Background: Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.Methods: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.
Results:The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P ¼ .27), and this did not significantly differ according to aspirin exposure at the time of surgery (interaction P ¼ .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P ¼ .053).
Conclusions:In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.
Background:Apneic oxygenation by insufflating O2 through nasal prongs (NP) and nasopharyngeal catheter (NC) has been proven to be effective. We conducted this study to compare the relative efficacy of these two techniques in a simulated difficult airway situation.Objective:The objective of this study is to evaluate the influence of two techniques of apneic oxygenation (NP vs. NC) on the duration of oxygen saturation ≥95% during simulated prolonged difficult laryngoscopy.Methods:A randomized non-blinded study was conducted in 56 adult patients, 28 in each group belonging to American Society of Anesthesiologists physical status class I and II scheduled for elective surgical procedures under general endotracheal anesthesia randomized to either NC or NP group. After pre-oxygenating for an end tidal oxygen concentration of 90% and induction, ability to mask ventilate was checked and paralyzed with rocuronium. Apneic oxygenation using 5 L/min of O2 was established either by NP or NC. After laryngoscopy the laryngoscope was withdrawn to simulate a Grade 4 laryngoscopy and held in this position for an apnea time (T1) of 10 min with SpO2 maintained at ≥95% or until SpO2 dropped to < 95%, whichever is earlier. An arterial blood gas analysis was performed at the end of T1. Desaturation to < 95% were compared between the groups using Chi-square test (P < 0.05 as significant). Arterial blood gas analysis among those who sustained T1 for 10 min between the groups were compared using independent sample t-test (P < 0.05 was considered as significant). None of patients were excluded from the study.Results:In NP group nine patients desaturated as against none in the NC group (P = 0.001). Arterial blood gas analysis among non-desaturated patients was comparable with respect to PO2, PCO2 and pH.Conclusion:Nasopharyngeal catheter is a better device than nasal prongs in maintaining safe oxygenation during apnea in a simulated prolonged difficult laryngoscopy.
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