Influence of Diabetes Mellitus on the Results of Coronary Bypass Surgery
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Abstract:
To determine the long-term influence of the severity of preoperative diabetes mellitus on the results of coronary bypass, a review was made of 212 diabetics operated on between 1968 and 1973, of whom 87 patients (41%) were receiving no drugs, 108 patients (50.9%) were receiving oral hypoglycemic agents, and 17 patients (8%) were receiving insulin. They were compared with 1,222 nondiabetic patients operated on over the same period. Perioperative mortality was similar in the diabetics and nondiabetics: 7.1% vs 4.5%. Improvement in anginal symptoms was similar in all patient groups: 85.9% to 92.7%. Overall 15-year survival probability was .53 for the nondiabetic group, .43 for the diabetics not receiving drugs, .33 for those receiving oral agents, and .19 for the insulin-treated patients. Late graft patency ranged from 78% to 90% and was comparable in all groups. The preoperative blood glucose level was an important predictor of late mortality in all diabetic patients. Thus, coronary bypass surgery was effective in all groups of diabetic patients in long-term relief of anginal symptoms. Intermediate-term survival rates were good in all groups, but the initial severity of the diabetes was an important determinant of long-term survival rates.Keywords:
Bypass surgery
Section 1. Core issues.Ch 1. Perioperative homeostasis.Ch 2. Managing perioperative equipment.Ch 3. Perioperative pharmacology.Ch 4. Perioperative communication.Ch 5. Managing Perioperative risks.Section 2. Perioperative Care.Ch 6. Preoperative Assessment of Perioperative Patients.Ch 7. Anaesthetic Skills.Ch 8. Surgical Skills.Ch 9. Recovery Skills
Perioperative nursing
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Statins are frequently used as chronic therapy for reducing cardiovascular mortality and morbidity, but there has been less emphasis on the role of statins in the perioperative period. This review evaluates data regarding statin use in vascular and noncardiac surgery, the use of statins in combination with β-blockers in the perioperative period, perioperative statin use in patients already treated with statins, and the safety of statin therapy in the perioperative period. Current recommendations state that patients who are prescribed statins as chronic therapy should continue treatment in the perioperative period, but data suggest that there may be benefit from the use of perioperative statins in a wider population.
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Abstract Background: The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries. Aim: To evaluate perioperative complications rate, mortality related to complications, different patients’ demographics, and procedural risk factors for perioperative complication and post-operative death. Methods: Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery. Results: Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality – 8.1% among patients with only 1 perioperative complication, 35.3% – with 2 perioperative complications, and 42.1% – with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37). Conclusions: In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.
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Background
Blood glucose is the main energy source of human body. Many perioperative factors can cause significant change of blood glucose levels, which lead to poor prognosis and even increase mortality.
Objective
To make a elaboration and a further understanding of the related research reports about the influence of perioperative blood glucose status and its change on prognosis.
Content
This review systematically summarized the definitions of different perioperative blood glucose status and the impact of it on patients′ prognosis and analyzed the reasonable program of perioperative blood glucose management.
Trend
The perioperative blood glucose status and its change are closely related to patients′ prognosis. Therefore, taking effective measures to monitor, regulate perioperative blood glucose changes and maintain stable blood glucose level will help to achieve rapid postoperative recovery.
Key words:
Perioperative period; Blood glucose; Prognosis
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Perioperative beta-blocker therapy has been considered a mainstay of perioperative cardioprotection in patients with or at risk of coronary artery diseases. However, current recommendations for perioperative beta blockade are based mainly on the findings of trials with inadequate methodology and data analysis. The recently published results of the first adequately powered large controlled randomized trial on the efficacy and safety of perioperative beta-blocker therapy confirmed the benefit of such therapy on the perioperative incidence of non-fatal myocardial infarctions. However, such a benefit occurred at the expense of increased total mortality and increased incidence of stroke, negating any beneficial effect. A subsequently published meta-analysis confirmed, in large part, these findings. Given these recent publications, most of the current recommendations for perioperative beta-blocker therapy are no longer supported by evidence, therefore respective revision is needed.
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Beta blocker
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Massive perioperative allogeneic blood transfusion, that is, perioperative transfusion of more than 10 units of packed red blood cells (pRBC), is one of the main contributors to perioperative morbidity and mortality in cardiac surgery. Prediction of perioperative blood transfusion might enable preemptive treatment strategies to reduce risk and improve patient outcomes while reducing resource utilisation. We, therefore, investigated the precision of five different machine learning algorithms to predict the occurrence of massive perioperative allogeneic blood transfusion in cardiac surgery at our centre.Is it possible to predict massive perioperative allogeneic blood transfusion using machine learning?Retrospective, observational study.Single adult cardiac surgery centre in Austria between 01 January 2010 and 31 December 2019.Patients undergoing cardiac surgery.Primary outcome measures were the number of patients receiving at least 10 units pRBC, the area under the curve for the receiver operating characteristics curve, the F1 score, and the negative-predictive (NPV) and positive-predictive values (PPV) of the five machine learning algorithms used to predict massive perioperative allogeneic blood transfusion.A total of 3782 (1124 female:) patients were enrolled and 139 received at least 10 pRBC units. Using all features available at hospital admission, massive perioperative allogeneic blood transfusion could be excluded rather accurately. The best area under the curve was achieved by Random Forests: 0.810 (0.76 to 0.86) with high NPV of 0.99). This was still true using only the eight most important features [area under the curve 0.800 (0.75 to 0.85)].Machine learning models may provide clinical decision support as to which patients to focus on for perioperative preventive treatment in order to preemptively reduce massive perioperative allogeneic blood transfusion by predicting, which patients are not at risk.Johannes Kepler University Ethics Committee Study Number 1091/2021, Clinicaltrials.gov identifier NCT04856618.
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Various exogenous steroid preparations have been in use for a wide range of indications. We, as an anesthesiologist often encounters a surgical patient receiving chronic steroid therapy. Perioperative use of steroid is associated with major complications such as full-blown adrenal crisis in the perioperative period due to the secondary adrenal insufficiency. Henceforth, comes the role of the perioperative "stress-dose" of steroids to mitigate this rare but potentially fatal complication. There have been opposing views regarding the need and the appropriate dosage of the perioperative steroids. The present review discusses the changing concept of perioperative "stress dose" of corticosteroids, its pharmacokinetics, clinical relevance, and the related controversies such as the need and the appropriate dose.
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Background
Perioperative stroke can be a catastrophic complication for surgical patients. Compared with patients without stroke, the length of hospital stay of these patients were significantly prolonged, the quality of life and survival rate obviously reduced, the prognosis is seriously worse.
Objective
To help clinical anesthesiologist comprehensively understand perioperative stroke in order to identify the patients with high risk in advance, and take corresponding measures to reduce the incidence of perioperative stroke.
Content
This article introduces the definition of perioperative stroke, risk factors, morbidity and mortality, mechanism, and the perioperative management measures reducing the risk.
Trend
Further reseach about the perioperative stroke required to help high-risk patients survive from the perioperative stroke.
Key words:
Stroke; Perioperative; Cerebrovascular accident; Noncardiovascular surgery
Stroke
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