scholarly journals Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery

2021 ◽  
Vol 5 (2) ◽  
pp. 838-841
Author(s):  
Alfred Ibrahimi ◽  
Saimir Kuci ◽  
Ervin Bejko ◽  
Stavri Llazo ◽  
Marsela Goga ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Analgesia ◽  
Artery Bypass ◽  
Visual Observation ◽  
Background Pain ◽  
Pump Coronary Artery Bypass ◽  
Long Acting ◽  
Fentanyl Group ◽  
Remifentanil Group ◽  
Post Cardiac Surgery

Background: Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternative is remifentanil. We compared the efficacity of remifentanil vs morphine -metamizole   for post cardiac surgery pain relief. Methods; Twenty patients undergoing on-pump coronary artery bypass surgery, receiving standardized propofol–fentanyl and propofol based anesthesia, remifentanil group (Group R, n = 10) and fentanyl (Group F, n = 10). Postoperative analgesia was provided in R group initially with remifentanil and later with morphine-metamizole and in F group immediately after operation.  Pain was controlled by visual observation, questioning, in rest and during coughing, with a score (0-3). Results; There is no difference in time of extubation between groups but, pain score was much higher in F (3-9) group in first hour compared with R group (0-4). Morphine requirements was higher in (R) after remifentanil was stopped, in a first hour, but was lower after 24 hours compared with F group. Conclusion: Use of remifentanil is associated with lower scale of pain in postoperative period and lower morphine requirement after 24 hours, when analgesia treatment was changed.

Risk Factors and Outcomes Associated With Sepsis After Coronary Artery Bypass and Open Heart Valve Surgeries

2018 ◽  
Vol 22 (4) ◽  
pp. 359-368 ◽  
Author(s):  
Sergey Karamnov ◽  
Ethan Y. Brovman ◽  
Katherine J. Greco ◽  
Richard D. Urman
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
High Risk ◽  
Coronary Artery Bypass ◽  
Heart Valve ◽  
Artery Bypass ◽  
Open Heart ◽  
Postoperative Sepsis ◽  
Post Cardiac Surgery

Purpose. Sepsis causes significant morbidity and mortality after cardiac surgery and carries a significant burden on health care costs. There is a general association of increased risk of post–cardiac surgery sepsis in patients with postoperative complications. We sought to investigate significant patient and procedural risk factors and outcomes associated with sepsis after cardiac surgery. Materials and Methods. In this retrospective study, we analyzed 531 coronary artery bypass grafting and open heart valve surgery cases that developed postoperative sepsis in the National Surgical Quality Improvement Program database between 2007 and 2014. Patient-based and surgery-based parameters were analyzed for risk factors and outcomes reported in the 30 days postoperatively. The association between sepsis and patient outcomes was assessed in a propensity-matched cohort using univariable logistic regression. Results. Modifiable and nonmodifiable patient characteristics, including age >80, poor preoperative functional status, chronic diseases such as diabetes mellitus, congestive heart failure, chronic kidney disease with serum creatinine ⩾1.5, as well as serum albumin <3.5 and emergent nature of the case were associated with post–cardiac surgery sepsis. Surgical outcomes associated with sepsis included mortality (15.4% vs 4.5%), unplanned intubation (29.8% vs 8.2%), transfusion (53.4% vs 48.4%), acute kidney injury (7.1% vs 1.4%), postoperative dialysis (18.8% vs 3.5%), and return to the operating room (29.8% vs 8.2%). Conclusions. We identified multiple patient and surgical characteristics as well as postoperative outcomes associated with postoperative sepsis development in the high-risk population of patients undergoing cardiac surgery. Early identification of patients who are at high risk for postoperative sepsis can facilitate early treatment interventions.

scholarly journals The relationship between intraoperative cerebral oximetry and postoperative delirium in patients undergoing off-pump coronary artery bypass graft surgery: a retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Leerang Lim ◽  
Karam Nam ◽  
Seohee Lee ◽  
Youn Joung Cho ◽  
Chan-Woo Yeom ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Postoperative Delirium ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cerebral Oximetry ◽  
Artery Bypass Graft ◽  
Off Pump ◽  
Pump Coronary Artery Bypass ◽  
The Relationship

Abstract Background Cerebral oximetry has been widely used to measure regional oxygen saturation in brain tissue, especially during cardiac surgery. Despite its popularity, there have been inconsistent results on the use of cerebral oximetry during cardiac surgery, and few studies have evaluated cerebral oximetry during off pump coronary artery bypass graft surgery (OPCAB). Methods To evaluate the relationship between intraoperative cerebral oximetry and postoperative delirium in patients who underwent OPCAB, we included 1439 patients who underwent OPCAB between October 2004 and December 2016 and among them, 815 patients with sufficient data on regional cerebral oxygen saturation (rSO2) were enrolled in this study. We retrospectively analyzed perioperative variables and the reduction in rSO2 below cut-off values of 75, 70, 65, 60, 55, 50, 45, 40, and 35%. Furthermore, we evaluated the relationship between the reduction in rSO2 and postoperative delirium. Results Delirium occurred in 105 of 815 patients. In both univariable and multivariable analyses, the duration of rSO2 reduction was significantly longer in patients with delirium at cut-offs of < 50 and 45% (for every 5 min, adjusted odds ratio (OR) 1.007 [95% Confidence interval (CI) 1.001 to 1.014] and adjusted OR 1.012 [1.003 to 1.021]; p = 0.024 and 0.011, respectively). The proportion of patients with a rSO2 reduction < 45% was significantly higher among those with delirium (adjusted OR 1.737[1.064 to 2.836], p = 0.027). Conclusions In patients undergoing OPCAB, intraoperative rSO2 reduction was associated with postoperative delirium. Duration of rSO2 less than 50% was 40% longer in the patients with postoperative delirium. The cut-off value of intraoperative rSO2 that associated with postoperative delirium was 50% for the total patient population and 55% for the patients younger than 68 years.

scholarly journals Is postoperative cognitive decline after cardiac surgery associated with plasma beta amyloid 1–42 levels?

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Zrinka Požgain ◽  
Grgur Dulić ◽  
Goran Kondža ◽  
Siniša Bogović ◽  
Ivan Šerić ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Cognitive Decline ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Off Pump ◽  
Bypass Group ◽  
Postoperative Cognitive Decline ◽  
Pump Coronary Artery Bypass

Abstract Background Postoperative cognitive decline following cardiac surgery is one of the frequently reported complications affecting postoperative outcome, characterized by impairment of memory or concentration. The aetiology is considered multifactorial and the research conducted so far has presented contradictory results. The proposed mechanisms to explain the cognitive decline associated with cardiac surgery include the neurotoxic accumulation of β-amyloid (Aβ) proteins similar to Alzheimer's disease. The comparison of coronary artery bypass grafting procedures concerning postoperative cognitive decline and plasmatic Aβ1-42 concentrations has not yet been conducted. Methods The research was designed as a controlled clinical study of patients with coronary artery disease undergoing surgical myocardial revascularization with or without the use of a cardiopulmonary bypass machine. All patients completed a battery of neuropsychological tests and plasmatic Aβ1-42 concentrations were collected. Results The neuropsychological test results postoperatively were significantly worse in the cardiopulmonary bypass group and the patients had larger shifts in the Aβ1-42 preoperative and postoperative values than the group in which off-pump coronary artery bypass was performed. Conclusions The conducted research confirmed the earlier suspected association of plasmatic Aβ1-42 concentration to postoperative cognitive decline and the results further showed that there were less changes and lower concentrations in the off-pump coronary artery bypass group, which correlated to less neurocognitive decline. There is a lot of clinical contribution acquired by this research, not only in everyday decision making and using amyloid proteins as biomarkers, but also in the development and application of non-pharmacological and pharmacological neuroprotective strategies.

Cardiac Surgery: Beyond Conventional Sternotomy With Cardiopulmonary Bypass

2020 ◽  
Vol 40 (1) ◽  
pp. 66-73
Author(s):  
Sharon Wahl
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Artery Bypass ◽  
High Risk Patient ◽  
Risk Groups ◽  
Tricuspid Valve Repair ◽  
Off Pump ◽  
Risks And Benefits ◽  
Cardiac Procedures ◽  
Pump Coronary Artery Bypass

Minimally invasive cardiac surgery options, which originated with off-pump coronary artery bypass grafting and aortic valve procedures, continue to evolve in order to address complex conditions, including those requiring mitral and tricuspid valve repair. Although these procedures are primarily indicated for high-risk patient populations, favorable patient outcomes have resulted in recommendations being expanded to include intermediate-risk groups. This article increases nursing-related knowledge of minimally invasive cardiac procedures, providing an overview of current minimally invasive cardiac surgeries and their associated risks and benefits.

Outcome Improvement and Cost Reduction in an Increasingly Morbid Cardiac Surgery Population

2006 ◽  
Vol 10 (2) ◽  
pp. 171-175 ◽  
Author(s):  
Scott M. Goldman ◽  
Francis P. Sutter ◽  
Mary Ann C. Wertan ◽  
Francis D. Ferdinand ◽  
Candace L. Trace ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Artery Bypass ◽  
Clinical Effectiveness ◽  
Cerebral Oximetry ◽  
Control Group ◽  
Study Group ◽  
Bypass Grafting ◽  
Off Pump ◽  
Prolonged Ventilation ◽  
Pump Coronary Artery Bypass

Two studies assessed initiatives to improve the quality and the cost-effectiveness of cardiac surgery. The first evaluated a system for access and stabilization (SAS), with coronary stabilization, and a clinical effectiveness quality initiative (CEQI) in off-pump coronary artery bypass grafting. The SAS + CEQI cohort showed significantly lower mortality, a lower percentage of patients requiring prolonged ventilation, and a shorter mean postoperative length of hospital stay than the pre-SAS cohort who underwent on-pump coronary artery bypass grafting. The second study assessed the potential for noninvasive cerebral oximetry to reduce strokes related to all cardiac surgery by optimizing cerebral oxygen delivery. The incidence of permanent stroke was significantly lower in the cerebral oximetry group than in an earlier control group in which cerebral oximetry was not used, despite the fact that the study group had a significantly greater number of patients in New York Heart Association classes III and IV. The proportion of patients requiring prolonged ventilation was significantly lower, and the length of postoperative hospital stay was significantly shorter in the study group than in the control group. The incidence of cerebrovascular accident in the study group was 0.97%, compared with 2.03% in the controls. This translated to a potential avoidance of 12 cerebrovascular accidents and approximately $254 214 in direct costs and more than $425000 in total costs. The results show that specific measures can improve outcomes and reduce costs in cardiac surgery. Therefore, the use of a clinical effectiveness quality initiative and cerebral oximetry in all cardiac surgery, with the SAS system for off-pump surgery, should be advocated.

Comparison of Sleep and Mood in Patients After On-Pump and Off-Pump Coronary Artery Bypass Surgery

2008 ◽  
Vol 17 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Christine Hedges ◽  
Nancy S. Redeker
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Sleep Quality ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Mood Disturbance ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Background Off-pump coronary artery bypass surgical procedures have been advocated to reduce the adverse effects of cardiopulmonary bypass on the brain. Objective To examine differences in objective and subjective characteristics of sleep and mood disturbance between patients after on-pump and off-pump coronary artery bypass surgery. Methods In a secondary analysis of pooled data from 2 previous studies, sleep characteristics and mood disturbance on postoperative night 2 after transfer to the cardiac surgery step-down unit were compared in patients who had on-pump and off-pump cardiac surgery. The sample included 129 coronary artery bypass patients: 48 on-pump patients from one hospital and 81 off-pump patients from another hospital. Data were obtained with wrist actigraphs. Subjective characteristics of sleep were determined by using the Pittsburgh Sleep Quality Index and a sleep diary; mood disturbance was evaluated by using the short form of the Profile of Mood States. Results Off-pump surgery was associated with better objective sleep continuity (decreased percentage of wake time after sleep onset and fewer awakenings) but not longer sleep duration after controlling for age and sex. The 2 groups of patients did not differ overall in subjective sleep characteristics, mood disturbance, or preoperative sleep quality. Conclusion Use of off-pump coronary artery bypass surgery may improve sleep continuity during the early postoperative period. Prospective longitudinal studies are needed to evaluate the potential long-term benefits of this procedure during the different phases of recovery.

scholarly journals ANALGESIA FOR AGED AND GERIATRIC PATIENTS DURING CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

2019 ◽  
Vol 19 (1) ◽  
pp. 12-16
Author(s):  
О.М. Druzhyna ◽  
О.А. Loskutov ◽  
S.R. Maruniak
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Side Effects ◽  
Postoperative Analgesia ◽  
Postoperative Period ◽  
Geriatric Patients ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Opioid Analgesia ◽  
Average Dose

Balanced perioperative multimodal analgesia using multiple synergistic agents minimizes side effects that can be caused by high doses of only one aesthetic agent. The aim of the work was to determine the efficacy of perioperative multimodal low-opioid analgesia as anesthetic assurance techniques in aged and geriatric patients during cardiac surgery with cardiopulmonary bypass.Materials and methods. The study included 18 patients (11 (61.1%) men and 7 (38.9%) women) aged from 63 to 76 years old (mean age 69.5±6.2 years), who underwent coronary artery bypass grafting with cardiopulmonary bypass support. The average body weight was 89.6±13.9 kg (75 to 115 kg). The anaesthesia consisted of intravenous (iv) administration of propofol in a dose of 1.52±0.05 mg/kg and fentanyl in a dose of 1 μg/kg. Muscle relaxation was achieved by injecting pipecuronium bromide in a dose of 0.1 mg/kg. Sevoflurane inhalation was used to maintain anesthesia. Before making incision, the subnarcotic dose of ketamine (0.5 mg / kg) and lidocaine 1 mg/kg bolus were added with simultaneous administration of the continuous infusion of the latter in a dose of 1.5-2 mg/kg per hour. For postoperative analgesia ketorolac tromethamine was used. The intensity of the pain syndrome was assessed using a 10-point visual-analog scale of pain. The level of endocrine-metabolic response was determined by measuring the dynamics of lactate and cortisol.Results. The average dose of fentanyl, which was used for the patient during the whole time of anaesthesia, was 1.09±0.03 μg / kg per hour (on average 358.3±27.1 μg for all time of surgery). During the extracorporeal circulation and in the early postoperative period, the blood circulation parameters in all patients examined corresponded to the hemodynamic profile of the operated pathology. Positive verbal contact with patients was recorded in 18.6±3.4 minutes after the end of anaesthesia. The level of cortisol in the early postoperative period was 479.3±26.4 nmol/l. The average values of the intraoperative level of lactate were 1.61±0.2 mmol/l. The mean pain level in the first postoperative day in the examined patients was 4.6 ± 1.2 (3-6) scores by VAS, one day after the operation – 2.6±1.1 (1.5-4) scores by the VAS.Conclusions. Multimodal low-opioid analgesia provides an adequate analgesic effect in aged and geriatric patients that is confirmed by the absence of hemodynamic and endocrine-metabolic disorders. The use of ketorolac as a component of multimodal low-opioid analgesia is an effective method for achieving adequate postoperative analgesia and contributes to reducing the side effects associated with the use of narcotic analgesics.

scholarly journals Perioperative Multimodal General Anesthesia Focusing on Specific CNS Targets in Patients Undergoing Cardiac Surgeries: The Pathfinder Feasibility Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Akshay Shanker ◽  
John H. Abel ◽  
Shilpa Narayanan ◽  
Pooja Mathur ◽  
Erin Work ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Surgery ◽  
General Anesthesia ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Hemodynamic Instability ◽  
Feasibility Trial ◽  
Pump Coronary Artery Bypass ◽  
Electroencephalogram Eeg ◽  
High Risk Cohort

Multimodal general anesthesia (MMGA) is a strategy that utilizes the well-known neuroanatomy and neurophysiology of nociception and arousal control in designing a rational and clinical practical paradigm to regulate the levels of unconsciousness and antinociception during general anesthesia while mitigating side effects of any individual anesthetic. We sought to test the feasibility of implementing MMGA for seniors undergoing cardiac surgery, a high-risk cohort for hemodynamic instability, delirium, and post-operative cognitive dysfunction. Twenty patients aged 60 or older undergoing on-pump coronary artery bypass graft (CABG) surgery or combined CABG/valve surgeries were enrolled in this non-randomized prospective observational feasibility trial, wherein we developed MMGA specifically for cardiac surgeries. Antinociception was achieved by a combination of intravenous remifentanil, ketamine, dexmedetomidine, and magnesium together with bupivacaine administered as a pecto-intercostal fascial block. Unconsciousness was achieved by using electroencephalogram (EEG)-guided administration of propofol along with the sedative effects of the antinociceptive agents. EEG-guided MMGA anesthesia was safe and feasible for cardiac surgeries, and exploratory analyses found hemodynamic stability and vasopressor usage comparable to a previously collected cohort. Intraoperative EEG suppression events and postoperative delirium were found to be rare. We report successful use of a total intravenous anesthesia (TIVA)-based MMGA strategy for cardiac surgery and establish safety and feasibility for studying MMGA in a full clinical trial.Clinical Trial Number:www.clinicaltrials.gov; identifier NCT04016740 (https://clinicaltrials.gov/ct2/show/NCT04016740).

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