Shiduan Wang

The effect of tranexamic acid to reduce blood loss and transfusion on off-pump coronary artery bypass surgery: A systematic review and cumulative meta-analysis

STUDY OBJECTIVE To assess the safety and efficacy of tranexamic acid (TA) on off-pump coronary artery bypass (OPCAB) surgery. DESIGN Meta-analysis. SETTING Operating room, OPCAB surgery, all surgeries were elective measurements. Searching the following data sources respectively: PubMed/MEDLINE, the Cochrane Library, EMBASE and reference lists of identified articles, we performed a meta-analysis of postoperative 24h blood loss, postoperative allogeneic transfusion, re-operation for massive bleeding, postoperative mortality, and postoperative thrombotic complications. MAIN RESULTS Using electronic databases, we selected 15 randomized control trials (RCTs), carried out between 2003 and 2016, with a total of 1250 patients for our review. TA significantly reduced the postoperative 24h blood loss (mean difference -213.32ml, 95% confidence intervals, -247.20ml to -179.43ml; P<0.0001). And, TA also significantly reduced the risk of packed red blood cell (PRBCs) transfusion (risk ratio 0.62; 95% confidence intervals 0.51 to 0.76; P<0.0001) and fresh frozen plasma (FFP) transfusion (0.65; 0.52 to 0.81; P<0.001). There were no statistical significance on platelet transfusion (risk difference -0.00, 95% confidence interval -0.02 to 0.02; P=0.73) and re-operation (0.00, -0.02 to 0.02; P=1.00). No association was found between TA and morbility (risk difference -0.00, 95% confidence interval -0.02 to 0.02; P=0.99) and thrombotic complications (-0.01, -0.01 to 0.02; P=0.70). CONCLUSIONS TA reduced the probability of receiving a PRBCs and FFP transfusion during OPCAB surgery. And no association with postoperative death and thrombotic events was found. However, further trials with an appropriate sample size are required to confirm TA safety in OPCAB surgery.

Is NT-pro-BNP predictive of atrial fibrillation in patients undergoing coronary artery bypass surgery?

I am very glad to see that Dr Shih et al. reportedmy case of haemomediastinum caused by a ruptured bronchial artery aneurysm [1]. This is one of the bronchial arterial embolisation cases that I performed during October 2006. However, I have to point out a misinterpretation of Fig. 1 of this article [1]. The location the arrow is pointing to is actually the superior vena cava (SVC) with streak artefacts due to highly concentrated contrast injection from the right arm. If we trace that vein carefully upwards, we can see that the noncontrasted blood from the left brachiocephalic vein is draining into this SVC. The small bronchial artery is a branch from the descending thoracic aorta. The bronchial arterial aneurysm is actually showed as a small dot located anterior to the thoracic vertebra in Fig. 1. The angiogram in Fig. 2 will prove that the aneurysm is truly lying anterior to the spine. Due to the rules of ‘Letter to the Editor’, I cannot explain it out in an image or figure with legend; however, the reader may contact me if they want any further explanations and/or would like to see images of the case.

Perioperative dexmedetomidine reduces delirium after cardiac surgery: A meta-analysis of randomized controlled trials

STUDY OBJECTIVE To evaluate the efficiency of dexmedetomidine on the incidence of delirium in patients after cardiac surgery. DESIGN Meta-analysis of randomized controlled trials. SETTING Operating room and Intensive Care Unit (ICU). PATIENTS Ten trials with a total of 1387 patients undergoing cardiac surgery met the inclusion criteria. INTERVENTION Randomized controlled trials (RCTs) comparing the effect of dexmedetomidine versus non-treatment of dexmedetomidine (normal saline (NS), propofol and other anesthetic drugs) on delirium in patients undergoing cardiac surgery were retrieved from PubMed/Medline, Embase, the Cochrane Library and Web of science. The primary outcome was the incidence of delirium. The secondary outcomes were the rate of bradycardia and hypotension, the duration of mechanical ventilation and the length of ICU and hospital stay. MAIN RESULTS Compared with the control group, Dexmedetomidine significantly decreased the incidence of postoperative delirium, (risk ratio 0.46; 95% confidence intervals, 0.34 to 0.62; P < 0.00001), while the incidence of bradycardia was increased in dexmedetomidine group (risk ratio 1.86; 95% confidence intervals, 1.16 to 2.99; P = 0.01). There was no significant difference between groups with regarding to the occurrence of hypotension (risk ratio 0.90; 95% confidence intervals, 0.59 to 1.38; P = 0.63), the duration of mechanical ventilation (Mean Difference 0.21; 95% confidence intervals, -0.70 to 1.12; P = 0.65), and the length of ICU (Standard Mean Difference - 0.07; 95% confidence intervals, -0.19 to 0.06; P = 0.3) and hospital stay (Mean Difference - 0.13; 95% confidence intervals, -0.56 to 0.30; P = 0.56). CONCLUSION Perioperative dexmedetomidine administration decreased the incidence of delirium in patients after cardiac surgery, but might increase the rate of bradycardia. Furthermore, we did not observe significant differences in the incidence of hypotension, the duration of mechanical ventilation and length of ICU and hospital stay between groups. Future studies are needed to ascertain the effect of dexmedetomidine on the incidence of delirium after coronary artery bypass grafting (CABG) and in patient with cognitive disorder at baseline, whether intraoperative dexmedetomidine infusion could reduce postoperative delirium and the optimal dose of dexmedetomidine.

Reasons elevated B-type natriuretic peptide levels are associated with adverse outcome in patients undergoing cardiac surgery.

2. Smaka TJ, Cobas M, Velazquez OC, et al: Perioperative management of endovascular abdominal aortic aneurysm repair: Update 2010. J Cardiothorac Vasc Anesth 25:166-176, 2011 3. Scurr JR, Brennan JA, Gilling-Smith GL, et al: Fenestrated endovascular repair for juxtarenal aortic aneurysm. Br J Surg 95:326-332, 2008 4. Gabrielli L, Baudo A, Molinari A, et al: Early complications in endovascular treatment of abdominal aortic aneurysm. Acta Chir Belg 104:519-526, 2004