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.

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.

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 &lt; 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.

Left Subclavian Artery Revascularization in Preparation for Coronary Artery Bypass Grafting

Cardiology ◽  
2015 ◽  
Vol 133 (3) ◽  
pp. 191-194
Author(s):  
Saum A. Rahimi ◽  
Noor Shah ◽  
Volodymyr Labinskyy ◽  
Leonard Y. Lee
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Subclavian Steal Syndrome ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Coronary subclavian steal syndrome is a rare but important condition that occurs after a left internal mammary artery (LIMA) to coronary artery bypass in the setting of a stenotic left subclavian artery. The lack of blood flow through the subclavian artery causes the reversal of flow in the LIMA so that it essentially steals blood from the myocardium. In order to avoid this complication, many surgeons now opt to either revascularize the stenotic subclavian artery prior to coronary artery bypass grafting or to use an alternate vessel as the bypass graft. Here, we present the case of an asymptomatic patient with poor exercise tolerance who was recently diagnosed with both triple-vessel coronary disease and peripheral arterial disease, which was most notably characterized by occlusion of the left subclavian artery. This case demonstrates the surgical management of this complex clinical entity.

Early Antiplatelet Therapy in Coronary Artery Bypass Grafting a Calculated Benefit

2010 ◽  
Vol 5 (5) ◽  
pp. 317-325 ◽  
Author(s):  
Gregory D. Trachiotis
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Antiplatelet Therapy ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Bypass Grafting ◽  
Platelet Activity ◽  
Artery Bypass Grafting ◽  
Increased Risk

Studies have demonstrated that antagonists of platelet activity, including aspirin and clopidogrel, reduce the risk of major adverse events in patients with acute coronary syndromes. Although antiplatelet agents also convey an increased risk of bleeding, particularly in patients proceeding to coronary artery bypass graft surgery, in most cases, the benefits of early initiation of antiplatelet therapy outweigh the risks. The purpose of this review is to distinguish perceived and actual risk versus the benefit associated with early antiplatelet therapy to help clinicians make informed decisions on using these agents in an acute setting where patients may require coronary artery bypass grafting.

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.

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