Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study
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Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study A Multicentre Double Blind Randomised Controlled Clinical Tr
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Author :
language : en
Publisher:
Release Date : 2016
Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study A Multicentre Double Blind Randomised Controlled Clinical Tr written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016 with categories.
Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study
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Author :
language : en
Publisher:
Release Date : 2016
Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016 with categories.
The Effect Of Remote Ischaemic Conditioning And Glyceryl Trinitrate On Perioperative Myocardial Injury In Cardiac Bypass Surgery Patients
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Author : Ashraf Atef Jiries Hamarneh
language : en
Publisher:
Release Date : 2019
The Effect Of Remote Ischaemic Conditioning And Glyceryl Trinitrate On Perioperative Myocardial Injury In Cardiac Bypass Surgery Patients written by Ashraf Atef Jiries Hamarneh and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019 with categories.
BACKGROUND: Due to the aging population and increased prevalence of co-morbidities (such as diabetes, obesity and renal failure), higher risk patients are undergoing coronary artery bypass graft and/or valve (CABG±valve) surgery, increasing the risk of post-surgical complications (such as perioperative myocardial injury/infarction), and worse clinical outcomes. As such, novel cardioprotective strategies are required to protect the heart against perioperative myocardial injury (PMI) during CABG±valve surgery. A number of clinical studies have shown that remote ischaemic preconditioning (RIPC), in which the arm or leg is subjected to cycles of brief ischaemia and reperfusion, by inflating a cuff placed on the upper arm or thigh, can reduce peri-operative myocardial injury (PMI) during CABG±valve surgery. However, not all studies have been positive, and large clinical outcomes studies (ERICCA and RIPHeart) have reported no benefit with RIPC in this clinical setting. The reasons for this are unclear but may relate to co-medications used in this clinical setting including agents such as propofol anaesthesia, and morphine. In this thesis, I investigated whether glyceryl trinitrate (GTN), which is often given as an intra-operative intravenous (IV) infusion, is cardioprotective in its own right, and whether it attenuates the cardioprotective effect of RIPC in patients undergoing CABG±valve surgery. Primary hypothesis: The effect of RIPC on reducing PMI will be attenuated in the presence of GTN administered as an intra-operative IV infusion in patients undergoing CABG±valve surgery. Secondary hypothesis: GTN administered as an intra-operative IV infusion will reduce PMI in patients undergoing CABG±valve surgery. METHODOLOGY : The ERIC-GTN trial (http://www.clinicaltrials.gov: NCT01864252) was a single-site, double-blinded, randomised, placebo-controlled clinical study investigating whether an intra-operative IV GTN infusion attenuates the cardioprotective effect of RIPC in patients undergoing CABG±valve surgery. Consenting adult patients (age >18 years) undergoing elective CABG±valve surgery with blood cardioplegia were eligible for inclusion. Following anaesthetic induction, patients were randomised to receive one of the four treatment groups: Group 1 - Sham+Saline: a sham RIPC protocol (comprising simulated limb cuff inflations and deflations) followed by an intra-operative intravenous (IV) saline infusion. Group 2 - Sham+GTN: a sham RIPC protocol followed by an intra-operative IV GTN infusion. Group 3 - RIPC+Saline: a RIPC protocol (comprising three 5-minute cycles of simultaneous upper arm and thigh cuff inflations/deflations) followed by an intra-operative IV saline infusion. Group 4 - RIPC+GTN: a RIPC protocol followed by an intra-operative IV GTN infusion. The primary endpoint was PMI, as quantified by 72 hour area-under-the-curve (AUC) serum high-sensitivity Troponin T. RESULTS : The intended sample size was 260 patients, but following the results of an interim analysis of 189 patients, the ERIC-GTN trial was stopped. There was no difference in PMI in patients from Groups 1 (Sham+Saline) and 2 (Sham+GTN), suggesting that, in itself, an intra-operative GTN infusion was not cardioprotective. However, patients in Group 3 (RIPC+Saline) did sustain less PMI as evidenced by a 37% reduction in 72 hour AUC Troponin T release, when compared to patients in Group 1 (Sham+Saline), confirming the cardioprotective effects of RIPC. Interestingly, the beneficial effect of RIPC on reducing PMI in Group 3 (RIPC+Saline), was abrogated in the presence of GTN (Group 4, RIPC+GTN), suggesting a negative interaction between RIPC and intra-operative IV GTN infusion. CONCLUSIONS: The interim analysis of the ERIC-GTN study has shown a negative interaction between RIC and GTN, suggesting that an intra-operative GTN infusion, attenuated the cardioprotective effects of GTN, in terms of reducing PMI in patients undergoing CABG±valve surgery. This finding may, in part, explain the results of the ERICCA trial in which RIPC failed to reduce major adverse cardiovascular events in patients undergoing CABG±valve surgery.
The Effect Of Remote Ischaemic Conditioning And Glyceryl Trinitrate On Perioperative Myocardial Injury In Cardiac Bypass Surgery Patients
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Author : Ashraf Atef Jiries Hamarneh
language : en
Publisher:
Release Date : 2019
The Effect Of Remote Ischaemic Conditioning And Glyceryl Trinitrate On Perioperative Myocardial Injury In Cardiac Bypass Surgery Patients written by Ashraf Atef Jiries Hamarneh and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019 with categories.
Evidence Based Practice Of Anesthesiology
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Author : Lee A. Fleisher
language : en
Publisher: Elsevier Health Sciences
Release Date : 2022-03-22
Evidence Based Practice Of Anesthesiology written by Lee A. Fleisher and has been published by Elsevier Health Sciences this book supported file pdf, txt, epub, kindle and other format this book has been release on 2022-03-22 with Medical categories.
Addressing both routine and complex situations with practical decision-making tools, Evidence-Based Practice of Anesthesiology, 4th Edition, helps anesthesiologists make sound decisions in everyday practice. World-renowned authority, Dr. Lee A. Fleisher, takes an evidence-based approach to a variety of high-impact topics related to effective perioperative patient management: preoperative assessment; monitoring and administration of anesthesia during surgery; postoperative intensive care management; and postoperative pain management. The 4th Edition has been updated from cover to cover, helping you make informed clinical decisions based on reliable, up-to-date guidance in every aspect of patient care. Explores important issues in perioperative management, discussing the available options, examining the relevant research, and presenting practical recommendations. Features concise, to-the-point chapters with numerous quick-reference tables for fast and effective decision making. Includes decision trees throughout to provide visual guidance and a logical flow of key decision points. Contains nine new chapters on how to identify patients at risk for postoperative neurocognitive disorder; the best strategy for perioperative ACE and ARB agents; emergency laparotomy; optimal postoperative analgesia and the opiate naïve patient; the best method for perioperative handoffs; myocardial injury after non-cardiac surgery (MINS); and more. Helps you master the current best practices you need to know for successful day-to-day practice and oral board review.
Cardioprotection
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Author : Derek Hausenloy
language : en
Publisher: Oxford University Press
Release Date : 2009-08-20
Cardioprotection written by Derek Hausenloy and has been published by Oxford University Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-08-20 with Medical categories.
Coronary heart disease (CHD) is the leading cause of death worldwide. Cardioprotection refers to the prevention of CHD and the clinical improvement in patients suffering from cardiovascular problems.
Cardiac Surgery In The Adult Fifth Edition
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Author : Lawrence H. Cohn
language : en
Publisher: McGraw Hill Professional
Release Date : 2017-09-08
Cardiac Surgery In The Adult Fifth Edition written by Lawrence H. Cohn and has been published by McGraw Hill Professional this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017-09-08 with Medical categories.
The most comprehensive and current full-color cardiac surgery resource – updated by leading surgeons A Doody’s Core Title for 2022! In Cardiac Surgery in the Adult, Fifth Edition, the world’s foremost cardiovascular surgeons deliver thorough, up-to-date coverage of operative strategy, decision making, technique, and pre- and post-operative management for treating the adult cardiac patient. Unmatched in both scope and clinical rigor, this classic text contains 63 chapters that highlight every important topic in cardiovascular surgery. Presented in full color, Cardiac Surgery in the Adult takes readers through the optimal treatment of congenital, acquired, infectious, and traumatic diseases of the heart and great vessels. The book opens with a history of cardiac surgery and basic cardiac science, then moves into all types of cardiac surgery, providing both practicing surgeons and residents with insight into the very latest surgical protocols. Cardiac Surgery in the Adult is logically divided into ten sections: Basics (includes history, anatomy, physiology, pharmacology, computed tomography, risk assessment, simulation, and the fully integrated cardiovascular center) Perioperative/Intraoperative Care Ischemic Heart Disease Aortic Valve Disease Mitral Valve Disease Surgery of the Great Vessels Rhythm Surgery Other Cardiac Operations (including congenital heart disease, pericardial disease, and cardiac neoplasms) Transplant and Mechanical Circulatory Support The Fifth Edition has been updated throughout, and includes the latest advances in minimally invasive surgery and simulation.
Myocardial Protection
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Author : Tomas A. Salerno
language : en
Publisher: John Wiley & Sons
Release Date : 2008-04-15
Myocardial Protection written by Tomas A. Salerno and has been published by John Wiley & Sons this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008-04-15 with Medical categories.
Myocardial protection is regarded as one of the most important, yet also most controversial aspects of cardiac surgery. There has been considerable improvement in myocardial protection strategies over recent years, utilising a variety of new approaches to treat cardiac diseases, and this text is intended to embrace the state of the art in this field. The book summarises the state of knowledge on all aspects of myocardial protection, including the latest in the treatment of cardiac diseases, robotics, pediatric surgery and the treatment of cardiac failure. Robotic surgery, valvular surgery, pediatric surgery and coronary surgery are all covered by renowned experts, producing a comprehensive, forward-looking view of the field of myocardial protection. This book should function to update physicians and surgeons interested in the field of cardiac surgery on the current state of knowledge on myocardial protection.
Vascular Anaesthesia
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Author : Jonathan Thompson
language : en
Publisher: Oxford University Press, USA
Release Date : 2014
Vascular Anaesthesia written by Jonathan Thompson and has been published by Oxford University Press, USA this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014 with Medical categories.
Providing a practical, current, evidence-based approach to all aspects of perioperative care for the patient with vascular disease, Vascular Anaesthesia is an essential read for all vascular anaesthetists, anaesthetic nurses and anyone else involved in the care of vascular patients throughout the world. Vascular Anaesthesia summarizes current knowledge, particularly on interventional procedures (radiological, diagnostic, and surgical). This book also equips the trainee anaesthetist with the scientific and clinical knowledge to pass the Final FRCA examination. It enables doctors to approach vascular surgical patients with a firm understanding of a particular procedure, particularly its risks and options for perioperative management based on current best practice. The management of the patient with vascular disease is evolving rapidly: this indispensible poket reference is of sufficient detail to update the regular and occasional vascular anaesthetist with current best practice for particular, common clinical scenarios. The book also equips the non-anaesthetic medical, nursing, and theatre staff with knowledge and understanding of all other aspects of perioperative care.
Inflammation In Heart Failure
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Author : Matthijs Blankesteijn
language : en
Publisher: Academic Press
Release Date : 2014-12-05
Inflammation In Heart Failure written by Matthijs Blankesteijn and has been published by Academic Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014-12-05 with Medical categories.
Inflammation in Heart Failure, edited by W. Matthijs Blankesteijn and Raffaele Altara, is the first book in a decade to provide an in-depth assessment on the causes, symptoms, progression and treatments of cardiac inflammation and related conditions. This reference uses two decades of research to introduce new methods for identifying inflammatory benchmarks from early onset to chronic heart failure and specifically emphasizes the importance of classifying at-risk subgroups within large populations while determining the patterns of cytokines in such classifications. Further, the book details clinical applications of the pathophysiological mechanisms of heart failure, diagnosis and therapeutic strategies. Inflammation in Heart Failure’s breadth of subject matter, easy-to-follow structure, portability, and high-quality illustrations create an accessible benefit for researchers, clinicians and students. Presents updated information and research on the relevant inflammatory mediators of heart failure to aid in targeting future translational research as well as the improvement of early diagnosis and treatment Provides research into better understanding the different inflammatory mediators that signal the underlying diseases that potentially lead to heart failure Contains 20 years of research, offering a brief overview of the topic leading to current opinions on, and treatment of, heart failure Provides a structured, systematic and balanced overview of the role of inflammation in heart failure making it a useful resource for researchers and clinicians, as well as those studying cardiovascular diseases