Tratamiento de la fibrilación auricular postoperatoria
Management of postoperative atrial fibrillation.
Omae T, Kanmura Y.
Department of Anesthesiology, Fujimoto Hayasuzu Hospital, Miyakonojo, Miyazaki, Japan. omae@za2.so-net.ne.jp
J Anesth. 2012 Jun;26(3):429-37. doi: 10.1007/s00540-012-1330-9. Epub 2012 Jan 25.
Abstract
The impact of postoperative atrial fibrillation (PAF) on patient outcomes has prompted intense investigation into the optimal methods for prevention and treatment of this complication. In the prevention of PAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. However, their use requires caution due to the possibility of drug-related adverse effects. Aside from these risks, perioperative prophylactic treatment with statins seems to be effective for preventing PAF and is associated with a low incidence of adverse effects. PAF can be treated by rhythm control, heart-rate control, and antithrombotic therapy. For the purpose of heart rate control, β-blockers, calcium-channel antagonists, and amiodarone are used. In patients with unstable hemodynamics, cardioversion may be performed for rhythm control. Antithrombotic therapy is used in addition to heart-rate maintenance therapy in cases of PAF >48-h duration or in cases with a history of cerebrovascular thromboembolism. Anticoagulation is the first choice for antithrombotic therapy, and anticoagulation management should focus on maintaining international normalized ratio (INRs) in the 2.0-3.0 range in patients <75 years of age, whereas prothrombin-time INR should be controlled to the 1.6-2.6 range in patients ≥75 years of age. In the future, dabigatran could be used for perioperative management of PAF, because it does not require regular monitoring and has a quick onset of action with short serum half-life. Preventing PAF is an important goal and requires specific perioperative management as well as other approaches. PAF is also associated with lifestyle-related diseases, which emphasizes the ongoing need for appropriate lifestyle management in individual patients
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375013/pdf/540_2012_Article_1330.pdf
Fibrilación auricular postoperatoria en pacientes sometidos a bypass coronario o cirugía valvular: uso intraoperatorio de landiolol
Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol.
Nakanishi K, Takeda S, Kim C, Kohda S, Sakamoto A.
Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. n-kazu@nms.ac.jp
J Cardiothorac Surg. 2013 Jan 24;8:19. doi: 10.1186/1749-8090-8-19.
Abstract
BACKGROUND: Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF) after cardiac surgery. METHODS: Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3-5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group) and those who did not receive any β-blockers during surgery (control group). An unpaired t test and Fisher's exact test were used to compare between-group differences in mean values and categorical data, respectively. RESULTS: Seventeen of the 105 patients (16.2%) developed postoperative atrial fibrillation: 5/57 (8.8%) in the landiolol group and 12/48 (25%) in the control group. There was a significant difference between the two groups (P=0.03). The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant. CONCLUSIONS: Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564867/pdf/1749-8090-8-19.pdf
Meta-análisis de estudios controlados randomizados sobre la adición de magnesio al betabloqueadores para prevenir arritmias auriculares después de bypass coronario
Meta-analysis of randomized controlled trials on magnesium in addition to beta-blocker for prevention of postoperative atrial arrhythmias after coronary artery bypass grafting.
Wu X, Wang C, Zhu J, Zhang C, Zhang Y, Gao Y.
Department of Cardiovascular Medicine, the Second Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
BMC Cardiovasc Disord. 2013 Jan 23;13:5. doi: 10.1186/1471-2261-13-5.
Abstract
BACKGROUND: Atrial arrhythmia (AA) is the most common complication after coronary artery bypass grafting (CABG). Only beta-blockers and amiodarone have been convincingly shown to decrease its incidence. The effectiveness of magnesium on this complication is still controversial. This meta-analysis was performed to evaluate the effect of magnesium as a sole or adjuvant agent in addition to beta-blocker on suppressing postoperativeAA after CABG. METHODS: We searched the PubMed, Medline, ISI Web of Knowledge, Cochrane library databases and online clinical trial database up to May 2012. We used random effects model when there was significant heterogeneity between trials and fixed effects model when heterogeneity was negligible...... CONCLUSIONS: This meta-analysis offers the more definitive evidence against the prophylactic administration of intravenous magnesium for prevention of AA after CABG when beta-blockers are routinely administered, and shows an association with more adverse events in those people who received magnesium.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557180/pdf/1471-2261-13-5.pdf
Arritmias postoperatorias en pacientes de cirugía general
Postoperative arrhythmias in general surgical patients.
Walsh SR, Tang T, Wijewardena C, Yarham SI, Boyle JR, Gaunt ME.
Cambridge Vascular Research Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
Ann R Coll Surg Engl. 2007 Mar;89(2):91-5.
Abstract
INTRODUCTION: New-onset arrhythmias are a common problem in cardiothoracic surgery. They are also common following major non-cardiac surgery. This review examines the available literature to establish the incidence and significance of new-onset arrhythmias following major non-cardiothoracic surgery. MATERIALS AND METHODS: A literature search was performed using the Medline and Pubmed databases using the terms 'post-operative arrhythmia', 'peri-operative arrhythmia', 'atrial fibrillation/flutter', 'supraventricular arrhythmia/tachycardia', 'cardiac complications' and 'non-cardiothoracic surgery'. Articles were cross-referenced for additional relevant publications and reviewed for data regarding new-onset arrhythmias following major non-cardiothoracic surgery. RESULTS: There was considerable heterogeneity in the literature regarding cardiac monitoring, types of arrhythmias considered and potential associations investigated, thus hindering interpretation. The available data suggest that new-onset arrhythmias affect about 7% of patients following major non-cardiothoracic surgery. These arrhythmias are often associated with other underlying complications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964549/pdf/rcse8902-091.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Management of postoperative atrial fibrillation.
Omae T, Kanmura Y.
Department of Anesthesiology, Fujimoto Hayasuzu Hospital, Miyakonojo, Miyazaki, Japan. omae@za2.so-net.ne.jp
J Anesth. 2012 Jun;26(3):429-37. doi: 10.1007/s00540-012-1330-9. Epub 2012 Jan 25.
Abstract
The impact of postoperative atrial fibrillation (PAF) on patient outcomes has prompted intense investigation into the optimal methods for prevention and treatment of this complication. In the prevention of PAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. However, their use requires caution due to the possibility of drug-related adverse effects. Aside from these risks, perioperative prophylactic treatment with statins seems to be effective for preventing PAF and is associated with a low incidence of adverse effects. PAF can be treated by rhythm control, heart-rate control, and antithrombotic therapy. For the purpose of heart rate control, β-blockers, calcium-channel antagonists, and amiodarone are used. In patients with unstable hemodynamics, cardioversion may be performed for rhythm control. Antithrombotic therapy is used in addition to heart-rate maintenance therapy in cases of PAF >48-h duration or in cases with a history of cerebrovascular thromboembolism. Anticoagulation is the first choice for antithrombotic therapy, and anticoagulation management should focus on maintaining international normalized ratio (INRs) in the 2.0-3.0 range in patients <75 years of age, whereas prothrombin-time INR should be controlled to the 1.6-2.6 range in patients ≥75 years of age. In the future, dabigatran could be used for perioperative management of PAF, because it does not require regular monitoring and has a quick onset of action with short serum half-life. Preventing PAF is an important goal and requires specific perioperative management as well as other approaches. PAF is also associated with lifestyle-related diseases, which emphasizes the ongoing need for appropriate lifestyle management in individual patients
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375013/pdf/540_2012_Article_1330.pdf
Fibrilación auricular postoperatoria en pacientes sometidos a bypass coronario o cirugía valvular: uso intraoperatorio de landiolol
Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol.
Nakanishi K, Takeda S, Kim C, Kohda S, Sakamoto A.
Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. n-kazu@nms.ac.jp
J Cardiothorac Surg. 2013 Jan 24;8:19. doi: 10.1186/1749-8090-8-19.
Abstract
BACKGROUND: Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF) after cardiac surgery. METHODS: Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3-5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group) and those who did not receive any β-blockers during surgery (control group). An unpaired t test and Fisher's exact test were used to compare between-group differences in mean values and categorical data, respectively. RESULTS: Seventeen of the 105 patients (16.2%) developed postoperative atrial fibrillation: 5/57 (8.8%) in the landiolol group and 12/48 (25%) in the control group. There was a significant difference between the two groups (P=0.03). The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant. CONCLUSIONS: Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564867/pdf/1749-8090-8-19.pdf
Meta-análisis de estudios controlados randomizados sobre la adición de magnesio al betabloqueadores para prevenir arritmias auriculares después de bypass coronario
Meta-analysis of randomized controlled trials on magnesium in addition to beta-blocker for prevention of postoperative atrial arrhythmias after coronary artery bypass grafting.
Wu X, Wang C, Zhu J, Zhang C, Zhang Y, Gao Y.
Department of Cardiovascular Medicine, the Second Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
BMC Cardiovasc Disord. 2013 Jan 23;13:5. doi: 10.1186/1471-2261-13-5.
Abstract
BACKGROUND: Atrial arrhythmia (AA) is the most common complication after coronary artery bypass grafting (CABG). Only beta-blockers and amiodarone have been convincingly shown to decrease its incidence. The effectiveness of magnesium on this complication is still controversial. This meta-analysis was performed to evaluate the effect of magnesium as a sole or adjuvant agent in addition to beta-blocker on suppressing postoperativeAA after CABG. METHODS: We searched the PubMed, Medline, ISI Web of Knowledge, Cochrane library databases and online clinical trial database up to May 2012. We used random effects model when there was significant heterogeneity between trials and fixed effects model when heterogeneity was negligible...... CONCLUSIONS: This meta-analysis offers the more definitive evidence against the prophylactic administration of intravenous magnesium for prevention of AA after CABG when beta-blockers are routinely administered, and shows an association with more adverse events in those people who received magnesium.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557180/pdf/1471-2261-13-5.pdf
Arritmias postoperatorias en pacientes de cirugía general
Postoperative arrhythmias in general surgical patients.
Walsh SR, Tang T, Wijewardena C, Yarham SI, Boyle JR, Gaunt ME.
Cambridge Vascular Research Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
Ann R Coll Surg Engl. 2007 Mar;89(2):91-5.
Abstract
INTRODUCTION: New-onset arrhythmias are a common problem in cardiothoracic surgery. They are also common following major non-cardiac surgery. This review examines the available literature to establish the incidence and significance of new-onset arrhythmias following major non-cardiothoracic surgery. MATERIALS AND METHODS: A literature search was performed using the Medline and Pubmed databases using the terms 'post-operative arrhythmia', 'peri-operative arrhythmia', 'atrial fibrillation/flutter', 'supraventricular arrhythmia/tachycardia', 'cardiac complications' and 'non-cardiothoracic surgery'. Articles were cross-referenced for additional relevant publications and reviewed for data regarding new-onset arrhythmias following major non-cardiothoracic surgery. RESULTS: There was considerable heterogeneity in the literature regarding cardiac monitoring, types of arrhythmias considered and potential associations investigated, thus hindering interpretation. The available data suggest that new-onset arrhythmias affect about 7% of patients following major non-cardiothoracic surgery. These arrhythmias are often associated with other underlying complications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964549/pdf/rcse8902-091.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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