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ObjectiveDespite evidence that preoperative aspirin improves outcomes in cardiac surgery, recommendations for aspirin use are inconsistent due to aspirin’s anti-platelet effect and concern for bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on bleeding and transfusion in cardiac surgery.MethodsThis retrospective study involved consecutive patients (n=1571) who underwent CABG, valve, or combined CABG and valve surgery at a single center between March 2007 and July 2012. Of all patients, 728 met the inclusion criteria and were divided into two groups: those using (n=603) or not using (n=125) aspirin within 5 days of surgery. Data were collected on chest tube drainage, re-operation for bleeding, and transfusion of red blood cells (RBCs), fresh frozen plasma (FFP), and platelets.ResultsNo significant difference was observed between the two groups in chest tube drainage or re-operation for bleeding. An increase in patients transfused with RBCs was observed in the aspirin group (61.9 vs 51.2%, adjusted OR 1.77, p=0.027); however, among those transfused RBCs, no significant difference in mean units transfused or massive transfusion was observed. No significant difference was seen in transfusion requirement of FFP or platelets.ConclusionsIn patients undergoing CABG, valve, or combined CABG/valve surgery, preoperative aspirin, within 5 days of surgery, was associated with an increased probability of receiving an RBC transfusion. Preoperative aspirin was not associated with an increase in chest tube drainage, re-operation for bleeding complications, or transfusion of FFP or platelets.

Aim of review:Diabetes is a chronic and slowly progressing disease that has a tendency to develop rapidly deteriorating complications such as major adverse cardiovascular events (MACE), especially under the stress of surgery. While clinical strategy to prevent MACE is controversial and uncertain. Method: We conducted a comprehensive review of current clinical strategies in preventing perioperative MACE, in particularly related to diabetic patients. Results: The major findings are: 1) Current clinical studies have demonstrated that coronary artery bypass graft (CABG) is still a better therapy than percutaneous coronary intervention (PCI) on the ground of reducing repeat revascularization, myocardial infarction and death for most diabetic patients with left main-stem and multivessel coronary artery disease who require revascularization, however, it remains to be studied whether coronary revascularization before noncardiac surgery can protect diabetic patients from MACE; 2) There is lack of evidence that intensive or "tight" glycemic control perioperatively can reduce MACE, instead, a moderate or less stringent glucose management probably is safer for patients undergoing surgery;3) The recent results of clinical trials on beta-blockers appear to be disappointing in preventing MACE in surgical patients, including diabetic patients. Meanwhile, the perioperative therapy with statins, angiotensin-converting enzyme inhibitors or multifactorial interventions is promising in preventing MACE in diabetic patients. Summary: Further studies targeted at preventing MACE in diabetic patients undergoing surgery are needed in order to fight this major health problem in perioperative medicine. ABSTRACT

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It has been demonstrated in the literature that with 20 years of experience, the percutaneous dilational tracheotomy procedure is more affordable, faster to perform, and a generally safe procedure when performed under appropriate conditions. Most case series of percutaneous dilational tracheotomy reveal an equal or lower risk of short-term complications than open tracheotomy. This series demonstrates that tracheal stenosis is a potential long-term complication. Longitudinal follow-up of patients undergoing percutaneous dilational tracheotomy is indicated.

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