Cardiothoracic Anesthesia, Respiration and Airway

Eric, Jacobsohn; Lee, Trevorx W. R; Amadeo, Ryan J. J.; Syslak, Paul H; Debrouwere, Roland; Bell, Dean D.; Klock, P A; Tymkew, Heidi; Avidan, Michael S.

doi:10.1007/bf03021781

Cited by 11 publications

(2 citation statements)

References 18 publications

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“…Previous studies have analyzed the effect of ITMA on postoperative lung function. In 2 randomized controlled trials, ITMA was associated with an improved forced vital capacity (FVC) and forced expiratory volume (FEV) after cardiac surgery [ 26 , 27 ]. In contrast, dos Santos et al found a similar decline of the FVC and FEV in patients with ITMA and IVA that was likely attributed to the high intravenous opiate doses that were given in both groups [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study

et al. 2017

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BackgroundAcute pain and systemic opioids may both negatively impact respiratory function after cardiac surgery. This study analyzes the local practice of using intrathecal morphine analgesia (ITMA) with minimal parenteral opioid administration in cardiac surgery, specifically the impact on postoperative pulmonary complications (PPCs).MethodsData from adult patients who underwent elective cardiac surgery between January 2002, and December 2013 in a single center were analyzed. Propensity scores estimating the likelihood of receiving ITMA were used to match (1:1) patients with ITMA and patients with intravenous analgesia (IVA). Primary outcome was PPCs, a composite endpoint including pneumonia, adult respiratory distress syndrome, and any type of acute respiratory failure. Secondary outcomes were in-hospital mortality, cardiovascular complications, and length of stay in the intensive care unit (ICU) and hospital.ResultsFrom a total of 1′543 patients, 920 were treated with ITMA and 623 with IVA. No adverse event consequent to the spinal puncture was reported. Propensity score matching created 557 balanced pairs. The occurrence of PPCs in patients with ITMA was 8.1% vs. 12.8% in patients with IVA (odds ratio, 0.6; 95% CI, 0.40–0.89; p = 0.012). Fewer patients with ITMA had a prolonged stay in the ICU (> 4 days; 16.5% vs. 21.2%, p = 0.047) or in the hospital (> 15 days; 25.5% vs. 31.8%. p = 0.024). In-hospital mortality and cardiovascular complications did not differ significantly between the two groups.ConclusionIn this study involving cardiac surgical patients, ITMA was safely applied and was associated with fewer PPCs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0398-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study

et al. 2017

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“…reported that intraoperative stress responses in CABG patients were decreased with HSA, with these individuals also exhibiting enhanced preservation of beta-receptor function [ 16 ]. HSA may also improve aspects of post-operative pain management in patients following either cardiac or non-cardiac surgery [ 17 – 19 ]. We that note a comprehensive meta-analysis of clinical outcome data, specifically focussed on mortality and cardiovascular morbidity, did not indicate benefits from incorporation of spinal analgesia [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study

Lee¹,

Kowalski²,

Falk³

et al. 2016

PLoS ONE

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BackgroundCardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery.MethodsThis prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein (CRP, PTX3) and cardiovascular risk (sST2) biomarkers.ResultsThe kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005).ConclusionsThis hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia.Trial RegistrationClinicalTrials.gov NCT00348920

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Fast-track cardiac care for adult cardiac surgical patients

Wong

Lai

Chee

et al. 2016

Cochrane Database of Systematic Reviews

140

109

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Background Fast-track cardiac care is a complex intervention involving several components of care during cardiac anaesthesia and in the postoperative period, with the ultimate aim of early extubation a er surgery, to reduce length of stay in the intensive care unit and in the hospital. Safe and e ective fast-track cardiac care may reduce hospital costs. This is an update of a Cochrane review first published in 2003, updated in 2012 and updated now in 2016. Objectives To determine the safety and e ectiveness of fast-track cardiac care compared with conventional (not fast-track) care in adult patients undergoing cardiac surgery. Fast-track cardiac care intervention includes administration of low-dose opioid-based general anaesthesia or use of a time-directed extubation protocol, or both.

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Cardiothoracic Anesthesia, Respiration and Airway

Abstract: Low-dose ITM for cardiac surgery did not delay early extubation, but it improved postoperative analgesia and pulmonary function.

Cited by 11 publications

References 18 publications

Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study

Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study

High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study

Fast-track cardiac care for adult cardiac surgical patients

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