Abstract:
OBJECTIVE:To delineate associations between preoperative risk factors and clinical processes of care and perioperative glucose tolerance in patients managed on a fast-track cardiac surgery clinical pathway with prebypass methylprednisolone administration. DESIGN:Retrospective sequential cohort study. SETTING:University-affiliated Department of Veterans Affairs medical center. PARTICIPANTS:Fast-track patients (n = 293; n = 72 low-dose methylprednisolone [100-125 mg]; n = 221 moderate-dose methylprednisolone [500 mg]) plus pre-fast-track patients (n = 258; no methylprednisolone) undergoing cardiac surgery with cardiopulmonary bypass. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Multivariate linear regression was used to model the association of 17 preoperative risk and intraoperative process-of-care variables with serum glucose concentration on arrival in the intensive care unit. Preoperative serum glucose concentrations were not significantly different among the pre-fast-track, fast-track with low-dose methylprednisolone, and fast-track with moderate-dose methylprednisolone cohorts (129 +/- 54, 137 +/- 55, 127 +/- 46 mg/dL [mean +/- SD]). Postoperative serum glucose concentrations were significantly different (171 +/- 58, 223 +/- 56, 250 +/- 75 mg/dL; p < 0.03, for all pairwise comparisons). Using backward elimination from the full 17-variable multivariate model (R-square = 0.63), 4 variables remained significant (all p < 0.0001; R-square = 0.60): (1) Preoperative diabetes status (adjusted mean post-operative glucose level, mg/dL; [95% confidence interval (CI)]): no treatment, 193 (188-199); oral agent, 276 (262-291); insulin requiring, 301 (283-320); (2) steroid group: pre-fast-track, 201 (195-209), fast-track with low-dose methylprednisolone, 271 (256-287); fast-track with moderate-dose methylprednisolone, 295 (284-306); (3) volume of glucose-containing cardioplegia (beta coefficient, 95% CI): 2.22% (1.37-3.10) increase per 100 mL; and (4) intraoperative epinephrine infusion: none, 231 (224-239); yes, 276 (264-288). No significant interactions were identified. No significant effect of opioid dose was observed. CONCLUSION:At this institution, implementation of the fast-track pathway was associated with a deterioration of glucose tolerance. Preoperative diabetes, pre-cardiopulmonary bypass administration of steroids, volume of glucose-containing cardioplegia solution administered, and use of epinephrine infusions were significantly associated multivariate factors.
journal_name
J Cardiothorac Vasc Anesthjournal_title
Journal of cardiothoracic and vascular anesthesiaauthors
London MJ,Grunwald GK,Shroyer AL,Grover FLdoi
10.1053/jcan.2000.18298keywords:
subject
Has Abstractpub_date
2000-12-01 00:00:00pages
631-8issue
6eissn
1053-0770issn
1532-8422pii
S1053-0770(00)12461-9journal_volume
14pub_type
杂志文章abstract:OBJECTIVE:To evaluate if increasing age is a major determinant of long-term neuropsychologic (NP) dysfunction in patients undergoing coronary artery bypass graft (CABG) surgery. DESIGN:Prospective cohort study. SETTING:A single university hospital. PARTICIPANTS:Three hundred eighty-one patients undergoing elective C...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2000.7941
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:The actions of volatile anesthetics on left ventricular (LV) function in normal and failing hearts have been previously evaluated, but the effects of these agents on left atrial (LA) function in the presence of LV dysfunction are unknown. The hypothesis was tested that isoflurane alters LA mechanics evaluated...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2003.09.006
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVES:During cardiac surgery, circulating red blood cells (RBCs) are at risk of exposure to environmental factors during extracorporeal circulation and transfusion of stored RBCs. For this study, the authors observed morphological differences, deformability, density distribution, and erythrocyte indices of RBCs du...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2019.03.030
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVE:The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS:A multivariable Cox proportional hazards model was used amo...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2017.12.038
更新日期:2018-06-01 00:00:00
abstract::Surgical excellence in pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH) has begun to spread around the world. The perioperative mortality for this procedure is typically under 10%. The maximal benefit from PTE is derived in those patients who have a high proximal clot bur...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2011.03.182
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To compare dexmedetomidine-based to propofol-based sedation after coronary artery bypass graft (CABG) surgery in the intensive care unit (ICU). DESIGN:Randomized, open label. SETTING:Twenty-five centers in the United States and Canada. PARTICIPANTS:Two hundred ninety-five adults undergoing CABG surgery. I...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s1053-0770(03)00200-3
更新日期:2003-10-01 00:00:00
abstract:OBJECTIVE:To characterize the impact, on failure to rescue, of cerebrovascular accident as a first postoperative complication after thoracic endovascular aortic aneurysm repair (TEVAR). DESIGN:A retrospective cohort study using of National Surgical Quality Improvement Program Participants User File. SETTING:United St...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.11.061
更新日期:2020-12-02 00:00:00
abstract::Over the past 2 decades, the discipline of palliative care has evolved and expanded such that it is now the standard of care for a variety of acute and chronic processes. Although there are recommendations encouraging incorporation of palliative care into the routine management of patients with chronic cardiac process...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2018.04.047
更新日期:2019-03-01 00:00:00
abstract::Hospital CEOs are concerned about more than just cost of services to their patients. The advancement of patient car along with maintaining or improving patient safety are also key elements to the CEO, to limit patient risks, hospital liability, and negative public relations. The CEO is accountable to the hospital staf...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2004.06.003
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVE:Reducing mortality is a key target in critical care and perioperative medicine. The authors aimed to identify all nonsurgical interventions (drugs, techniques, strategies) shown by randomized trials to increase mortality in these clinical settings. DESIGN:A systematic review of the literature followed by a c...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2019.03.022
更新日期:2019-10-01 00:00:00
abstract::Perfusion strategies for cardiopulmonary bypass have direct consequences on pediatric cardiac surgery outcomes. However, inconsistent study results and a lack of uniform evidence-based guidelines for pediatric cardiopulmonary bypass management have led to considerable variability in perfusion practices among, and even...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.01.025
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:To compare the agreement of cardiac index measurements between transesophageal echocardiography across the prosthetic mitral valve and the continuous thermodilution method through a pulmonary artery catheter (PAC-TD) in patients undergoing double-valve replacement. DESIGN:Observational prospective study. SE...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2015.10.022
更新日期:2016-04-01 00:00:00
abstract::In this review, the authors discussed criteria for diagnosing ALI; incidence, etiology, preoperative risk factors, intraoperative management, risk-reduction strategies, treatment, and prognosis. The anesthesiologist needs to maintain an index of suspicion for ALI in the perioperative period of thoracic surgery, partic...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2009.10.032
更新日期:2010-08-01 00:00:00
abstract::The presence of an inotropic action of prostaglandin E1 (PGE1) in vivo is controversial, and there are conflicting results obtained by various indices of myocardial contractility. In this study, a direct effect of PGE1 on contractility was investigated in dogs by use of a load-independent contractile index: left ventr...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(92)90102-d
更新日期:1992-10-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate whether isoflurane, a known negative lusitropic agent, exacerbates diastolic dysfunction in patients with preexisting impaired relaxation. DESIGN:Prospective, experimental study. SETTING:Single-institution, university hospital. PARTICIPANTS:Twenty-five patients ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2006.01.018
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:To investigate the effect of the combination of oxycodone and dexmedetomidine for patient-controlled analgesia (PCA) after video-assisted thoracoscopic (VATS) lobectomy. DESIGN:A prospective, randomized, double-blind, controlled trial. SETTING:Shandong Cancer Hospital and Institute in Jinan, China. PARTICI...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2016.03.127
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:The diagnosis of perioperative myocardial infarction (PMI) after cardiac surgery remains an important issue. The present study was designed to determine the relevance of the measurement of serum cardiac troponin I (cTnI, a biochemical marker with high cardiospecificity. Therefore, cTnI was compared with creat...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(98)90008-8
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVES:The use of steroid therapy in cardiac surgical patients remains controversial. The aim of this clinical investigation was to determine the effect of small-dose dexamethasone therapy on patient-perceived quality of recovery (QoR) scores in elective cardiac surgical patients. In addition, the authors assessed ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2011.03.002
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVE:The value of a simplified, focused intraoperative transesophageal echocardiography (TEE) protocol in patients undergoing liver transplantation (LT) is unknown. We sought to create and assess a 5-view LT TEE examination focused on 5 prespecified common causes of hypotension during LT. DESIGN:Retrospective coh...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.01.028
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:The long-term use of milrinone is associated with increased mortality in chronic heart failure. A recent meta-analysis suggested that it might increase mortality in patients undergoing cardiac surgery. The authors conducted an updated meta-analysis of randomized trials in patients undergoing cardiac surgery t...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,meta分析,评审
doi:10.1053/j.jvca.2012.08.005
更新日期:2013-04-01 00:00:00
abstract::Pulmonary thromboendarterectomy (PTE) remains the only curative surgery for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Postoperative intensive care unit care challenges providers with unique disease physiology, operative sequelae, and the potential for detrimental complications. Central conce...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.03.005
更新日期:2019-11-01 00:00:00
abstract::The incidence of primary cardiac tumors is very rare (0.02%) with the majority being benign. Angiosarcoma is the most common malignant cardiac tumor. However, regardless of the histological nature of cardiac tumors, they can cause life-threatening mechanical obstruction. We present a case of urgent surgical removal of...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.12.018
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:To compare patients undergoing valve surgery through a minithoracotomy approach with a matched group undergoing conventional valve surgery. DESIGN:Control study. SETTING:University hospital, single center. PARTICIPANTS:Forty-one consecutive patients scheduled for valve surgery by minithoracotomy approach w...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章
doi:10.1016/s1053-0770(03)00051-x
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVES:To compare the effects of dexmedetomidine and propofol on sublingual microcirculation in patients after cardiac surgery. DESIGN:A prospective, randomized, single-blind study. SETTING:University hospital. PARTICIPANTS:Adult patients undergoing elective valve surgery with cardiopulmonary bypass. INTERVENTI...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2016.05.038
更新日期:2016-12-01 00:00:00
abstract::The efficacy of interpleural administration of sufentanil, 50 micrograms, was compared with that of 150 mg of bupivacaine, 0.5%, with epinephrine, 5 micrograms/mL, or saline, in 30 patients (N = 10 in each group) undergoing lateral thoracotomy. Sufentanil, bupivacaine, or saline was administered interpleurally after i...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(93)90307-7
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:To study the influence of preoperative warfarin anticoagulation on postoperative blood loss and allogeneic blood requirement. DESIGN:Retrospective study with a matched control group. SETTING:University and community hospital, single institutional. PARTICIPANTS:240 patients scheduled for cardiac surgery. I...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(05)80316-7
更新日期:1995-06-01 00:00:00
abstract::In the perioperative management of patients with hemophilia A, emicizumab prevents the accurate measurement of common clotting assays, including the activated clotting time (ACT), which is essential for high-dose heparin monitoring during cardiopulmonary bypass surgery. The authors describe the successful perioperativ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.08.058
更新日期:2020-08-27 00:00:00
abstract:OBJECTIVE:To examine the association between blood component transfusions and the incidence of major postoperative infections in patients undergoing esophageal resection surgery. DESIGN:Retrospective cohort study. SETTING:Single academic tertiary referral center. PARTICIPANTS:All patients who underwent esophagectomy...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2011.12.015
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVES:To determine the effect of the introduction of a specialty-specific progressive care unit (PCU) on the intensive care unit (ICU) to which relatively low-acuity patients had previously been admitted. DESIGN:Retrospective cohort study. SETTING:The thoracic (noncardiac) surgical ICU of a tertiary referral ins...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2007.12.015
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVE:This study was planned to pool existing data on outcome and to evaluate the efficacy of postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adult patients. DESIGN:Systematic review of the literature and meta-analysis. SETTING:Multi-institutional study. PARTICIPANTS:Adult patients w...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,meta分析,评审
doi:10.1053/j.jvca.2017.08.048
更新日期:2018-06-01 00:00:00