Background
Trimetazidine (TMZ) pretreatment protects cardiomyocytes during cardiac surgery. TMZ may protect elderly patients with ischaemic heart disease (IHD) undergoing non-cardiac surgery.
Methods
This was a randomized, double-blind, placebo-controlled trial (registration #ChiCTR1900025018) of patients with IHD scheduled to undergo non-cardiac surgery at Shenzhen People’s Hospital (Shenzhen, Guangdong Province, China) between June 2014 and September 2015, randomized to 60 mg TMZ or placebo 12 h before surgery. The primary endpoint was the occurrence of in-hospital cardiovascular events. The secondary endpoints were myocardial ischaemia on five-lead electrocardiogram (cECG), cardiac troponin I (cTnI) elevation, cardiac death, acute coronary events, heart failure, and arrhythmia requiring treatments.
Results
Compared with the placebo group, the TMZ group showed a lower occurrence of in-hospital cardiovascular events (primary endpoint, 20.0% vs. 37.5%, P = 0.02), myocardial ischaemia (15.0% vs. 32.5%, P < 0.01), cTnI elevation (2.5% vs. 10%, P < 0.01), acute coronary events (10.0% vs. 20.0%, P < 0.05), heart failure (0% vs. 2.5%, P < 0.05), and arrhythmia requiring treatment (17.5% vs. 35.0%, P < 0.05). There was no acute myocardial infarction during the 30-day postoperative period.
Conclusions
In elderly patients with IHD undergoing non-cardiac surgery, TMZ pretreatment was associated with myocardial protective effects.
Trial registration The trial was prospectively registered at http://www.chictr.org.cn/showproj.aspx?proj=41909 with registration number [ChiCTR1900025018] (7/8/2019).
Background: Patients undergoing emergency surgery often experience fluid depletion. Therefore, it is critical to use an efficient emergency preoperative blood volume assessment method. Based on current ultrasound assessment, a new method for ultrasound diagnosis and treatment, called Dai's preoperative ultrasound assessment (DPUA), has been developed. Three cardiovascular ultrasound views of DPUA include apical four-chamber, parasternal long-axis, and subxiphoid inferior vena cava views. Data of cardiovascular ultrasound slices correspond to volume conversion and fluid rehydration protocol ultrasound integration algorithm, which can be used to guide volume management in emergency surgery patients.
Methods: This trial was a single-center randomized controlled study whose subjects were 60 patients undergoing emergency general anesthesia with no one dropped out. They were divided into experience group and ultrasound group. In experience group, patient volume status was assessed through blood pressure, heart rate, and fluid supplementation for patients based on the personal experience of anesthesiologists. In ultrasound group, the anesthesiologist chose different rehydration solutions through DPUA.
Results: The main outcome indicator of this study was the stability of the circulatory blood pressure, which was mainly reflected in the comparison of the average arterial pressure at different times. The difference in the mean arterial pressure at the beginning of surgery was statistically significant (P=0.003**), and blood pressure fluctuation in ultrasound group was smaller than that in experience group, indicating that DPUA maintained better stability of the volume at the beginning of the operation. The experience group used more crystalloids within 30 min of choosing the fluid replacement regimen, and the ultrasound group used more colloids (P=0.036*).
Conclusions: Preoperative ultrasound assessment of the DPUA could effectively and accurately assess the patient's cardiac function and volume status, as well as better guide perioperative fluid management.
Trial registration: Registration number: ClinicalTrials.gov ID NCT04111783. First registered on 01/10/2019, https://clinicaltrials.gov/.
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