scholarly journals Propofol and Midazolam versus Propofol Alone for Sedation following Coronary Artery Bypass Grafting: A Randomized, Placebo-controlled Trial

2002 ◽  
Vol 30 (2) ◽  
pp. 171-178 ◽  
Author(s):  
B. Walder ◽  
A. Borgeat ◽  
P. M. Suter ◽  
J. A. Romand
Keyword(s):  
Mechanical Ventilation ◽  
Placebo Group ◽  
Low Dose ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Cumulative Number ◽  
Intention To Treat ◽  
Midazolam Group ◽  
Number Of Patients

The aim was to compare the efficacy and side-effects of propofol combined with a constant, low dose of midazolam versus propofol alone for sedation. In a prospective, randomized and double-blinded study, 60 male patients scheduled for elective coronary bypass grafting were enrolled. Postoperatively, patients were stratified to receive either a continuous intravenous infusion of midazolam 1 mg/h or placebo. Target Ramsay sedation score was 3 to 5 corresponding to conscious sedation. An intention-to-treat design for propofol was performed to reach target sedation. Efficacy of sedation was statistically significantly higher in the group midazolam+intention-to-treat with propofol compared with the group placebo+intention-to-treat with propofol (91% vs 79%; P=0.0005). Nine of 27 patients in the midazolam group (33.4%) and nine of 26 patients in the placebo group (34.6%) needed no supplementary propofol. Weaning time from mechanical ventilation was longer in the midazolam group whether or not they required supplemental propofol when compared with placebo group (all: 432±218 min vs 319±223 min; P=0.04; supplementary propofol: 424±234 min vs 265±175 min; P=0.03). The cumulative number of patients remaining intubated was significantly higher in the group midazolam+propofol compared with the group placebo+propofol (P=0.03). In conclusion, target sedation is reached slightly more often by the co-administration of propofol and a low dose of midazolam, but weaning time from mechanical ventilation is prolonged by the co-administration of propofol and a low dose of midazolam.

Prediction of Prolonged Ventilation after Coronary Artery Bypass Grafting: Data from an Artificial Neural Network

2017 ◽  
Vol 20 (1) ◽  
pp. 007 ◽  
Author(s):  
Eric Stephen Wise ◽  
David P. Stonko ◽  
Zachary A. Glaser ◽  
Kelly L. Garcia ◽  
Jennifer J. Huang ◽  
...  
Keyword(s):  
Neural Network ◽  
Mechanical Ventilation ◽  
Artificial Neural Network ◽  
Logistic Regression ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Early Identification ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Prolonged Ventilation

Objectives: The need for mechanical ventilation 24 hours after coronary artery bypass grafting (CABG) is considered a morbidity by the Society of Thoracic Surgeons. The purpose of this investigation was twofold: to identify simple preoperative patient factors independently associated with prolonged ventilation and to optimize prediction and early identification of patients prone to prolonged ventilation using an artificial neural network (ANN).Methods: Using the institutional Adult Cardiac Database, 738 patients who underwent CABG since 2005 were reviewed for preoperative factors independently associated with prolonged postoperative ventilation. Prediction of prolonged ventilation from the identified variables was modeled using both “traditional” multiple logistic regression and an ANN. The two models were compared using Pearson r2 and area under the curve (AUC) parameters.Results: Of 738 included patients, 14% (104/738) required mechanical ventilation ≥ 24 hours postoperatively. Upon multivariate analysis, higher body-mass index (BMI; odds ratio [OR] 1.10 per unit, P < 0.001), lower ejection fraction (OR 0.97 per %, P = 0.01) and use of cardiopulmonary bypass (OR 2.59, P = 0.02) were independently predictive of prolonged ventilation. The Pearson r2 and AUC of the multivariate nominal logistic regression model were 0.086 and 0.698 ± 0.05, respectively; analogous statistics of the ANN model were 0.159 and 0.732 ± 0.05, respectively.BMI, ejection fraction and cardiopulmonary bypass represent three simple factors that may predict prolonged ventilation after CABG. Early identification of these patients can be optimized using an ANN, an emerging paradigm for clinical outcomes modeling that may consider complex relationships among these variables.

scholarly journals The Role of Statins in the Management of Patients Undergoing Coronary Artery Bypass Grafting

Diseases ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 102
Author(s):  
Dimitrios Siskos ◽  
Konstantinos Tziomalos
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Preoperative Administration ◽  
Number Of Patients ◽  
High Doses

Each year, a large number of patients undergo coronary artery bypass grafting surgery (CABG) worldwide. Accumulating evidence suggests that the preoperative administration of statins might be useful in preventing adverse events after CABG. In the present review, we discuss the role of statins in the perioperative management of patients undergoing CABG. Preoperative administration of statins in these patients substantially reduces the risk of postoperative atrial fibrillation and shortens hospital and intensive care unit (ICU) stay. Atorvastatin appears to be more effective, particularly when administered at high doses. Given these benefits and the safety of statins, their administration should be considered in patients undergoing CABG, even though the statins do not appear to affect the incidence of cardiovascular events and overall mortality perioperatively.

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