Usefulness of monitoring platelet function by multiple electrode aggregometry in primary coronary artery bypass surgery.

Objectives: Antiplatelet therapy commonly is used for the prevention of cardiovascular complications but increases the risk of perioperative bleeding. Multiple-electrode aggregometry (MEA) was investigated for monitoring platelet inhibition by acetylsalicylic acid (ASA) and clopidogrel in patients undergoing elective coronary artery bypass graft (CABG) surgery with regard to clinical outcome as measured by postoperative blood loss and transfusion requirements.

Design: A prospective observational study.

Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial.

Introduction: Several studies have shown that goal-directed hemodynamic and fluid optimization may result in improved outcome. However, the methods used were either invasive or had other limitations. The aim of this study was to perform intraoperative goal-directed therapy with a minimally invasive, easy to use device (FloTrac/Vigileo), and to evaluate possible improvements in patient outcome determined by the duration of hospital stay and the incidence of complications compared to a standard management protocol.

Cardiopulmonary bypass priming using a high dose of a balanced hydroxyethyl starch versus an albumin-based priming strategy.

Background: The optimal priming solution for cardiopulmonary bypass (CPB) is unclear. In this study, we evaluated the influence of high-volume priming with a modern balanced hydroxyethyl starch (HES) preparation on coagulation, inflammation, and organ function compared with an albumin-based CPB priming regimen.

Methods: In 50 patients undergoing coronary artery bypass grafting, the CPB circuit was prospectively and randomly primed with either 1500 mL of 6% HES 130/0.

Cardiac output derived from arterial pressure waveform.

Purpose Of Review: Cardiac output (CO) and other flow-based hemodynamic variables have become increasingly important to guide treatment of patients undergoing major surgery with expected fluid shifts in the operating room as well as critically ill ICU patients. Established techniques such as pulmonary artery thermodilution, however, might not be justified in all of these patients. As arterial access is commonly available, less-invasive arterial pressure waveform-based CO devices are becoming more and more popular.

Uncalibrated arterial pressure waveform analysis for less-invasive cardiac output determination in obese patients undergoing cardiac surgery.

Background: Uncalibrated arterial waveform analysis (FloTrac/Vigileo) uses standard arterial access to determine cardiac output (CO). Calculations are based on arterial waveform characteristics in combination with patient characteristic data to estimate individual arterial compliance. It has been shown that obesity is associated with altered arterial compliance independently of other risk factors.

Influence of continuous perioperative beta-blockade in combination with phosphodiesterase inhibition on haemodynamics and myocardial ischaemia in high-risk vascular surgery patients.

Background: We sought to assess the intra- and postoperative haemodynamic effects of continuous perioperative beta-adrenergic blockade combined with phosphodiesterase (PDE) III inhibition and its potential benefits in limiting perioperative myocardial ischaemia in high-risk vascular surgery patients.

Methods: Seventy-five patients were randomly assigned to receive tight heart rate (HR) control by a continuous infusion of: esmolol in combination with the PDE III inhibitor enoximone (esmolol+enoximone group), esmolol infusion alone (esmolol group), or standard therapy (control group) for a period of 48 h. Myocardial ischaemia and dysfunction were detected by serial plasma Troponin T (TnT) and B-type natriuretic peptide (BNP) measurements.

Crystalloid/colloid versus crystalloid intravascular volume administration before spinal anesthesia in elderly patients: the influence on cardiac output and stroke volume.

Background: Hypotension is the most common cardiovascular response to spinal anesthesia. We compared the effects of crystalloid/colloid versus crystalloid administration before spinal anesthesia on cardiac output (CO) in elderly patients undergoing transurethral resection of the prostate.

Methods: Sixty male ASA I-III patients were randomized to one of three groups the control group received no intravascular volume preload, the saline group received 500 mL saline, and the hydroxyethyl starch (HES) group received 500 mL of saline plus 500 mL of 6% HES 130/0.

Influence on coagulation of a potato-derived hydroxethylstarch (HES 130/0.42) and a maize-derived hydroxethylstarch (HES 130/0.4) in patients undergoing cardiac surgery.

Background: This study compared the effects of a potato-based hydroxyethyl starch (HES) with those of a maize-derived HES preparation on coagulation in cardiac surgery patients.

Methods: Sixty patients undergoing elective cardiac surgery with cardiopulmonary bypass were allocated randomly to receive either a potato-derived HES (6% HES 130/0.42) (n=30) or a waxy-maize-derived HES (6% HES 130/0.

Is albumin administration in hypoalbuminemic elderly cardiac surgery patients of benefit with regard to inflammation, endothelial activation, and long-term kidney function?

Background: Because patients with low albumin levels may benefit from human albumin (HA) administration, we studied correction of hypovolemia with HA in hypoalbuminic elderly cardiac surgery patients.

Methods: In a prospective, randomized study, 50 patients aged >80 yr undergoing cardiac surgery using cardiopulmonary bypass with a preoperative serum albumin concentration of <3.5 mg/dL, received either 5% HA (n = 25) or hydroxyethyl starch (6% HES 130/0.

The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients.

Purpose: A balanced fluid replacement strategy appears to be promising for correcting hypovolemia. The benefits of a balanced fluid replacement regimen were studied in elderly cardiac surgery patients.

Methods: In a randomized clinical trial, 50 patients aged >75 years undergoing cardiac surgery received a balanced 6% HES 130/0.

The influence of aprotinin and tranexamic acid on platelet function and postoperative blood loss in cardiac surgery.

Background: Antifibrinolytic drugs including aprotinin and tranexamic acid are currently used in cardiac surgery to reduce postoperative bleeding and transfusion requirements, and may have different effects on platelets. We therefore evaluated platelet function after cardiopulmonary bypass (CPB) and cardiac surgery to determine the effect of either aprotinin or tranexamic acid.

Methods: In a prospective, randomized study, 50 patients scheduled for elective cardiac surgery with CPB were evaluated.

Association of N-terminal pro-brain natriuretic peptide and cardiac troponin T with in-hospital cardiac events in elderly patients undergoing coronary artery surgery.

Background And Objectives: Despite evidence of their prognostic power for non-surgical patients, the value of perioperative natriuretic peptides and cardiac troponins as markers of cardiac events is incompletely defined. This study sought to examine whether perioperative N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) levels could be used for the prediction of in-hospital cardiac events in elderly patients undergoing elective coronary artery bypass grafting.

Methods: Ninety-eight elderly patients (>75 yr) undergoing elective coronary artery bypass grafting with cardiopulmonary bypass were enrolled and followed up for 121 and 0.

Individual titration of propofol plasma target improves anaesthetic stability in patients undergoing major abdominal surgery: a comparison with manually controlled infusion.

Background And Objective: The impact of anaesthesia using target-controlled infusion with propofol on intraoperative stability, recovery and cost compared to manually controlled infusion has been evaluated with inconsistent results. We studied a new device that allows more individual titration of propofol target-controlled infusion by using the effect-site concentration at the loss of eyelash reflex to predict the maintenance infusion rate (FM-TCI).

Methods: Fifty-six patients undergoing major abdominal surgery lasting >2 h were randomly assigned to receive either FM-TCI (n = 28) or MCI-controlled (n = 28) anaesthesia.

Hepatocellular integrity in patients requiring parenteral nutrition: comparison of structured MCT/LCT vs. a standard MCT/LCT emulsion and a LCT emulsion.

Background And Objective: The aetiology of parenteral nutrition-associated hepatic injury remains unresolved. The aim of the study was to evaluate the effects of structured triglycerides in parenteral nutrition compared either to a physical medium-chain triglycerides (MCT)/long-chain triglcerides (LCT) mixture or to a LCT emulsion on hepatic integrity.

Methods: In a randomized, double-blinded trial, we studied 45 patients undergoing abdominal surgery, who were expected to receive parenteral nutrition for 5 days.

Postoperative nausea and vomiting after surgery for prognathism: not only a question of patients' comfort. A placebo-controlled comparison of dolasetron and droperidol.

Introduction: The aim of this study was to evaluate the efficacy of dolasetron and droperidol (DHB) for preventing postoperative nausea and vomiting (PONV) in patients undergoing surgery for prognathism.

Material And Methods: In a randomised, placebo-controlled, double-blind trial, the efficacy of 12.5 mg dolasetron i.

Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device.

Background: The performance of a recently introduced, arterial waveform-based device for measuring cardiac output (CO) without the need of invasive calibration (FloTrac/Vigileo) has been controversial. We designed the present study to assess the validity of an improved version of this monitoring technique compared with intermittent thermodilution CO measurement using a pulmonary artery catheter in patients undergoing cardiac surgery.

Methods: Forty ASA III patients scheduled for elective coronary artery bypass grafting with cardiopulmonary bypass (CPB) were studied.

[Continuous beta-block with esmolol in combination with enoximone: influence on cardiac function in high risk patients undergoing vascular surgery].

Background: The aim of this study was to assess cardiac function in vascular surgery patients with known coronary artery disease (CAD) who received continuous perioperative beta blocker therapy with esmolol alone versus esmolol in combination with the phosphodiesterase (PDE) III inhibitor enoximone.

Patients And Methods: Over a period of 24 h, 28 patients were assigned to receive heart rate (HR) control by continuous infusion of esmolol in combination with the PDE III inhibitor enoximone (Esmolol+Enoximone group) or esmolol alone (Esmolol group; n=14). Cardiac function was assessed by the use of a pulmonary artery catheter and serial measurements of plasma troponin T (TnT) und B-type natriuretic peptide (BNP).

Prevention of atrial fibrillation after coronary artery bypass graft surgery using a potassium-magnesium-aspartate solution (Inzolen).

Background: Atrial fibrillation (AFIB) following cardiac surgery is a frequent complication. The purpose of this study was to evaluate the efficacy of a potassium-magnesium-aspartate solution (Inzolen) for the prevention of AFIB.

Methods: In a randomised, prospective, double-blinded study, we studied 88 patients undergoing elective coronary artery bypass graft surgery (CABG).

Combined use of ultra-short acting beta-blocker esmolol and intravenous phosphodiesterase 3 inhibitor enoximone.

In patients with impaired myocardial contractility associated with downregulation of the beta-receptors, compounds inhibiting phosphodiesterase (PDE) 3 may be useful to increase contractility. The PDE3 inhibitor enoximone has been shown to improve pump-function independent from the beta-receptor pathway. A simultaneous decrease in ventricular preload and afterload by vasodilation has led to the term 'inodilator'.

Bispectral index-guided general anesthesia in combination with thoracic epidural analgesia reduces recovery time in fast-track colon surgery.

Background: The impact of bispectral index (BIS)-guided general anesthesia on recovery from general anesthesia has been evaluated in different patient populations. The benefit of using BIS has been inconsistent. We designed this study to examine the value of BIS-guided anesthesia in a fast-track setting where the goal is rapid recovery.

Influence of controlled hypotension using esmolol and sodium nitroprusside on natriuretic peptides in patients undergoing endonasal sinus surgery.

Background And Objective: Atrial and brain natriuretic peptide, synthesized by cardiac myocytes, are mediators secreted secondary to cardiac volume expansion and increased filling pressure. The study was designed to assess serum concentration of atrial and brain natriuretic peptide in patients undergoing endonasal sinus surgery receiving controlled hypotension.

Methods: We studied 45 patients without cardiovascular history, scheduled for elective endonasal sinus surgery.