Perioperative Medication Management in Adult Cardiac Surgery: The 2017 European Association for Cardio-Thoracic Surgery Guidelines

Milojevic, Milan; Pisano, Antonio; Sousa-Uva, Miguel; Landoni, Giovanni

doi:10.1053/j.jvca.2018.09.029

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…190 Moreover, safety concerns, or at least the practical issues related to the timing of insertion/removal of the catheter, may be exacerbated in the current era in which an aggressive antithrombotic regimen (eg, with early postoperative dual-antiplatelet therapy) is increasingly recommended in the perioperative period. 14 The use of peripheral nerve blocks, such as ultrasoundguided paravertebral block or erector spinae plane block, 197,198 as an alternative to central neuraxial techniques for multimodal anesthesia/analgesia in cardiac surgery, could carry fewer safety issues and is a potential area of future interest within the research field investigating the effect of anesthesia on postoperative outcomes, particularly in consideration of the emerging minimally invasive (eg, thoracotomy) cardiac surgery techniques.…”

Section: Effect On Outcomes Of Neuraxial Anesthesia/analgesia As An Amentioning

confidence: 99%

“…[11][12][13] However, there is growing evidence that also optimizing perioperative care may improve outcomes significantly. 2,14 The potential role of anesthesia (and of the anesthesiologist) in influencing outcome, particularly mortality, after cardiac surgery has been suggested since the mid-1980s. 15 Although the results of recent investigations 12,13 may lead to the opposite, and simplistic, conclusion that "the anesthesiologist makes no difference," there are plenty of reasons for the inability of such investigations to highlight a difference in outcome according to the individual attending cardiac anesthesiologist.…”

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confidence: 99%

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The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Pisano

Torella

Yavorovskiy

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Effect On Outcomes Of Neuraxial Anesthesia/analgesia As An Amentioning

confidence: 99%

mentioning

confidence: 99%

The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Pisano

Torella

Yavorovskiy

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

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“…Систематизировали и проанализировали следующие данные: возраст, пол, рост, масса тела, скорость клубочковой фильтрации, фракция изгнания левого желудочка, недавний прием антиагрегантов [25], плохая мобильность и тяжесть предоперационного состояния пациентов (согласно критериям E-CABG [26] Методы статистического анализа. Для каждого пациента рассчитали значение номограммы М (табл.…”

Section: материал и методыunclassified

Risk Assessment of Hemodynamically Significant Arrhythmias after Elective Cardiac Operations with Cardiopulmonary Bypass Using the Modified Nomogram (Retrospective Study)

Берикашвили

Yadgarov

Герасименко

et al. 2021

Obŝaâ reanimatologiâ

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Aim of the study was to evaluate the feasibility of using a modified nomogram (the M nomogram) to predict the occurrence of new postoperative hemodynamically significant arrhythmias after elective cardiac surgery with cardiopulmonary bypass within 30 days post operation.Materials and methods. This was a retrospective cohort study. The prognostic value of the model using ROC-analysis of the modified nomogram was estimated based on the medical records of 144 patients who underwent elective cardiac surgery with cardiopulmonary bypass.Results. The incidence of new postoperative hemodynamically significant arrhythmias was 13.9% (20 of 144 patients). For the modified nomogram, the AUC was 0.777 [95% CI: 0.661–0.892] (P<0.001); at a cutoff of 12 points, the sensitivity was 60.0% and specificity was 89.52%. The odds ratio was 10.26 (95% CI: 3.63–29.06) (P<0.001). Conclusion. The modified nomogram has an acceptable prognostic value for the occurrence of new hemodynamically significant arrhythmias after elective cardiac operations with cardiopulmonary bypass based on AUC 0.777 [0.661–0.892] (P<0.001), and is currently the best model for predicting the outcome.

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“…5,6,[9][10][11][12] A lack of clear medication guidelines leaves treatment decisions up to clinical experience, findings from small observational studies, and extrapolation from adult data rather than relying on robust clinical trial evidence. 13,14 This exponentiates variation in post-operative medical management, and the lack of definitive data to support medication use puts children at risk for adverse events and denies them potential therapeutic benefits. [15][16][17] Clear medication guidelines may help minimise practice variation and ultimately improve the quality of care these children receive.Drug trials in critically ill infants and children with CHD are challenging due to a limited number of eligible patients and the need to address substantial pathophysiologic and age-related variability in drug disposition, efficacy, and safety.…”

mentioning

confidence: 99%

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

et al. 2021

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Background: Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass. Methods: We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass. Results: We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety. Conclusion: In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

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Perioperative Medication Management in Adult Cardiac Surgery: The 2017 European Association for Cardio-Thoracic Surgery Guidelines

Cited by 6 publications

References 31 publications

The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

Risk Assessment of Hemodynamically Significant Arrhythmias after Elective Cardiac Operations with Cardiopulmonary Bypass Using the Modified Nomogram (Retrospective Study)

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

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