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High-risk Surgery (high-risk + surgery)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Nontransplant Surgical Options for Congestive Heart Failure

CONGESTIVE HEART FAILURE, Issue 1 2003
Aftab R. Kherani MD
A wide array of surgical options are currently available for the treatment of congestive heart failure ranging from traditional coronary artery bypass grafting to total artificial heart implantation. The indications for each procedure depend on the severity of disease and the individual patient's desires. Some surgical options are indicated for patients with moderate disease and prevent worsening heart failure, whereas other procedures are limited to patients who will only survive with high-risk surgery. Ongoing technologic advances are increasing the number of patients that benefit from the reparative surgical treatment of congestive heart failure. [source]

Impaired glucose regulation, elevated glycated haemoglobin and cardiac ischaemic events in vascular surgery patients

DIABETIC MEDICINE, Issue 3 2008
H. H. H. Feringa
Abstract Aims Cardiac morbidity and mortality is high in patients undergoing high-risk surgery. This study investigated whether impaired glucose regulation and elevated glycated haemoglobin (HbA1c) levels are associated with increased cardiac ischaemic events in vascular surgery patients. Methods Baseline glucose and HbA1c were measured in 401 vascular surgery patients. Glucose < 5.6 mmol/l was defined as normal. Fasting glucose 5.6,7.0 mmol/l or random glucose 5.6,11.1 mmol/l was defined as impaired glucose regulation. Fasting glucose , 7.0 or random glucose , 11.1 mmol/l was defined as diabetes. Perioperative ischaemia was identified by 72-h Holter monitoring. Troponin T was measured on days 1, 3 and 7 and before discharge. Cardiac death or Q-wave myocardial infarction was noted at 30-day and longer-term follow-up (mean 2.5 years). Results Mean (± sd) level for glucose was 6.3 ± 2.3 mmol/l and for HbA1c 6.2 ± 1.3%. Ischaemia, troponin release, 30-day and long-term cardiac events occurred in 27, 22, 6 and 17%, respectively. Using subjects with normal glucose levels as the reference category, multivariate analysis revealed that patients with impaired glucose regulation and diabetes were at 2.2- and 2.6-fold increased risk of ischaemia, 3.8- and 3.9-fold for troponin release, 4.3- and 4.8-fold for 30-day cardiac events and 1.9- and 3.1-fold for long-term cardiac events. Patients with HbA1c > 7.0% (n = 63, 16%) were at 2.8-fold, 2.1-fold, 5.3-fold and 5.6-fold increased risk for ischaemia, troponin release, 30-day and long-term cardiac events, respectively. Conclusions Impaired glucose regulation and elevated HbA1c are risk factors for cardiac ischaemic events in vascular surgery patients. [source]

Functional intravascular volume deficit in patients before surgery

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010
M. BUNDGAARD-NIELSEN
Background: Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal-directed therapy, improves outcome in high-risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients. Methods: Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20), or open major abdominal surgery (n=20) were anaesthetized, and before the start of surgery, a 200 ml colloid fluid challenge was provided and repeated if a ,10% increment in SV estimated by oesophageal Doppler was established. The volume needed for SV maximization defined the intravascular volume deficit. Results: Forty-two (70%) of the patients needed volume to establish a maximal SV. For the patients needing volume, the required amount was median 200 ml (range 200,600 ml), with no significant difference between the three groups of patients. The required volume was ,400 ml in nine patients (15%). Conclusion: The majority of anaesthetized patients present with a functional intravascular volume deficit before surgery. Although the deficit in general was minor, a fraction of patients presented with a deficit that may be of clinical relevance, emphasizing the importance of the individual approach of goal-directed fluid therapy. [source]

Comparison of calibrated and uncalibrated arterial pressure,based cardiac output monitors during orthotopic liver transplantation,

LIVER TRANSPLANTATION, Issue 6 2010
Vladimir Krejci
Arterial pressure,based cardiac output monitors (APCOs) are increasingly used as alternatives to thermodilution. Validation of these evolving technologies in high-risk surgery is still ongoing. In liver transplantation, FloTrac-Vigileo (Edwards Lifesciences) has limited correlation with thermodilution, whereas LiDCO Plus (LiDCO Ltd.) has not been tested intraoperatively. Our goal was to directly compare the 2 proprietary APCO algorithms as alternatives to pulmonary artery catheter thermodilution in orthotopic liver transplantation (OLT). The cardiac index (CI) was measured simultaneously in 20 OLT patients at prospectively defined surgical landmarks with the LiDCO Plus monitor (CIL) and the FloTrac-Vigileo monitor (CIV). LiDCO Plus was calibrated according to the manufacturer's instructions. FloTrac-Vigileo did not require calibration. The reference CI was derived from pulmonary artery catheter intermittent thermodilution (CITD). CIV -CITD bias ranged from ,1.38 (95% confidence interval = ,2.02 to ,0.75 L/minute/m2, P = 0.02) to ,2.51 L/minute/m2 (95% confidence interval = ,3.36 to ,1.65 L/minute/m2, P < 0.001), and CIL -CITD bias ranged from ,0.65 (95% confidence interval = ,1.29 to ,0.01 L/minute/m2, P = 0.047) to ,1.48 L/minute/m2 (95% confidence interval = ,2.37 to ,0.60 L/minute/m2, P < 0.01). For both APCOs, bias to CITD was correlated with the systemic vascular resistance index, with a stronger dependence for FloTrac-Vigileo. The capability of the APCOs for tracking changes in CITD was assessed with a 4-quadrant plot for directional changes and with receiver operating characteristic curves for specificity and sensitivity. The performance of both APCOs was poor in detecting increases and fair in detecting decreases in CITD. In conclusion, the calibrated and uncalibrated APCOs perform differently during OLT. Although the calibrated APCO is less influenced by changes in the systemic vascular resistance, neither device can be used interchangeably with thermodilution to monitor cardiac output during liver transplantation. Liver Transpl 16:773-782, 2010. © 2010 AASLD. [source]