Reply to: association of preoperative cardiovascular drugs with short-term mortality after coronary artery bypass grafting
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To determine whether the administration of ketamine during coronary artery bypass grafting (CABG) surgery leads to a reduction in the quantity of opioids required over the first 48 hours after surgery.
Abstract BACKGROUND: It is unclear whether transfusion of platelets or fresh frozen plasma, in addition to red blood cells, is associated with an increased risk of mortality and infection after cardiac surgery. METHODS: Patients who underwent valve surgery and/or coronary artery bypass grafting from January 1, 2011 to June 30, 2017 and September 1, 2013 to June 30, 2017 at 2 centers performing cardiac surgery were included in this retrospective study. After stratifying patients based on propensity score matching, we compared rates of mortality and infection between patients who transfused red blood cells, fre...
To test the hypothesis that a positive end-expiratory pressure test and the mini-fluid challenge predict fluid responsiveness in patients after off-pump coronary artery bypass grafting.
Hey guys heres a case. 65 y.o. 77kg, 5'11" BMI 23, with previous medical history of CAD, MI x3 (last in 2017); s/p DES to OM (6/07); periprocedure thalamic CVA x 2 with right-sided weakness; s/p CABG (LIMA-LAD, SVG-RCA/PDA in 4/2010) and DES x4 (OM1 6/2017, LAD 5/2008 and 2017, LCx 5/2015) with ischemic cardiomyopathy, h/o VT and CHB s/p AICD (pacemaker dependent); infected AICD, lead extraction 4/26/2019 and generator change with leadless single chamber pacemaker; chronic stable angina... How would you do this case?
CONCLUSION: This study did not show a clinically important increase in PaCO2 associated with higher SpO2 values in this specific population of obese patients after CABG. Partial pressure of carbon dioxide increased with liberal oxygen administration in almost half of the patients, but no predictive factor was identified. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT02917668); registered 25 September, 2016. PMID: 31650500 [PubMed - as supplied by publisher]
Postoperative atrial fibrillation (POAF) after cardiac surgery remains a highly prevalent and costly condition that negatively impacts patient quality of life and survival. Numerous retrospective studies, meta-analysis, and review papers have been reported identifying POAF risk based on patients ’ risk factors and clinical biomarkers. In this narrative review, the authors report significant variations among selected pre- and perioperative biomarkers used to predict POAF incidence in patients without a history of atrial fibrillation (AF).
Coronary artery bypass graft (CABG) surgery may lead to postoperative complications such as the acute kidney dysfunction (AKD), identified as any post-intervention increase of serum creatinine level. Cardiovascular control reflexes like the baroreflex can play a role in the AKD development. The aim of this study is to test whether baroreflex sensitivity (BRS) estimates derived from non-causal and causal approaches applied to spontaneous systolic arterial pressure (SAP) and heart period (HP) fluctuations can help in identifying subjects at risk of developing AKD after CABG and which BRS estimates provide the best performanc...
ConclusionsThe overall VTE rate after CABG has been low. However, the condition has been associated with worse 30-day postoperative outcomes and complications. The independent predictors of VTE development included a history of bleeding disorders, congestive heart failure in the 30 days before surgery, and operative time of ≥310 minutes. Understanding these risk factors should aid physicians in the decisions regarding prophylaxis and treatment.
Looks like another hit on cardiac surgery volumes coming - this time in patients with left main disease. At our center, we already see a big decline in straight-forward CABG or surgical AVRs now and the acuity of the patients that do make it in for cardiac surgery is is becoming higher. https://www.nejm.org/doi/10.1056/NEJMoa1909406 Abstract BACKGROUND Long-term outcomes after percutaneous coronary intervention (PCI)... Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease
We read with interest the article by Chanowski and collaborators, published on the pages of this journal, on an opiate-sparing approach involving the siting of erector spinae plane catheters to achieve fast-track coronary artery bypass graft surgery with only acetaminophen, gabapentin, and one single dose of 10 mg of oxycodone for postoperative analgesia.1 Integrating a multimodal pharmacologic approach with regional anesthesia could prove an intelligent solution to the ongoing opioid crisis. Over-reliance on opioids for pain management starts perioperatively and extends post discharge.