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Cardiology


 


   





Cardiac Surgery Complications Dysrhythmias and Prevention

     

  • Daoud
    EG, Strickberger SA, Man KC, et al


    Preoperative Amiodarone As Prophylaxis Against Atrial Fibrillation After Heart Surgery


    N Engl J Med 337: 1785-1791, 1997

      


    Postoperative atrial fibrillation can occur in as many as 40% of patients having cardiac surgery. Amiodarone is effective against atrial fibrillation therefore the oral use of amiodarone as prophylaxis against postoperative atrial fibrillation was investigated in a double-blind randomizes study.

      


    124 patients undergoing cardiac surgery [ 84 men] received either 600 mg oral amiodarone daily [ n=64] or placebo [n=60] for an average of 12 days before surgery. Patients receiving amiodarone before surgery also received 200 mg of it daily after surgery until discharge.

       


    Postoperatively significantly fewer amiodarone patients than placebo patients had atrial fibrillation [25% vs 53%]. During hospitalization also the same observation was made [amiodarone 23% vs placebo 42%]. The maximal heart rates during atrial fibrillation were significantly lower in the amiodarone group than the placebo group [ 112 vs 135 beats per minute]. Duration of atrial fibrillation was similar in the two groups. The use of beta-blockers made no difference in the prevalence of atrial fibrillation. Patients having valvular surgery had higher incidence of atrial fibrillation than those undergoing coronary bypass surgery [46% vs 29%]. Patients in the placebo group had a significantly longer stay in the hospital [7.9 vs 6.5 days]. The incidence of other postoperative complications was the same in both groups. Morbidity occurred in 6 placebo patients and 8 amiodarine patients. Two placebo and three amiodarone patients died. Five placebo and one amiodarone patient had malignant ventricular arrhythmias. Amiodarone patients had significantly lower hospital costs than the placebo patients.

       


    Thus low dose amiodarone taken prophylactically significantly reduced the incidence of atrial fibrillation and the cost of hospitalisation in cardiac surgery patients.

         

  • Curtis JJ, Parker BM, Mckenney CA, et al

    Incidence and Predictors of Supraventricular Dysrhythmias after Pulmonary Resection.

    Ann. Thorac. Surg 66: 1766-1771, 1998

         

    Patients undergoing pulmonary resection were prospectively examined to study the incidence of and predictors for the development of supraventricular dysrhythmias Holter monitoring was performed preoperatively, on the day of surgery and the second day, as well as continuous cardiac monitoring throughout hospitalization in 116 patients who underwent pulmonary resection.

         

    Of 116 patients the mean age of 77 men and 39 women was 59.8 years [range 20 to 80 years]; 26 had pneumonectomy, 7 bilobectomy, 47 lobectomy and 36 wedge resection. Twenty-six patients [22.4%] had dysrhythmias; 22 had atrial fibrillation, 3 atrial flutter/fibrillation, and 1 atrial flutter.

         

    The rate of atrial fibrillation with pneumonectomy was 46.1% bilobectomy 14.3%, lobectomy 17% and wedge resection 13.8%.

        

    In 26 patients undergoing pneumonectomy 31% needed pharmacologic therapy compared to only 16% of the rest undergoing lesser resections.

        

    Peak incidence of atrial fibrillation occurred on postoperative day 2 and 3 and lasted 1 to 7 days; and was seen in patients over the age of 64 years.

         

    Of the 30 pre and postoperative variables evaluated none were significant predictors for the development of postoperative atrial fibrillation.

          

  • Donaldson GC, Seemungal T, Jeffries DJ, et al

    Effect of Temperature on Lung Function and Symptoms in COPD 

    Eur. Respir J 13: 844-849

         

    Seventy-six patients living in East London who had moderate to severe chronic obstructive pulmonary disease [COPD] were followed up for 12 months to see if cold weather had a deleterious effect on their symptoms and lung function.

        

    Patients completed questionnaires about the nature of night time heating and made daily records of symptoms, peak expiratory flow rate and indoor temperature in their bedroom on awakening. Data on outdoor temperatures were obtained from the meteorological office.

        

    The results showed drop in outdoor or bedroom temperature was correlated with increased exacerbation of symptoms and fall in lung function. Forced expiratory volume in 1 second [FEVI] and forced vital capacity dropped notably by a median of 45 ml, and 74 ml, respectively between the warmest and coolest weeks. Only 21% of patients heated their bedrooms and 10% kept their bedroom temperatures below 13 degrees Celsius and 48% kept the windows open in November.

       

    Cold weather does add to morbidity and mortality in patients with COPD.

           




 

 

Speciality Spotlight

 

   

Cardiac Surgery Complications Dysrhythmias and Prevention
     

  • Daoud EG, Strickberger SA, Man KC, et al
    Preoperative Amiodarone As Prophylaxis Against Atrial Fibrillation After Heart Surgery
    N Engl J Med 337: 1785-1791, 1997
      
    Postoperative atrial fibrillation can occur in as many as 40% of patients having cardiac surgery. Amiodarone is effective against atrial fibrillation therefore the oral use of amiodarone as prophylaxis against postoperative atrial fibrillation was investigated in a double-blind randomizes study.
      
    124 patients undergoing cardiac surgery [ 84 men] received either 600 mg oral amiodarone daily [ n=64] or placebo [n=60] for an average of 12 days before surgery. Patients receiving amiodarone before surgery also received 200 mg of it daily after surgery until discharge.
       
    Postoperatively significantly fewer amiodarone patients than placebo patients had atrial fibrillation [25% vs 53%]. During hospitalization also the same observation was made [amiodarone 23% vs placebo 42%]. The maximal heart rates during atrial fibrillation were significantly lower in the amiodarone group than the placebo group [ 112 vs 135 beats per minute]. Duration of atrial fibrillation was similar in the two groups. The use of beta-blockers made no difference in the prevalence of atrial fibrillation. Patients having valvular surgery had higher incidence of atrial fibrillation than those undergoing coronary bypass surgery [46% vs 29%]. Patients in the placebo group had a significantly longer stay in the hospital [7.9 vs 6.5 days]. The incidence of other postoperative complications was the same in both groups. Morbidity occurred in 6 placebo patients and 8 amiodarine patients. Two placebo and three amiodarone patients died. Five placebo and one amiodarone patient had malignant ventricular arrhythmias. Amiodarone patients had significantly lower hospital costs than the placebo patients.
       
    Thus low dose amiodarone taken prophylactically significantly reduced the incidence of atrial fibrillation and the cost of hospitalisation in cardiac surgery patients.
         

  • Curtis JJ, Parker BM, Mckenney CA, et al
    Incidence and Predictors of Supraventricular Dysrhythmias after Pulmonary Resection.
    Ann. Thorac. Surg 66: 1766-1771, 1998
         
    Patients undergoing pulmonary resection were prospectively examined to study the incidence of and predictors for the development of supraventricular dysrhythmias Holter monitoring was performed preoperatively, on the day of surgery and the second day, as well as continuous cardiac monitoring throughout hospitalization in 116 patients who underwent pulmonary resection.
         
    Of 116 patients the mean age of 77 men and 39 women was 59.8 years [range 20 to 80 years]; 26 had pneumonectomy, 7 bilobectomy, 47 lobectomy and 36 wedge resection. Twenty-six patients [22.4%] had dysrhythmias; 22 had atrial fibrillation, 3 atrial flutter/fibrillation, and 1 atrial flutter.
         
    The rate of atrial fibrillation with pneumonectomy was 46.1% bilobectomy 14.3%, lobectomy 17% and wedge resection 13.8%.
        
    In 26 patients undergoing pneumonectomy 31% needed pharmacologic therapy compared to only 16% of the rest undergoing lesser resections.
        
    Peak incidence of atrial fibrillation occurred on postoperative day 2 and 3 and lasted 1 to 7 days; and was seen in patients over the age of 64 years.
         
    Of the 30 pre and postoperative variables evaluated none were significant predictors for the development of postoperative atrial fibrillation.
          

  • Donaldson GC, Seemungal T, Jeffries DJ, et al
    Effect of Temperature on Lung Function and Symptoms in COPD 
    Eur. Respir J 13: 844-849
         
    Seventy-six patients living in East London who had moderate to severe chronic obstructive pulmonary disease [COPD] were followed up for 12 months to see if cold weather had a deleterious effect on their symptoms and lung function.
        
    Patients completed questionnaires about the nature of night time heating and made daily records of symptoms, peak expiratory flow rate and indoor temperature in their bedroom on awakening. Data on outdoor temperatures were obtained from the meteorological office.
        
    The results showed drop in outdoor or bedroom temperature was correlated with increased exacerbation of symptoms and fall in lung function. Forced expiratory volume in 1 second [FEVI] and forced vital capacity dropped notably by a median of 45 ml, and 74 ml, respectively between the warmest and coolest weeks. Only 21% of patients heated their bedrooms and 10% kept their bedroom temperatures below 13 degrees Celsius and 48% kept the windows open in November.
       
    Cold weather does add to morbidity and mortality in patients with COPD.
           

 

By |2022-07-20T16:44:32+00:00July 20, 2022|Uncategorized|Comments Off on Cardiac Surgery Complication

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