Mortality Factor ◽

Membrane Oxygenation ◽

Group I ◽

The Impact ◽

Residual Lesions

Background: To assess the impact of diagnostic procedures in identifying residual lesions during extracorporeal membrane oxygenation (ECMO) on survival after pediatric cardiac surgery. Methods: Between January 2012 and December 2017, 74 patients required postcardiotomy ECMO. Patients were retrospectively divided into 2 groups: Group I underwent only echocardiography ([echo only] 46 patients, 62.2%) and group II (echo+) underwent additional diagnostic tests (ie, computed tomography [CT] or cardiac catheterization; 28 patients, 37.8%). Propensity score matching was used to balance the 2 groups by baseline characteristics. Results: Two equal groups (28 patients in each group) were formed by propensity score matching. Fourteen (50%) patients in the echo-only group and 20 (71%) patients in the echo+ group were successfully weaned from ECMO ( P = .17). Four (14.3%) patients survived in the echo-only group and 15 (53.5%) patients survived in the echo+ group ( P = .004). Patients in the echo+ group had a lower chance of dying compared to the echo-only group (odds ratio, 0.14.6; 95% CI, 0.039-0.52; P = .003). The residual lesions, which may have served as a mortality factor, were found by autopsy in 8 (40%) patients in the echo-only group, while none were found in the echo+ group ( P = .014). Conclusions: The autopsies of patients who died despite postcardiotomy ECMO support showed that in 40% of cases that had been investigated by echo only, residual lesions that had not been detected by echocardiography were present. The cardiac catheterization and CT during ECMO are effective and safe for identifying residual lesions. Early detection and repair of residual lesions may increase the survival rate of pediatric cardiac patients on ECMO.

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Should interventional cardiac catheterization procedures take place at the time of diagnostic procedures?

Clinical Cardiology ◽

10.1002/clc.4960230505 ◽

2000 ◽

Vol 23 (5) ◽

pp. 332-334 ◽

Cited By ~ 5

Author(s):

Varadendra B. Panchamukhi ◽

Greg C. Flaker

Keyword(s):

Cardiac Catheterization ◽

Diagnostic Procedures

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Clinical characteristics and surgical management of vascular complications in patients undergoing cardiac catheterization: Interventional versus diagnostic procedures

Journal of Vascular Surgery ◽

10.1016/0741-5214(91)90341-q ◽

1991 ◽

Vol 13 (5) ◽

pp. 593-600 ◽

Cited By ~ 118

Author(s):

Louis M. Messina ◽

Thomas E. Brothers ◽

Thomas W. Wakefield ◽

Gerald B. Zelenock ◽

S.Martin Lindenauer ◽

...

Keyword(s):

Surgical Management ◽

Cardiac Catheterization ◽

Clinical Characteristics ◽

Vascular Complications ◽

Diagnostic Procedures

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Tumor Diagnosis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100053966 ◽

1982 ◽

Vol 40 ◽

pp. 262-265

Author(s):

Bruce Mackay

Keyword(s):

Electron Microscopy ◽

Transmission Electron Microscopy ◽

Differential Diagnosis ◽

Light Microscopy ◽

Clinical Examination ◽

Ultrastructural Study ◽

Diagnostic Procedures ◽

Specific Diagnosis ◽

Transmission Electron ◽

Microscopic Diagnosis

The broadest application of transmission electron microscopy (EM) in diagnostic medicine is the identification of tumors that cannot be classified by routine light microscopy. EM is useful in the evaluation of approximately 10% of human neoplasms, but the extent of its contribution varies considerably. It may provide a specific diagnosis that can not be reached by other means, but in contrast, the information obtained from ultrastructural study of some 10% of tumors does not significantly add to that available from light microscopy. Most cases fall somewhere between these two extremes: EM may correct a light microscopic diagnosis, or serve to narrow a differential diagnosis by excluding some of the possibilities considered by light microscopy. It is particularly important to correlate the EM findings with data from light microscopy, clinical examination, and other diagnostic procedures.

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