Identifying optimal heparin management during cardiopulmonary bypass in obese patients

Haas, Emmanuel; Fischer, F; Lévy, François; Degirmenci, S.-E.; Grunebaum, Lélia; Kindo, Michel; Collange, Olivier; Mertès, Paul-Michel; Steib, A.

doi:10.1097/eja.0000000000000431

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…The majority of studies retrieved concerned the cardiovascular (n = 14) [9][10][11][12][13][14][15][16][17][18][19][20][21][22], respiratory (n = 7) [23][24][25][26][27][28][29], and neurological (n = 9) [30][31][32][33][34][35][36][37] systems. Two pertained to point-of-care testing [38,39]. These were tabulated according to theme (Tables 1, 2, 3, 4, 5, 6, 7, 8, 9, hereafter).…”

Section: Resultsmentioning

confidence: 99%

“…Obesity is associated with physiological and anthropometric changes that alter the pharmacokinetics of most drugs. As our focus was on intraoperative monitoring, we included two studies (Table 9 ) [ 38 , 39 ] which looked at point-of-care testing and heparin dosing in obesity. In the context of extracorporeal circulation, point-of-care testing (activated clotting time) did not reliably detect the excessively high plasma heparin concentrations often achieved in the obese patient dosed according to total body weight.…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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With the increasing prevalence of obesity in the population, anaesthetists must confidently manage both the pathophysiological and technical challenges presented in bariatric and non-bariatric surgery. The intraoperative period represents an important opportunity to optimise and mitigate risk. However, there is little formal guidance on what intraoperative monitoring techniques should be used in this population. This narrative review collates the existing evidence for intraoperative monitoring devices in the obese patients. Although a number of non-invasive blood pressure monitors have been tested, an invasive arterial line remains the most reliable monitor if accurate, continuous monitoring is required. Goal-directed fluid therapy is recommended by clinical practice guidelines, but the methods tested to assess this had guarded applicability to the obese population. Transcutaneous carbon dioxide (CO 2 ) monitoring may offer additional benefit to standard capnography in this population. Individually titrated positive end expiratory pressure (PEEP) and recruitment manoeuvres improved intraoperative mechanics but yielded no benefit in the immediate postoperative period. Depth of anaesthesia monitoring appears to be beneficial in the perioperative period regarding recovery times and complications. Objective confirmation of reversal of neuromuscular blockade continues to be a central tenet of anaesthesia practice, particularly relevant to this group who have been characterised as an “at risk” extubation group. Where deep neuromuscular blockade is used, continuous neuromuscular blockade is suggested. Both obesity and the intraoperative context represent somewhat unstable search terms, as the clinical implications of the obesity phenotype are not uniform, and the type and urgency of surgery have significant impact on the intraoperative setting. This renders the generation of summary conclusions around what intraoperative monitoring techniques are suitable in this population highly challenging.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

et al. 2021

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“…Moreover, the excess of heparin in that plateau phase, which is responsible for the increased perioperative bleeding, cannot be accurately assessed by ACT. [13] It is stated in the EACTA/EACTS 2017 guidelines that the most optimal follow-up would be achieved with heparin blood level, not with ACT. [14] Protamine administration is another important issue and dependent on heparin dose.…”

Section: Discussionmentioning

confidence: 99%

Heparin dose calculated according to lean body weight during on-pump heart surgery

Aykut

Sabuncu

Demir

et al. 2018

Turk Gogus Kalp Dama

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Bu çalışmada geleneksel heparin rejimi ile yağsız vücut ağırlığına göre hesaplanan heparin doz rejimi yeterli antikoagülasyonun sağlanması ve perioperatif kanama ile ilişkili komplikasyonlar açısından karşılaştırıldı. Ça lış ma pla nı: Bu prospektif, tek kör, randomize çalışmaya Haziran 2016-Ocak 2017 tarihleri arasında kardiyopulmoner baypas ile elektif kapak ameliyatı yapılan toplam 100 erişkin hasta (42 erkek, 58 kadın; ort. yaş 52.7 yıl; dağılım, 22-84 yıl) alındı. Kardiyopulmoner baypas öncesinde heparin dozu, aktüel vücut ağırlığına göre (n=50) ve yağsız vücut ağırlığına göre (n=50) olmak üzere 4 mg/kg olarak ayarlandı. Kardiyopulmoner baypasa başlanması için minimum aktive pıhtılaşma zamanı hedef değeri 480 sn. olarak kabul edildi. Demografik ve hemodinamik veriler, heparin sonrası aktive pıhtılaşma zamanı, ek heparin ve perioperatif transfüzyon, ameliyat sonrası drenaj miktarları, yeniden ameliyatlar ve mortalite kaydedildi. Bul gu lar: Demografik veriler, kros klemp ve kardiyopulmoner baypas süreleri ve ameliyat sırası transfüzyon ihtiyacı gruplar arasında anlamlı düzeyde farklı değildi. Heparinin başlangıç ve toplam dozlarının yanı sıra toplam protamin dozu, aktüel vücut ağırlığı grubunda anlamlı düzeyde daha yüksekti. Ameliyat sonrası transfüzyon oranları da, bu grupta daha yüksekti. Yağsız vücut ağırlığı grubunda hiçbir hastada yeniden ameliyat gerekli olmaz iken, aktüel vücut ağırlığı grubunda üç hasta yeniden ameliyat edildi. So nuç: Çalışma sonuçlarımız kardiyopulmoner baypas sırasında yağsız vücut ağırlığına göre hesaplanan heparin doz titrasyonu ile yeterli antikoagülasyon sağlanabileceğini ve toplam heparin ve protamin dozlarının düşürülmesi ile ameliyat sonrası kanama ve kan ürünü transfüzyonu gereksinimin azaltılabileceğini göstermiştir. Anah tarsöz cük ler: Aktüel vücut ağırlığı; kan yönetimi; kardiyak anestezi; kalp cerrahisi; kardiyopulmoner baypas; heparin; yağsız vücut ağırlığı; protamin; tamponad.

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Identifying optimal heparin management during cardiopulmonary bypass in Chinese people: a retrospective observational comparative study

Gan

Yang

Mei

et al. 2019

J Thromb Thrombolysis

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Identifying optimal heparin management during cardiopulmonary bypass in obese patients

Cited by 6 publications

References 29 publications

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

Heparin dose calculated according to lean body weight during on-pump heart surgery

Identifying optimal heparin management during cardiopulmonary bypass in Chinese people: a retrospective observational comparative study

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