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Left Atrial Appendage Occlusion: A Narrative Review
Left atrial appendage occlusion (LAAO) is a proposed alternative to oral anticoagulation in reducing stroke in patients with atrial fibrillation. It is suggested that LAAO is most suitable in patients at increased risk of stroke or bleeding or with contraindication to pharmacologic intervention. Despite the increase in evidence evaluating LAAO, the relative safety and efficacy of the procedure remains uncertain. Presently, several ongoing randomized trials are comparing various devices to each other and to pharmacologic anticoagulation.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 8, 2019 Category: Anesthesiology Authors: Ali Alsagheir, Alex Koziarz, Emilie P. Belley-C ôté, Richard P. Whitlock Tags: Review Article Source Type: research

Goal-directed versus Standard Fluid Therapy to Decrease Ileus after Open Radical Cystectomy A Prospective Randomized Controlled Trial
Conclusions Goal-directed fluid therapy may not be an effective strategy for lowering the risk of postoperative ileus in patients undergoing open radical cystectomy.Editor ’s PerspectiveWhat We Already Know about This TopicPostoperative ileus is a common complication after intraabdominal surgeriesPrevious studies have found mixed evidence for benefit in goal-directed intraoperative fluid therapy over standard fluid therapyWhat This Article Tells Us That Is NewIn a randomized trial of goal-directedversus standard fluid therapy in patients having radical cystectomy, there was no difference in the primary outcome of postope...
Source: Anesthesiology - July 14, 2020 Category: Anesthesiology Source Type: research

Patients Requiring Conversion to General Anesthesia during Endovascular Therapy Have Worse Outcomes: A Post Hoc Analysis of Data from the SAGA Collaboration INTERVENTIONAL
CONCLUSIONS: Patients undergoing conversion had significantly worse outcome compared with patients remaining in conscious sedation. No factor was identified that predicted conversion from conscious sedation to general anesthesia.
Source: American Journal of Neuroradiology - December 11, 2020 Category: Radiology Authors: Simonsen, C. Z., Schönenberger, S., Henden, P. L., Yoo, A. J., Uhlmann, L., Rentzos, A., Bösel, J., Valentin, J., Rasmussen, M. Tags: INTERVENTIONAL Source Type: research

Red Blood Cell Distribution Width as a 5-Year Prognostic Marker in Patients Submitted to Carotid Endarterectomy
Conclusion: RDW is a widely available and low-cost marker that independently predicts long-term mortality, MACE, and MI after CEA. This biomarker could prove useful in assessing which patients would likely benefit from CEA in the long term.Cerebrovasc Dis Extra 2020;10:181 –192
Source: Cerebrovascular Diseases Extra - December 16, 2020 Category: Neurology Source Type: research

Incidence, Risk Factors, and Outcomes of Perioperative Atrial Fibrillation following Noncardiothoracic Surgery: A Systematic Review and Meta-Regression Analysis of Observational Studies
CONCLUSION: We identified advanced age, male gender, preoperative hypertension, diabetes mellitus, and cardiac disease as important risk factors for perioperative atrial fibrillation. The atrial fibrillation group was at increased odds for postoperative cardiac complications, stroke, and higher mortality, emphasizing the need for risk stratification and close monitoring.PMID:34007270 | PMC:PMC8099514 | DOI:10.1155/2021/5527199
Source: Anesthesiology Research and Practice - May 19, 2021 Category: Anesthesiology Authors: Yamini Subramani Omar El Tohamy Daniil Jalali Mahesh Nagappa Homer Yang Ashraf Fayad Source Type: research

Safety of Tranexamic Acid in Hip and Knee Arthroplasty in High-risk Patients
ConclusionsAlthough effective in reducing blood transfusions, tranexamic acid is not associated with increased complications, irrespective of patient high-risk status at baseline.Editor ’s PerspectiveWhat We Already Know about This TopicThe use of tranexamic acid to decrease blood loss during lower-extremity arthroplasty is commonplaceSafety concerns remain for patients with a history of thromboembolic, cardiovascular, renal, or neurologic comorbiditiesWhat This Article Tells Us That Is NewNational administrative data from more than 500 hospitals and 40,000 patients demonstrate that approximately half of high-risk patien...
Source: Anesthesiology - June 9, 2021 Category: Anesthesiology Source Type: research

The Use of Corticosteroids for Cardiopulmonary Bypass in Adults
AbstractPurpose of ReviewCardiopulmonary bypass for on-pump cardiac surgery induces a systemic inflammation that may contribute to postoperative major complications. To reduce this inflammatory response in patients undergoing heart surgery, the perioperative use of anti-inflammatory corticosteroids has long been recommended to improve clinical outcomes. However, the efficacy and safety of steroids remain still unclear.Recent FindingsWe reviewed recent published literature, including the large clinical trials DECS and SIRS and the two meta-analysis by Dvirnik et al. (2018) and Ng et al. (2020), on mortality and major postop...
Source: Current Anesthesiology Reports - August 10, 2021 Category: Anesthesiology Source Type: research

Percutaneous left atrial appendage closure in patients with primary hemostasis disorders and atrial fibrillation
ConclusionsPercutaneous LAAC in primary HD carriers appeared as safe and as effective as in overall LAAC population for stroke and bleeding prevention at midterm follow-up.Graphical abstractPercutaneous left atrial appendage closure in patients with atrial fibrillation and primary hemostasis disorders. The percutaneous LAAC in primary hemostasis disorders and AF carriers requires a multidisciplinary approach. Cardiologist, anesthesiologist, and hematologist discussion is a cornerstone to assess anticoagulant contraindication, LAAC feasibility, periprocedural management, and follow-up(high). This multidisciplinary care is i...
Source: Journal of Interventional Cardiac Electrophysiology - November 25, 2021 Category: Cardiology Source Type: research

Managing New Oral Anticoagulants in the Perioperative and Intensive Care Unit Setting
Managing patients in the perioperative setting receiving novel oral anticoagulation agents for thromboprophylaxis or stroke prevention with atrial fibrillation is an important consideration for clinicians. The novel oral anticoagulation agents include direct Factor Xa inhibitors rivaroxaban and apixaban, and the direct thrombin inhibitor dabigatran. In elective surgery, discontinuing their use is important, but renal function must also be considered because elimination is highly dependent on renal elimination. If bleeding occurs in patients who have received these agents, common principles of bleeding management as with an...
Source: Anesthesiology - April 23, 2013 Category: Anesthesiology Tags: Education: Review Article Source Type: research

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