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Singh SP, Qureshi U, Qureshi F, Qureshi F. Commentary: Eighteen cases of renal aneurysms: clinical retrospective analysis and experience of endovascular interventional treatment. Front Surg 2024; 11:1352880. [PMID: 38348468 PMCID: PMC10860334 DOI: 10.3389/fsurg.2024.1352880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Affiliation(s)
- Som P. Singh
- Department of Biomedical Sciences, Kansas City School of Medicine, University of Missouri, Kansas City, MO, United States
| | - Ursula Qureshi
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, MO, United States
| | - Farah Qureshi
- Lake Erie College of Osteopathic Medicine, Erie, PA, United States
| | - Fawad Qureshi
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
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Zhu D, Li Y, Tian AY, Wang HN. Comparison of amiodarone and esmolol for prevention of reperfusion ventricular fibrillation in individuals undergoing heart valve or aortic surgery: a study protocol for a randomized controlled clinical trial. Trials 2023; 24:758. [PMID: 38012733 PMCID: PMC10680225 DOI: 10.1186/s13063-023-07816-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Amiodarone and esmolol can help to prevent and treat post-cardiac surgery reperfusion ventricular fibrillation. However, the relative efficacies of these two drugs remain unknown. The aim of the current trial is to compare the performances of amiodarone and esmolol for preventing reperfusion ventricular fibrillation following open heart surgery. METHODS/DESIGN This is a single-center, prospective, double-blind, controlled clinical trial. A total of 260 patients undergoing heart valve or aortic surgery will be assigned randomly to treatment with prophylactic esmolol (intervention group) or amiodarone (control group). The main outcome is the incidence of reperfusion ventricular fibrillation following aortic opening during extracorporeal circulation. The secondary outcomes are the rate of automatic cardiac resuscitation, energy and frequency of electrical defibrillation, number of electrical defibrillations, and pacemaker use in the two groups of patients. Information on the patients' general condition and the durations of anesthesia, extracorporeal circulation, aortic occlusion, and operation time will be recorded. We will also compare the heart rate, mean arterial pressure, and central venous pressure between the two groups of patients at induction of anesthesia (T1), start of surgery (T2), start of extracorporeal circulation (T3), aortic block (T4), aortic opening (T5), after opening for 10 (T6), 20 (T7), and 30 min (T8), at cessation of extracorporeal circulation (T9), and at the end of surgery (T10) and compare blood gas analysis results at T1, T5, T9, and T10. DISCUSSION This study will determine if prophylactic esmolol is more effective than amiodarone for reducing the incidence of reperfusion ventricular fibrillation in patients undergoing heart valve or aortic surgery. TRIAL REGISTRATION China Clinical Trials Registry ChiCTR1900026429. Registered on 2019.10.9.
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Affiliation(s)
- Dan Zhu
- Department of Anesthesiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang City, Liaoning Province, China
| | - Yu Li
- Department of Anesthesiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang City, Liaoning Province, China
| | - A-Yong Tian
- Department of Anesthesiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang City, Liaoning Province, China
| | - Hong-Nan Wang
- Department of Anesthesiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang City, Liaoning Province, China.
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3
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Miyama N, Komai H, Nakamura T, Iwahashi M, Mukobara N, Yoshida M, Fujimura H, Sugimoto T, Asada H, Tanimura N, Azami T, Kawata M, Tsuji Y, Wakita N, Ogino H, Shindo S, Hatada A, Oka T. Long-Term Results of Crossover Bypass for Iliac Atherosclerotic Lesions in the Era of Endovascular Treatment: The Re-ACTION Study ( Retrospective Assessment of Crossover Bypass as a Treatment for Iliac Lesi ONs). Ann Vasc Dis 2018; 11:217-222. [PMID: 30116414 PMCID: PMC6094041 DOI: 10.3400/avd.oa.18-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to elucidate the long-term results of crossover bypass (CB) for iliac atherosclerotic lesions in the era of endovascular treatment (EVT). Methods: A retrospective multicenter cohort study was performed. CB was performed in 242 patients between 2003 and 2014 by vascular surgeons at multiple medical centers in Japan. Results: Perioperative mortality was 1.7%. Primary patency rates were 86% at 5 years and 82% at 8 years. Univariate analysis showed that critical limb ischemia (Rutherford class 4–6), vein graft, and superficial femoral artery occlusion were significantly associated with low primary patency. In multivariate analysis, only critical limb ischemia influenced primary patency. The secondary patency rate was 87% at both 5 and 8 years. The limb salvage rate was 98% at both 5 and 8 years. The overall survival rates were 71% at 5 years and 49% at 8 years. Conclusion: The long-term results of CB were good in our study, compared with previous reports. Our results suggest that CB remains an option for the arterial reconstruction in unilateral iliac occlusive disease after EVT failed.
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Affiliation(s)
- Noriyuki Miyama
- Department of Vascular Surgery, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Hiroyoshi Komai
- Department of Vascular Surgery, Kansai Medical University Medical Center, Moriguchi, Japan.,Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.,Department of Cardiovascular Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Takashi Nakamura
- Department of Vascular Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Masahiro Iwahashi
- Department of Cardiovascular Surgery, National Hospital Organization Wakayama Hospital, Wakayama, Japan.,Department of Cardiovascular Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Nobuhiko Mukobara
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Masato Yoshida
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Hironobu Fujimura
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Takaki Sugimoto
- Department of Cardiovascular Surgery, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Hidenori Asada
- Department of Vascular Surgery, Kyoto Medical Center, Kyoto, Japan
| | - Nobuhiro Tanimura
- Department of Vascular Surgery, Soryukai Inoue Hospital, Suita, Japan.,Department of Cardiovascular Surgery, Takatsuki General Hospital, Takatsuki, Japan
| | - Takashi Azami
- Department of Cardiovascular Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Masatoshi Kawata
- Department of Cardiovascular Surgery, Saiseikai Suita Hospital, Suita, Japan
| | - Yoshihiko Tsuji
- Department of Surgery, Shinsuma General Hospital, Kobe, Japan
| | - Noboru Wakita
- Department of Cardiovascular Surgery, Kobe Rosai Hospital, Kobe, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shunya Shindo
- Department of Cardiovascular Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Atsutoshi Hatada
- Department of Cardiovascular Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan
| | - Takanori Oka
- Department of Cardiovascular Surgery, Takatsuki General Hospital, Takatsuki, Japan
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Abstract
PURPOSE OF REVIEW Coronary artery event includes acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery. Following such an event, risk of noncardiac surgery is increased. Of major concern is what can make this surgery safer? RECENT FINDINGS High functional capacity improves cardiovascular (CV) risk; at least 4.0 metabolic equivalents (METs) on stress test are favorable. Risk scores can suggest need for further evaluation. Coronary angiography prior to surgery usually is not indicated since revascularization shows disappointing CV risk reduction results. Due to high association of peripheral arterial disease (PAD) with coronary artery disease (CAD), low ankle-brachial index (ABI) indicates increased CV risk. New perioperative beta blockade has shown disappointing benefit, but if ongoing should be continued. De novo perioperative beta blockade is for the highest CV risk patient undergoing noncardiac vascular surgery. Good evidence supports CV risk reduction from new or existing statin in the perioperative period, especially for the diabetic. Diabetics should also be on an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) secondarily, during the perioperative period to decrease 30-day perioperative mortality. Optimal timing of elective noncardiac surgery following a coronary artery event appears to be 180 days with CV risk decreased by a statin and an ACEI or an ARB.
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Affiliation(s)
- Thomas F Whayne
- Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA.
| | - Sibu P Saha
- Gill Heart and Vascular Institute, University of Kentucky, 326 Wethington Building, 900 South Limestone Street, Lexington, KY, 40536-0200, USA
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Zheng Y, Gu Q, Chen HW, Peng HM, Jia DY, Zhou Y, Xiang MX. Efficacy of amiodarone and lidocaine for preventing ventricular fibrillation after aortic cross-clamp release in open heart surgery: a meta-analysis of randomized controlled trials. J Zhejiang Univ Sci B 2017; 18:1113-1122. [PMID: 29204991 PMCID: PMC5742294 DOI: 10.1631/jzus.b1700229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation (VF) after release of an aortic cross-clamp (ACC) during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. METHODS Prospective randomized controlled trials (RCTs) that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. PubMed, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. RESULTS We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable (relative risk (RR)=1.12, 95% confidence interval (CI): 0.70 to 1.80, P=0.63), but both were superior to the placebo (amiodarone, RR=0.71, 95% CI: 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI: 0.46 to 0.88, P=0.006). The percentage of patients requiring electric defibrillation counter shocks (DCSs) did not differ significantly among patients administered amiodarone (RR=0.21, 95% CI: 0.04 to 1.19, P=0.08), lidocaine (RR=2.44, 95% CI: 0.13 to 44.02, P=0.55), or the placebo (RR=0.56, 95% CI: 0.25 to 1.25, P=0.16). CONCLUSIONS Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.
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Affiliation(s)
- Yong Zheng
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- Cardiovascular Key Lab of Zhejiang Province, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Qiang Gu
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Hong-wu Chen
- Cardiology Division, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Huai-ming Peng
- Department of Respiratory, Tinhu People's Hospital, Yancheng 224001, China
| | - Dong-yu Jia
- Department of Biology, Georgia Southern University, Statesboro 30460, USA
| | - Yu Zhou
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- Cardiovascular Key Lab of Zhejiang Province, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Mei-xiang Xiang
- Department of Cardiology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- Cardiovascular Key Lab of Zhejiang Province, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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Nicolescu TO. Perioperative Surgical Home. Meeting tomorrow's challenges. Rom J Anaesth Intensive Care 2016; 23:141-147. [PMID: 28913487 DOI: 10.21454/rjaic.7518/232.sho] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
New healthcare models pose a variety of changes for anesthesiologists, ranging from the need to improve quality and to cost containment: as such, the concept of Perioperative Surgical Home (PSH) has been developed. Modelled after the UK's Enhanced Recovery After Surgery (ERAS), PSH takes a step further by coordinating care starting from the time a surgical decision is made for the patient to as many as 30 days postoperatively, taking a logical evidenced-based approach to judicious preoperative testing. Perioperative surgical home also relies heavily on engineering imported strategies such as the use of Lean Six Sigma methodologies, and involves active participation of all stakeholders. By comparison, ERAS is a series of well-defined clinical protocols that do not extend beyond the episode of surgical care. As an added aspect of its benefits, PSH also helps to control costs by decreasing unnecessary testing and cancellations, and allowing for more OR access by inpatients.
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Affiliation(s)
- Teodora O Nicolescu
- Department of Anesthesiology, Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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