Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2011
ReviewRe-evaluation of the role of antifibrinolytic therapy with lysine analogs during cardiac surgery in the post aprotinin era.
Hemorrhage, transfusions and the need for re-exploration can have a detrimental effect on patient outcome in cardiac surgery. With the suspension of aprotinin from the market, only the antifibrinolytics tranexamic acid and epsilon-aminocaproic acid (EACA) are left as pharmacological options to reduce hemostatic activation and associated bleeding complications. In light of the aprotinin story, the need for large independent safety studies has become evident. The current review will focus on the question of how far the quality of available data allows for judging these agents with regard to safety and efficacy, as well as whether or not new trails are warranted. ⋯ The lysine analogs are unspecific enzyme inhibitors. Therefore, it is conceivable that an overdosing might reveal severe clinical side-effects beyond the inhibition of plasmin. Further studies re-evaluating the drug safety of tranexamic acid and EACA using the recommended and approved doses are necessary.
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Perioperative acute pain and the development of persistent pain after thoracotomy are major problems severely affecting health-related quality of life. This review examines and highlights recent strategies and advances in perioperative pain management in this field. ⋯ Even though thoracotomy is associated with significant postoperative complications, a growing understanding of the underlying pathophysiology and advances in multimodal pain therapy concepts in this specific group of patients are promising improved postoperative outcomes and potential reduction of the incidence of persistent pain.
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Atrial fibrillation after cardiac surgery remains a very common and vexing clinical problem. This review summarizes recent clinical and laboratory investigations, the results of which may lead to a more effective strategy for the prevention of atrial fibrillation after cardiac surgery. ⋯ Atrial fibrillation after cardiac surgery remains a dysrhythmia with significant implications. A more comprehensive, multimodal preventive strategy, using preoperative beta-blockers and statins, perioperative magnesium and steroids, and preoperative amiodarone in high-risk patients should be rigorously evaluated.