USING BETA-BLOCKERS TO CUT PERIOPERATIVE RISK IN CAD Cardioprotective strategies for noncardiac surgery Prophylactic use of beta-blockers, illustrated here in four cases, is a relatively simple and low-cost way of preventing perioperative adverse events.

2005 ◽  
Vol 118 (6) ◽  
Author(s):  
Archana Roy ◽  
Vivek Roy
Keyword(s):  
Adverse Events ◽  
Beta Blockers ◽  
Low Cost ◽  
Noncardiac Surgery ◽  
Perioperative Risk ◽  
Prophylactic Use

scholarly journals Preoperative and Intraoperative Predictors of Cardiac Adverse Events after General, Vascular, and Urological Surgery

2009 ◽  
Vol 110 (1) ◽  
pp. 58-66 ◽  
Author(s):  
Sachin Kheterpal ◽  
Michael O’Reilly ◽  
Michael J. Englesbe ◽  
Andrew L. Rosenberg ◽  
Amy M. Shanks ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mean Arterial Pressure ◽  
Adverse Events ◽  
Arterial Pressure ◽  
Univariate Analysis ◽  
Noncardiac Surgery ◽  
University Hospital ◽  
Improvement Program ◽  
Urological Surgery ◽  
Cardiac Adverse Events

Background The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data. Methods The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included. The CAE outcome definition included cardiac arrest, non-ST elevation myocardial infarction, Q-wave myocardial infarction, and new clinically significant cardiac dysrhythmia within the first 30 postoperative days. Results Four years of data demonstrated that of 7,740 noncardiac operations, 83 patients (1.1%) experienced a CAE within 30 days. Nine independent predictors were identified (P < or = 0.05): age > or = 68, body mass index > or = 30, emergent surgery, previous coronary intervention or cardiac surgery, active congestive heart failure, cerebrovascular disease, hypertension, operative duration > or = 3.8 h, and the administration of 1 or more units of packed red blood cells intraoperatively. The c-statistic of this model was 0.81 +/- 0.02. Univariate analysis demonstrated that high-risk patients experiencing a CAE were more likely to experience an episode of mean arterial pressure < 50 mmHg (6% vs. 24%, P = 0.02), experience an episode of 40% decrease in mean arterial pressure (26% vs. 53%, P = 0.01), and an episode of heart rate > 100 (22% vs. 34%, P = 0.05). Conclusions In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery.

Safety and Efficacy of the Cyclooxygenase-2 Inhibitors Parecoxib and Valdecoxib after Noncardiac Surgery

2006 ◽  
Vol 104 (3) ◽  
pp. 518-526 ◽  
Author(s):  
Nancy A. Nussmeier ◽  
Andrew A. Whelton ◽  
Mark T. Brown ◽  
Girish P. Joshi ◽  
Richard M. Langford ◽  
...  
Keyword(s):  
Adverse Events ◽  
Artery Bypass ◽  
Opioid Analgesic ◽  
Analgesic Efficacy ◽  
Noncardiac Surgery ◽  
Double Blind ◽  
Related Symptom ◽  
Pain Ratings ◽  
Gastroduodenal Ulceration

Background Valdecoxib and its intravenous prodrug parecoxib are reported to increase thromboembolic risk after coronary artery bypass grafting. The authors conducted a randomized trial to examine their safety and analgesic efficacy in patients recovering from major noncardiac surgical procedures. Methods The trial was randomized and double-blind, with 10 days of treatment and 30 days of follow-up. Patients (n = 1,062) received either parenteral parecoxib for 3 days and oral valdecoxib for the rest of the treatment period or placebo medications throughout. The frequency of predefined adjudicated postrandomization adverse events, including cardiovascular thromboembolism, renal dysfunction, gastroduodenal ulceration, and wound-healing complications, was assessed in each group. Secondary efficacy endpoints included patients' pain ratings, opioid analgesic consumption (recorded as morphine equivalents), and reports of opioid-related adverse effects. Results Predefined adjudicated adverse events had similar frequencies among patients who received parecoxib and valdecoxib (2.7%) and placebo patients (3.2%) (P = 0.58), including cardiovascular thromboembolic events (1.0% in each group; P = 1.0). Placebo patients consumed more morphine equivalents (66.2 +/- 92.4 mg) than did patients receiving parecoxib and valdecoxib (43.2 +/- 65.7 mg) (P < 0.001). Placebo patients had higher mean pain ratings on each of study days 2-10 (P < 0.01) and reported more opioid-related symptom distress on days 2-6 (P < 0.01). Conclusions Parecoxib and valdecoxib are useful adjuncts to opioids for the treatment of postoperative pain in noncardiac surgical patients. Further study will be required to determine the safety profile of parecoxib and valdecoxib administered to patients with known atherosclerotic disease after noncardiac surgery.

scholarly journals Beta-blockers in noncardiac surgery: Did observational studies put us back on safe ground?

2018 ◽  
Vol 121 (1) ◽  
pp. 16-25 ◽  
Author(s):  
M.E. Jørgensen ◽  
C. Andersson ◽  
S. Venkatesan ◽  
R.D. Sanders
Keyword(s):  
Observational Studies ◽  
Beta Blockers ◽  
Noncardiac Surgery

Abstract 12444: Outcomes After Starting Beta-Blockade Within a Clinically Sensible Period Before Major Elective Noncardiac Surgery

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Duminda N Wijeysundera ◽  
Dennis T Ko ◽  
Harindra C Wijeysundera ◽  
Lingsong Yun ◽  
W. Scott Beattie
Keyword(s):  
Cohort Study ◽  
Beta Blockers ◽  
Risk Index ◽  
Cardiac Risk ◽  
Population Based ◽  
Noncardiac Surgery ◽  
Beta Blockade ◽  
Matched Cohort ◽  
Post Surgery ◽  
Median Daily Dose

INTRODUCTION: Guidelines recommend that perioperative beta-blockade be started days to weeks before surgery. Nonetheless, all randomized trials except for the controversial DECREASE trials started treatment ≤1 day before surgery, while most observational studies did not distinguish between long-term beta-blockade versus beta-blockers started for perioperative reasons. We thus conducted a population-based cohort study of the effectiveness of beta-blockade started within a clinically sensible period (8-60 days) before surgery. METHODS: Following research ethics approval, we conducted a cohort study of patients (≥66 years) who underwent major elective noncardiac surgery from 2003 and 2012 in Ontario, Canada. Propensity-score methods were used to form a matched cohort that reduced important differences between patients who started beta-blockers 8-60 days before surgery versus controls (no beta-blockers within 1 year before surgery). We measured the association of beta-blockade with 30-day (death, MI, stroke) and 1-year (death) outcomes post-surgery. Subgroup analyses were performed based on Revised Cardiac Risk Index class and history of prior CAD. RESULTS: The cohort included 4268 beta-blocked patients and 154,357 controls. Metoprolol (median daily dose 50 mg) was prescribed to 36% of beta-blocked patients, atenolol (median 25 mg) to 26%, and bisoprolol (median 5 mg) to 37%. In the matched cohort (n=8492), beta-blockade was not associated with death (RR 0.96; CI 0.70-1.32), MI (RR 0.92; CI 0.72-1.17), and stroke (RR 1.31; CI 0.68-2.52) at 30-days, or death at 1-year (Figure). Associations with outcomes did not differ significantly across subgroups. CONCLUSIONS: Outcomes were not altered in patients who start perioperative beta-blockade within a clinically sensible period before surgery. A large randomized trial is needed to determine if the continued use of perioperative beta-blockade in clinical practice is justified.

scholarly journals Soft Coagulation Using Hemostatic Forceps for Prevention of Postendoscopic Papillectomy Hemorrhage

2018 ◽  
Vol 09 (03) ◽  
pp. 114-117
Author(s):  
Nobuhiko Fukuba ◽  
Hiroki Sonoyama ◽  
Ichiro Moriyama ◽  
Shunji Ishihara ◽  
Yoshikazu Kinoshita
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Primary Outcome ◽  
Exact Test ◽  
Conventional Procedure ◽  
Soft Coagulation ◽  
Secondary Endpoints ◽  
Closed Position ◽  
The Difference ◽  
Prophylactic Use

Aim: Few reports of the prophylactic use of soft coagulation with hemostatic forceps for postendoscopic papillectomy hemorrhage (PEPH) have been presented. The aim of this study was to clarify the utility of that procedure for prophylaxis. Materials and Methods: From April 2009 to March 2012, PEPH was treated in four patients after the development of the condition with a conventional procedure at our institution. Thereafter, from April 2012 to March 2016, soft coagulation using hemostatic forceps was performed as prophylactic hemostasis following an EP in five patients. For the latter procedure, the hemostatic forceps device (FD411‑QR, Olympus, Tokyo, Japan) was used in a closed position, with the coagulation wave set at 60 W (VIO 300D; ERBE, Tubingen, Germany). The primary outcome was the onset of PEPH, which was defined as a decrease in hemoglobin ≥2 g/dL after EP. Secondary endpoints were the success rate and the incidence of adverse events of soft coagulation using hemostatic forceps for emergency bleeding cases after EP. Results: The incidence of PEPH was 20% (1 of 5 cases) in the prophylactic procedure group, which was lower than that in the conventional procedures group (75%, 3 of 4 cases), though the difference was not statistically significant (P = 0.206, Fisher’s exact test). All cases of PEPH were successfully treated by soft coagulation using hemostatic forceps. Conclusion: Soft coagulation with hemostatic forceps may be suitable for use as a routine technique following EP to prevent PEPH.

Perioperative Beta-blockers for Major Noncardiac Surgery: Primum Non Nocere

2009 ◽  
Vol 122 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Vineet Chopra ◽  
Benjamin Plaisance ◽  
Erdal Cavusoglu ◽  
Scott A. Flanders ◽  
Kim A. Eagle
Keyword(s):  
Beta Blockers ◽  
Noncardiac Surgery
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