Systemic Immune-Inflammation Index Predicts Poor Outcome After Elective Off-Pump CABG: A Retrospective, Single-Center Study
To investigate the role of preoperative hematologic indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], systemic immune-inflammation index [SII; neutrophil × platelet/lymphocyte) in predicting short-term outcomes after off-pump coronary artery bypass grafting (OPCABG).
Conclusions: Carotid endarterectomy continues to prove its safety in carotid artery stenosis patients. Continuous cerebral oxygenation monitoring is indispensable for carotid surgery. Despite discrepancies in surgical techniques, we believe that "one fits all strategy: general anesthesia, conventional endarterectomy without patch plasty, never shunter and always NIRS monitorization" may be used safely in patients undergoing carotid endarterectomy. PMID: 33014089 [PubMed]
Conclusions: Multimodal low-opioid anesthesia during coronary artery bypass surgery with artificial blood circulation allows one to ensure adequate analgesia and avoid the intraoperative usage of routine doses of fentanyl, as indicated by the absence of hemodynamic and endocrine-metabolic changes. PMID: 33014084 [PubMed]
Authors: Nilsson S, Appelblad M, Svenmarker S Abstract The sensitivity to heparin during cardiopulmonary bypass (CPB) is determined by patient-specific characteristics and is assessed by the whole blood activated clotting time (ACT). We aimed to examine reliability measures between two different ACT monitors using Bland-Altman analysis: bias should not exceed 50 ± 50 seconds for measurements performed during CPB or 10 ± 10 seconds before and after CPB. The ACT response should be linear in relation to the concentration of heparin in plasma. Twenty patients (n = 20) aged 20-80 years and admitted for cor...
AbstractBackgroundCardiac surgery accounts for 10 –15% of blood transfusions in the US, despite benefits and calls of limiting its use. We sought to evaluate the impact of a restrictive transfusion protocol on blood use and clinical outcomes in patients undergoing isolated primary coronary artery bypass grafting (CABG).MethodsBlood conservation measures, instituted in 2012, include preoperative optimization, intraoperative anesthesia, and pump fluid restriction with retrograde autologous priming and vacuum ‐assisted drainage, use of aminocaproic acid and cell saver, intra‐ and postoperative permissive anemia, and...
This case happenEd in Stockton, Ca to my anesthesiologist friend. i am not involved in the case. This is second hand information. Patient is 75 year old elderly female had Htn, CAD, s/p CABG A few years ago now is cleared by cards and is scheduled for total hip replacement. A spinal was given and achieved good anesthesia level with routine monitors. Intraop significant blood loss is noted and was resuscitated with crystalloids. Post op the patient was sent to PACU. The nurses /... Paralysis of lower legs after Total hip replacement
Conclusion: The use of topical TXA in GABC significantly reduced postoperative hemorrhage, packed cell volume, platelet> transfusion, and FFP after surgery. Besides, it had no significant effect on the return to the operating room and mortality.
Background: Cardiopulmonary bypass and aortic clamping evokes the obligatory global myocardial ischemia and dysfunction with a significant inflammatory response. The discrepancy about cardioprotective effects of erythropoietin still exist. The aim of this study was to assess the clinical immunomodulatory effects of EPO on serum inflammatory biomarkers (YKL-40, IL-6 ) and cardiac biomarkers, (pro-BNP, CK-MB and troponin). Methods: In this randomized double blind clinical trial, 132 patients admitted for elective coronary surgery with CPB were randomly assigned in one of three groups: 1- group EPO-A (n = 35) infusion of 300 ...
CONCLUSION Using the system's electronic waveform filter PRAM-CO shows good agreement and trending ability compared with PATD-CO in adults after off-pump coronary artery bypass surgery.
IN THE CURRENT issue, Oh et al. presented a large retrospective database review comparing total intravenous anesthesia (TIVA) with volatile maintenance on adverse outcomes after primary coronary bypass graft (CABG) surgery.1 The authors found a 3% absolute risk reduction in mortality that persisted up to 3 years after surgery favoring TIVA, the first time such a result has been reported. The current study suggested the exact opposite to all that have gone before —that not only are volatile anesthetics providing no protection against adverse outcomes after CABG, but that they are associated with an increase in mortality in the long-term.
For the students and residents. 70 something y/o pt for CABG. EF 30-35%, pretty bad CAD. ESRD, last HD last night. Inpatient. Pt is tiny, and anemic to boot. Hct high 20s. Looks frail. Edentulous. Has that aura of "I'm gonna give you trouble today." To the room and baseline SBP 180s. Induce gently and the pressures hold in the 100s throughout line placement. Yay, we're out of the woods I thought. I thought. Then all of a sudden the pressure drops to the 60s, and the sats drop to the... Cardiac Induction Case