Carl-johan Jakobsen
Aarhus University, Health Sciences, Faculty Member
Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to... more
Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is associated with development of POAF. Pre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University Hospital during 2010-2014. Multiple logistic regression was used to determine the risk of POAF according to transfusion of RBC on the day of surgery. Furthermore, we determined trend in storage time of RBC according to risk of POAF using restricted cubic splines. Patients with a history of preoperative atrial fibrillation, patients who received transfusions preoperative and patients who died at the day of surgery were among exclude...
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Recent studies conclude that cardiac surgery patients are prone to both mortality and morbidity in the weeks after discharge. Complications such as pleural and pericardial effusions may influence physical recovery due to symptoms such as... more
Recent studies conclude that cardiac surgery patients are prone to both mortality and morbidity in the weeks after discharge. Complications such as pleural and pericardial effusions may influence physical recovery due to symptoms such as dyspnoea, chest pain and fatigue. Dedicated follow-up and timely treatment of postoperative complications are suggested. A randomized, controlled intervention trial including 76 patients, in the ratio of 1 : 1. Patients scheduled for elective on-pump coronary artery bypass grafting and/or aortic valve replacement were eligible for inclusion. Patients were randomized to either standard postoperative care or complementary follow-up visits with clinical examinations, focused chest sonography and protocol-driven thoracentesis if applicable. Primary outcomes were the mean change in walking distance, peak expiratory flow and EuroQOL from baseline to 30 days after surgery. The mean difference in walking distance after 30 days was 15% (65 ± 22 m) between groups, P = 0.017. No differences were found in the peak expiratory flow or EuroQOL. In patients with pleural effusion, walking distance improved by 22% after thoracentesis (81 ± 42 m), P < 0.0001, and peak expiratory flow improved by 26% (1.1 ± 1.2 l/min), P < 0.001. Supplemental dedicated follow-up and treatment of postoperative effusions enhance recovery by 15% compared with standard care, measured by improvement in the walking distance 1 month after cardiac surgery. https://clinicaltrials.gov/ct2/show/NCT02045641. NCT02045641.
Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the intensive care unit (ICU) are important factors in patient turnover, a more efficient use of... more
Progressive cost containment has resulted in a growing interest for fast-track cardiac surgery. Ventilation time and length of stay (LOS) in the intensive care unit (ICU) are important factors in patient turnover, a more efficient use of resources, and early patient mobilization. However, LOS in ICU is not an objective measure because, in addition to medical factors, patient discharge may be guided by logistics and policy, and thus more objective measures are warranted. The authors hypothesized that remifentanil compared with sufentanil would reduce ventilation time and LOS in the ICU and that remifentanil would have beneficial effects on the overall quality of recovery. A randomized, prospective study. Sixty patients scheduled for elective coronary artery bypass grafting with or without aortic valve replacement. A university hospital. Patients were assigned randomly to receive either remifentanil or sufentanil combined with propofol. Patients with ejection fraction<0.3, myocardial infarction within the last 4 weeks, diabetes, and severe pulmonary or arterial hypertension were excluded. The primary outcome variables were ventilation time and time to eligibility of discharge from the cardiac recovery unit. Secondary outcomes were actual LOS in the cardiac recovery unit and quality of recovery. The groups were comparable in selected demographics and perioperative parameters. There were no differences in ventilation time or eligible ICU discharge time between the groups. Remifentanil patients received more morphine than did the sufentanil patients during recovery (20 mg v 10 mg; p = 0.040). No difference was found in pharmacologic support or use of a pacemaker. In a fast-track protocol, remifentanil did not seem to be superior to a standard moderate- to high-dose sufentanil regimen.
Previous research suggests that platelet transfusion is associated with adverse events after coronary artery bypass grafting (CABG). The aim of the current analysis was to verify this hypothesis. Data from 6745 consecutive patients... more
Previous research suggests that platelet transfusion is associated with adverse events after coronary artery bypass grafting (CABG). The aim of the current analysis was to verify this hypothesis. Data from 6745 consecutive patients undergoing CABG from 2006 through 2012 were collected. Patients receiving platelet transfusions intraoperatively or postoperatively in the intensive care unit were compared with control patients. To adjust for possible confounders, propensity score matching and conditional regression analyses were performed. Short-term outcomes were 30-day mortality, in-hospital myocardial infarction and stroke. Mid-term outcomes were 6-month mortality, and need for coronary angiography or repeat coronary revascularization within 6 months after surgery. Data were retrieved from the Western Denmark Heart Registry. Using propensity scores, 982 patients exposed to platelets were matched with 982 control patients. Platelet transfusion was associated with a higher rate of post...
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To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-hour Holter monitoring was analyzed in 102 patients... more
To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-hour Holter monitoring was analyzed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR-interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07/year (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or= 10 ectopic supraventricular beats/24 hour, relative risk 3.03 (1.05-8.72), and one or more event of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated preoperative cardiac vagal modulation, ectopic supraventr...
Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-surgical AKI, yet methodological concerns about existing studies raise questions about the magnitude of a protective effect. We sought to... more
Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-surgical AKI, yet methodological concerns about existing studies raise questions about the magnitude of a protective effect. We sought to determine the effect of initiating a statin prior to elective cardiac surgery on post-surgical AKI in a regional Danish surgical cohort. We identified adults who underwent cardiac surgery during 2006-11 using the Western Denmark Heart Registry. Presurgical medication use, pre- and post-surgical serum creatinine (sCr) measures, and other patient characteristics were obtained from Danish population-based registries. Post-surgical AKI was assessed using sCr measures within 5 days of surgery. The adjusted risk ratio (RR) of AKI and 95% confidence interval (CI) were estimated for patients who initiated a statin within 100 days prior to surgery compared with patients without prior statin use; long-term statin users were excluded to reduce healthy-user bias. Subanalyses were stratified by surgery type: coronary artery bypass grafting (CABG) and non-CABG surgeries. We identified 1929 CABG and 1775 non-CABG patients. AKI occurred in 25% of CABG and 28% of non-CABG surgeries, and in 29% of the non-users and 21% of the statin initiators. Half of CABG patients and 9% of non-CABG patients initiated a statin prior to surgery. The adjusted RRs for the effect of statin initiation on AKI were as follows: all surgeries combined, RR = 0.86 (95% CI: 0.74, 0.98); CABG, RR = 0.88 (0.74, 1.05); non-CABG RR = 0.87 (0.68, 1.11). Presurgical statin initiation is associated with a reduction in AKI risk after cardiac surgery.
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European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was... more
European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether the continued fall in short-term mortality reflects an actual improvement in late mortality, and subsequently, to investigate EuroSCORE as predictor of 1-year mortality. A population-based cohort study of 25,602 patients from a 12-year period from three public university hospitals undergoing coronary artery bypass grafting (CABG) or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE). During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P < 0.001, one-way ANOVA), and the number of females increased from 26.0% to 28.2% (P = 0.0012, Chi-square test). The total EuroSCORE increased from 4.67 to 5.68 while the residual Euro...
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During pregnancy haemodynamic changes are a stress to the cardiovascular system. Women with previously asymptomatic cardiovascular disease may develop life-threatening cardiac failure because of the extra demands of pregnancy. Early... more
During pregnancy haemodynamic changes are a stress to the cardiovascular system. Women with previously asymptomatic cardiovascular disease may develop life-threatening cardiac failure because of the extra demands of pregnancy. Early diagnosis, close control and treatment during pregnancy, delivery and the postpartum period are essential. We report a case where a woman with a mitral stenosis and insufficiency of the mitral and aortic valves gave birth to a child by caesarian section.
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Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac surgery. This may be facilitated by an increased oxygen demand and diastolic dysfunction. Levosimendan augments haemodynamics without... more
Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac surgery. This may be facilitated by an increased oxygen demand and diastolic dysfunction. Levosimendan augments haemodynamics without further oxygen consumption and improves echocardiographic indices of diastolic dysfunction. This study aimed to describe the haemodynamic effects of short-term pre- and intra-operative levosimendan infusion including advanced echocardiographic measures of diastolic and systolic heart function. The study was randomised, double-blinded and placebo-controlled performed at a single-centre university hospital. Patients with left ventricular hypertrophy and ejection fraction > 45% scheduled for single procedure aortic valve replacement were included and randomised to infusion of either levosimendan 0.1 μg/kg/min or placebo from 4 h before anaesthesia to the end of surgery. Outcome measures were echocardiographic indices of left ventricular diastolic function...
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High thoracic epidural analgesia (HTEA) offers a distinctive opportunity to enhance postoperative recovery for the thoracic surgery patient. In the modern hospital setting with day of admission surgery, the logistics of insertion of the... more
High thoracic epidural analgesia (HTEA) offers a distinctive opportunity to enhance postoperative recovery for the thoracic surgery patient. In the modern hospital setting with day of admission surgery, the logistics of insertion of the epidural catheter has become increasingly difficult. The greatest limitation to its use might be the believed increased risk of epidural hematoma associated with anticoagulation during cardiopulmonary bypass. The aim of this review is to give an overview of complications and effect on outcomes with focus on cardiac performance and postoperative glycemic control and kidney function. Patients with epidurals may have improved postoperative pulmonary function and shorter ventilation time, while impact on length of stay in the intensive care unit and hospital is not as evident. HTEA is effective in pain management, attenuates perioperative stress and seems to improve postoperative blood glucose control. Whether HTEA improves recovery and facilitates fast-...
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During the last ten years, transesophageal echocardiography has become an important tool for cardiac monitoring. In other countries it is widely applied, especially in cardiac surgery, but the areas of application are still expanding.... more
During the last ten years, transesophageal echocardiography has become an important tool for cardiac monitoring. In other countries it is widely applied, especially in cardiac surgery, but the areas of application are still expanding. Transesophageal echocardiography is a non-invasive technique in contrast to most other methods available for monitoring central haemodynamics. The complication frequency is extremely low. However, correct therapeutic decisions depend on profound experience with the equipment and image interpretation. The scope of transoesophageal echocardiography as a new tool in haemodynamic monitoring is described in this paper together with preliminary results.
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The effects of a preoperative beta-adrenoceptor antagonist, metoprolol, on peroperative anxiety, relaxation, general feeling, blood pressures and heart rate, were studied in patients undergoing orthopaedic surgery during epidural... more
The effects of a preoperative beta-adrenoceptor antagonist, metoprolol, on peroperative anxiety, relaxation, general feeling, blood pressures and heart rate, were studied in patients undergoing orthopaedic surgery during epidural anesthesia. The study was double-blind and placebo controlled. Twenty non-consecutive patients were randomized to receive either metoprolol 100 mg or placebo orally 1-2 hours before anaesthesia. Patients receiving metoprolol scored statistically significantly better on anxiety, and general feeling. The average height of the epidural block was ThVIII. The average blood pressure was reduced by 5% during the first 45 minutes in both groups. The average maximum falls in mean blood pressure from preanaesthetic to the lowest measured after the epidural were 14% (metoprolol) and 7% (placebo). The heart rates were significantly lower after metoprolol. In conclusion, the patients felt subjectively better after metoprolol and no significant differences were found in blood pressure after metoprolol compared to placebo.
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To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-h Holter monitoring was analysed in 102 patients before... more
To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-h Holter monitoring was analysed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07.year-1 (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or = 10 ectopic supraventricular beats . 24 h-1, relative risk 3.03 (1.05-8.72), and one or more events of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated pre-operative cardiac vagal modulation, ectopic suprave...
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Reduced use of allogenic blood components is a key issue in cardiac surgery. Several methods to conserve blood have been used; reinfusion of shed mediastinal blood (RSMB) has found widespread acceptance, but the efficacy and safety are... more
Reduced use of allogenic blood components is a key issue in cardiac surgery. Several methods to conserve blood have been used; reinfusion of shed mediastinal blood (RSMB) has found widespread acceptance, but the efficacy and safety are still debated. The purpose of this study was to evaluate the effects of RSMB on the use of allogenic blood components and selected complications. Six hundred and twenty-three consecutive cardiac surgery patients in three successive periods, of whom patients in the middle period did not receive RSMB due to manufacturer delivery problems, were evaluated. Patients and procedures were characterized by EuroSCORE. Prospective collected data were: units of transfused allogenic blood, fresh frozen plasma (FFP) and platelets, postoperative blood loss and postoperative complications such as dialysis, re-operation due to bleeding, sternal infection and stroke. Length of stay in ICU was used as a general indicator of perioperative complications. The number of patients receiving allogenic blood in periods with RSMB was significantly lower (36.5% versus 54.9%, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.005), while no difference was seen in FFP and platelets. The average number of transfused blood units was lower in patients receiving RSMB (2.07 versus 3.41, p=0.029), while FFP (1.34 versus 2.01, p=0.11) and platelets (0.58 versus 0.95, p=0.05) were not statistically significantly different. Postoperative bleeding was lower (759 versus 967 ml, p=0.032) in the periods with RSMB. Patients receiving RSMB were less transfused with allogenic blood and had less postoperative drainage, while the frequency of observed postoperative complications was not different from patients who did not receive RSMB.
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In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients. The study was designed as a randomised... more
In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients. The study was designed as a randomised controlled trial of a-TAVI (Edwards SAPIEN heart valve system; Edwards Lifesciences, Irvine, CA, USA) vs. SAVR. Operable patients with isolated aortic valve stenosis and an age ≥75 years were included. The primary endpoint was the composite of all-cause mortality, cerebral stroke and/or renal failure requiring haemodialysis at 30 days. After advice from the Data Safety Monitoring Board, the study was prematurely terminated after the inclusion of 70 patients because of an excess of events in the a-TAVI group. The primary endpoint was met in five a-TAVI patients (two deaths, two strokes, and one case of renal failure requiring dialysis) vs. one stroke in the SAVR group (p=0.07). In the a-TAVI group, one patient was converted to SAVR because of an abnormally positioned heart, and four patients were re-operated with open heart surgery because of annulus rupture (n=1), severe paravalvular leakage (n=2), and blockage of the left coronary artery (n=1). In the SAVR group, one patient was converted to TAVI because of a large intra-thoracic goitre. Given the limitations of a small prematurely terminated study, our results suggest that a-TAVI in its present form may be associated with complications and device success rates in low-risk patients similar or even inferior to those found in high-risk patients with aortic valve stenosis. This will probably change in the near future with improved catheter based devices and better pre-procedural assessment.
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Recent years have seen the introduction of catheter-based aortic valve substitution with stent valves to treat aortic valve stenosis in patients who were deemed inoperable via conventional open heart surgery. We here report our initial... more
Recent years have seen the introduction of catheter-based aortic valve substitution with stent valves to treat aortic valve stenosis in patients who were deemed inoperable via conventional open heart surgery. We here report our initial experience. Register-based study with prospective registration of prespecified parameters. A total of 26 patients were treated with an aortic stent valve, 12 via transfemoral (TFA-AVI) and 14 via transapical (TAP-AVI) access. In the TFA-AVI group, 75% were women and the average age was 85 4.5 years; in the TAP-AVI group, 71% were women and the average age was 79 8.4 years. In the TFA-AVI group, successful stent valve implantation was performed in 9/12 (75%) and TAP-AVI in 13/14 (93%) patients. Mortality after 30 days was 25% in the TFA-AVI and 7% in the TAP-AVI group. The aortic valve area increased from 0.6 0.13 cm(2) to 1.6 0.39 (2) in the TFA-AVI group and from 0.7 0.2 (2) to 1.6 0.37 (2) in the TAP-AVI group. 91% of patients showed clinical improv...
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The myocardial recovery time following on-pump cardiac surgery remains uncertain. Global peak longitudinal strain is a sensitive measure of endocardial function which is most susceptible to ischaemia. We aimed to evaluate changes in... more
The myocardial recovery time following on-pump cardiac surgery remains uncertain. Global peak longitudinal strain is a sensitive measure of endocardial function which is most susceptible to ischaemia. We aimed to evaluate changes in global peak longitudinal strain up to 6 months after surgery and to compare initial changes with alterations in troponin T. Secondarily, we aimed to describe perioperative changes in strain of the inter-ventricular septum when compared with reference segments. Patients scheduled for coronary bypass, aortic valve replacement or combination procedures were enrolled. Echocardiography was performed on the day before surgery, the day after surgery, 4 days after surgery, 30 days after surgery and 6 months after surgery. Troponin T was measured 3, 16 and 24 h following procedure. Forty patients were enrolled and one was later excluded. Global peak longitudinal strain decreased from -14.5 ± 3.33% preoperatively to -9.98 ± 3.09% and -10.57 ± 3.16% on the first an...
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ABSTRACT Acute kidney injury (AKI) after cardiac surgery is associated with increased mortality and morbidity. The AKI criteria used in the study is a slightly modification (72 hours instead of 48 hours) of the consensus report from the... more
ABSTRACT Acute kidney injury (AKI) after cardiac surgery is associated with increased mortality and morbidity. The AKI criteria used in the study is a slightly modification (72 hours instead of 48 hours) of the consensus report from the Acute Kidney Injury Network (AKI) is defined as an abrupt increase in s- creatinine &gt;26.5 μmol/L (0.3mg/dL), or a relative increase in s-creatinine &gt; 50%, or a decrease in urine output to &lt; 0.5 ml/kg/h for more than 6 h within the first postoperative day.We recently found that high thoracic epidural analgesia (HTEA) was associated with a decreased frequency of postoperative dialysis. The purpose of this study was to evaluate TEA on renal function expressed as postoperative changes in s-creatinine, with the hypothesis that HTEA improves renal function. Sixty low to moderate risk patients scheduled for elective coronary artery bypass grafting with or without aortic valve replacement were randomized to receive HTEA as supplement to general anaesthesia (GA). Results: Serum-creatinine was lower in HTEA patients in the first 72 hours after surgery (P=0.018, 2-way ANOVA), with overall maximal increase 12.1% vs. 23.8%.The incidence of AKI was, although not significantly, lower (13.3% vs. 36.7%, P=0.074, χ2-test). Use of inotropes, constrictors and vasodilators had no impact on development of AKI. Conclusion: HTEA as a supplement to GA in cardiac surgery is followed by a less increase in s-creatinine in the first 72 hours after surgery and a tendency towards lower incidence of AKI. The finding of a possibly kidney-protective effect of HTEA could be of clinical importance and warrants further investigation.
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Although pericardial effusions (PE) and pleural effusions (PLE) may lead to life-threatening respiratory and circulatory deterioration following open heart surgery the postoperative frequency is not fully recognized. The diagnosis is... more
Although pericardial effusions (PE) and pleural effusions (PLE) may lead to life-threatening respiratory and circulatory deterioration following open heart surgery the postoperative frequency is not fully recognized. The diagnosis is typically based on ultrasonography, X-ray or computer tomography and often disclosed when circulatory collapse is evident. Point-of-care (POC) ultrasonography protocols constitute a noninvasive evaluation of the cardiopulmonary status. We hypothesized that POC ultrasonography could diagnose unknown PE and PLE. Patients scheduled for open heart surgery were eligible for inclusion. Baseline evaluation including POC examination and dyspnea score was performed one day prior to surgery and repeated on the 4th and 30th postoperative day. Eighty patients were included and complete follow-up was 80%. Thirteen patients (19%) had PE on the 4th day postsurgery and 19 patients (30%) had PE on the 30th day. Ultrasonography facilitated change in management in one patient with PE requiring drainage. Forty-nine patients (70%) had PLE on the 4th day following surgery and 19 patients (30%) had PLE on the 30th postoperative day. Ultrasonography facilitated a change in management in seven patients with PLE requiring drainage. POC ultrasonography detected pathology, otherwise undisclosed, and was responsible for a change in management in a considerable number of cases.
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The rate of contamination of the inner surface of &#39;Venflon&#39; type cannulae with valved injection sideports was compared with that of &#39;Intraflux&#39; type cannulae with membranous injection sideports. Of 46... more
The rate of contamination of the inner surface of &#39;Venflon&#39; type cannulae with valved injection sideports was compared with that of &#39;Intraflux&#39; type cannulae with membranous injection sideports. Of 46 &#39;Venflon&#39; cannulae and 34 &#39;Intraflux&#39; cannulae, 17.4 per cent and 20.6 per cent, respectively, were contaminated and no correlation of contamination of lumen was found with frequency of use of the sideports in the different cannulae, or with duration of use of the cannulae.
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An intraluminal culture method was evaluated for central venous catheters and compared to conventional catheter tip cultures and cultures from the insertion site. The colonization-rate of the catheters was 43.7% using conventional tip... more
An intraluminal culture method was evaluated for central venous catheters and compared to conventional catheter tip cultures and cultures from the insertion site. The colonization-rate of the catheters was 43.7% using conventional tip culture, 34.4% with the intraluminal method and 40.1% at the skin puncture site. Only 37.5% of the catheters showed identical bacteria at the skin puncture site and catheter-tip, compared with 87.5% between intraluminal culture and catheter-tip culture (P less than 0.05).
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Intravenous administration sets were changed at varying time intervals between every 24 h and 120 h in 387 patients. The rates of intraluminal contamination of the cannulae and of local inflammation were measured in relation to the time... more
Intravenous administration sets were changed at varying time intervals between every 24 h and 120 h in 387 patients. The rates of intraluminal contamination of the cannulae and of local inflammation were measured in relation to the time interval between changing sets. There was no correlation between phlebitis and intraluminal contamination, but a significant association was found between phlebitis and fever, infusion of potassium at greater than 10 mmol l-1, Venflon type 140 and infusion of blood or intralipid. No correlation was found between septicaemia and intraluminal contamination of the infusion systems. Contamination of cannulae increased slightly with time, but this was not statistically significant. We conclude that there will be no clinical benefit by daily changing of administration sets, compared with changing up to every fifth day.
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Of patients undergoing coronary artery bypass grafting 30% develop atrial fibrillation (AF) or flutter. To determine if AF is initiated from the right or left atrium, atrial electrograms were continuously recorded in patients undergoing... more
Of patients undergoing coronary artery bypass grafting 30% develop atrial fibrillation (AF) or flutter. To determine if AF is initiated from the right or left atrium, atrial electrograms were continuously recorded in patients undergoing this procedure. In addition, to study whether the prematurity index of premature atrial contractions (PACs) eliciting AF differs from PACs not provoking AF, the distribution of prematurity indices was evaluated from R-R interval analysis. The right and left atrial recording electrodes were first activated by the ectopic beat provoking AF in six and eight patients, respectively. The prematurity index of the PAC eliciting AF was located in the middle (in half of the patients) or to the left of the median distribution of prematurity indices. The variability in activation of the atrial electrodes suggests that the PAC provoking AF can have its origin in the right, the septal, or the left region of the atrium. The initiation of AF depends on the prematurity index of the PAC.
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Research Interests: Cardiothoracic Surgery, Cardiac Surgery, Prospective studies, Humans, Liver, and 18 moreMale, Follow-up studies, Propofol, Aged, Pressure, Middle Aged, Blood Flow, Halothane, Hydrogen-Ion Concentration, Oxygen Consumption, Fentanyl, Oxygen saturation, Midazolam, Vascular Resistance, Cardiopulmonary bypass, Pulmonary Artery, Gastric mucosa, and splanchnic circulation
The association of atrial fibrillation with thoracic surgical procedures is well known, but nevertheless its cause is not well defined. Increased sympathetic activity may play a role in the development of atrial fibrillation, and reduced... more
The association of atrial fibrillation with thoracic surgical procedures is well known, but nevertheless its cause is not well defined. Increased sympathetic activity may play a role in the development of atrial fibrillation, and reduced beta-receptor activity may be advantageous. The objective was to evaluate the effect of oral beta-blockade on the frequency of atrial fibrillation and to evaluate some possible causative factors. The study was prospective, randomized, and double-blind, and was conducted at Aarhus University Hospital. Thirty patients without previous or present cardiovascular history undergoing elective thoracotomy for lung resection. The patients received either 100 mg of metoprolol or placebo orally before surgery and once daily postoperatively. Anesthesia consisted of a thoracic epidural block combined with general intravenous anesthesia. Epidural morphine was continued postoperatively. Patients were monitored with electrocardiograms (ECGs), capillary pulse oximetry, invasive hemodynamic monitoring, central venous oxygen saturation, arterial blood gases, serum electrolytes, and fluid balances. Atrial fibrillation developed in 23.3% of the patients, 6.7% after metoprolol compared with 40% in the placebo group. Atrial fibrillation developed a mean of 2.9 days postoperatively. The predominant hemodynamic findings were perioperative lower oxygen consumption and postoperative lower cardiac index after metoprolol. Patients developing atrial fibrillation had much higher oxygen consumption and postoperative cardiac index than other patients. Perioperative oral beta-blockade can reduce the frequency of atrial fibrillation without serious side effects. Increased sympathetic activity is one of the predominant factors in the cause of this complication.