The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: A prospective randomized trial

Prasongsukarn, Kriengchai; Abel, James G.; Jamieson, W.R. Eric; Cheung, Anson; Russell, James A.; Walley, Keith R.; Lichtenstein, Samuel V.

doi:10.1016/j.jtcvs.2004.09.014

Cited by 117 publications

(56 citation statements)

References 30 publications

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Section: Postoperative Biological Markers As Predictors Of Post-op Painmentioning

confidence: 99%

“…This approach has already been tried with success in other surgical fields, notably in cardiac surgery [70,71]. The administration of steroids in patients post coronary artery bypass grafting has been associated with improved patient outcomes (significant reduction in postoperative atrial fibrillation) [71]. A randomized clinical trial involving 34 patients undergoing bilateral TKA revealed that the administration of three doses of intravenous hydrocortisone (100 mg per dose) significantly decreased the degree of inflammation as measured by serum IL-6 level at 24 h after surgery compared to the placebo group.…”

Section: Postoperative Biological Markers As Predictors Of Post-op Painmentioning

confidence: 99%

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Towards an understanding of the painful total knee: what is the role of patient biology?

Preston

Petrera

Kim

et al. 2016

Curr Rev Musculoskelet Med

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Total knee arthroplasty (TKA) remains the treatment of choice for end-stage osteoarthritis of the knee.With an aging population, the demand for TKA continues to increase, placing a significant burden on a health care system that must function with limited resources. Although generally accepted as a successful procedure, 15-30 % of patients report persistent pain following TKA. Classically, pain generators have been divided into intra-articular and extra-articular causes. However, there remains a significant subset of patients for whom pain remains unexplained. Recent studies have questioned the role of biology (inflammation) in the persistence of pain following TKA. This article aims to serve as a review of previously identified causes of knee pain following TKA, as well as to explore the potential role of biology as a predictor of pain following knee replacement surgery.

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Section: Postoperative Biological Markers As Predictors Of Post-op Painmentioning

confidence: 99%

Section: Postoperative Biological Markers As Predictors Of Post-op Painmentioning

confidence: 99%

Towards an understanding of the painful total knee: what is the role of patient biology?

Preston

Petrera

Kim

et al. 2016

Curr Rev Musculoskelet Med

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“…Corticosteroids were evaluated as part of a regimen including beta blockers to prevent AF in 2 studies. 9,10 One randomized, double-blinded, multicenter study of 241 cardiac surgery patients evaluated a low dose of hydrocortisone (100 mg following surgery, then 100 mg every 8 hours for 3 days). 9 Although a power analysis was not described, the incidence of new onset AF during the fi rst 84 hours after cardiac surgery was 48% in the placebo group compared to 30% in the hydrocortisone group (hazard ratio, 0.54; 95% CI, 0.36-0.82; P = .01).…”

Section: Atrial Fibrillationmentioning

confidence: 99%

“…These results were consistent with a smaller but similar study, also using low dosing of corticosteroids (1,000 mg hydrocortisone prior to CPB followed by dexamethasone 4 mg every 6 hours for 1 day postoperatively). 10 Two meta-analyses evaluated the dose-dependent effect of corticosteroids on postoperative AF. 6,11 To avoid signifi cant heterogeneity, Marik and colleagues excluded studies using doses less than 200 mg/day and more than 10,000 mg/day of hydrocortisone equivalents.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Role of Corticosteroids during Cardiopulmonary Bypass

2014

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Corticosteroids are commonly used in the peri-operative setting for patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The infl ammatory response to CPB is associated with organ dysfunction and increased mortality. Corticosteroids reduce biochemical infl ammatory markers associated with CPB, however the impact on clinical outcomes is mixed. The purpose of this article is to evaluate the evidence of changes in clinical outcomes associated with the peri-operative administration of corticosteroids in patients undergoing cardiac surgery with CPB. Randomized, placebo-controlled trials and meta-analyses were reviewed for evidence evaluating the impact of corticosteroids on clinical outcomes including mortality, myocardial infarction, atrial fi brillation (AF), duration of intubation, length of intensive care unit (ICU) or hospital stay, hyperglycemia, and gastrointestinal complications. Most of the relevant studies are underpowered to assess major clinical outcomes. Although corticosteroids likely reduce the risk of AF, this needs to be evaluated when used in addition to or in lieu of other anti-arrhythmic agents. Evidence does not equivocally support the use of corticosteroids to improve clinical outcomes in cardiac surgery patients.

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“…[75][76][77][78] Reasons that corticosteroids may be effective for prevention of post-CABG AF but associated with induction of AF in patients not undergoing surgery are unclear. Evidence indicates that AF may occur in part as a result of an inflammatory process; inflammation may be particularly important as a mechanism of postoperative AF, and corticosteroids may reduce the risk of post-CABG AF due to antiinflammatory properties.…”

Section: Corticosteroids (Quality Of Evidence -Low)mentioning

confidence: 99%

Drug-Induced Atrial Fibrillation

Killeen¹

2012

Cardiac Drug Safety

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Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with severe consequences, including symptoms, hemodynamic instability, increased cardiovascular mortality, and stroke. While other arrhythmias such as torsades de pointes and sinus bradycardia are more typically thought of as drug-induced, AF may also be precipitated by drug therapy, although ascribing causality to drug-associated AF is more difficult than with other drug-induced arrhythmias. Drug-induced AF is more likely to occur in patients with risk factors and comorbidities that commonly coexist with AF, such as advanced age, alcohol consumption, family history of AF, hypertension, thyroid dysfunction, sleep apnea, and heart disease. New-onset AF has been associated with cardiovascular drugs such as adenosine, dobutamine, and milrinone. In addition, medications such as corticosteroids, ondansetron, and antineoplastic agents such as paclitaxel, mitoxantrone, and anthracyclines have been reported to induce AF. Whether bisphosphonate drugs are associated with new onset AF remains controversial and requires further study. The potential contribution of specific drug therapy should be considered when patients present with new onset AF.

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The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: A prospective randomized trial

Cited by 117 publications

References 30 publications

Towards an understanding of the painful total knee: what is the role of patient biology?

Towards an understanding of the painful total knee: what is the role of patient biology?

Role of Corticosteroids during Cardiopulmonary Bypass

Drug-Induced Atrial Fibrillation

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