New-onset postoperative atrial fibrillation (POAF) following Coronary artery bypass graft (CABG) surgery has been described in up to 15% to 40% of patients in the initial postoperative period. POAF is related with hig...New-onset postoperative atrial fibrillation (POAF) following Coronary artery bypass graft (CABG) surgery has been described in up to 15% to 40% of patients in the initial postoperative period. POAF is related with higher mortality, increased hospital resource utilization, postoperative extra ITU hours and hospital days, consequently increasing hospital-related budgets. Beta blocker administration decreases the rate of POAF from 30% - 40% to 12% - 16% after CABG. According to the EACTS (European Association of Cardiothoracic Surgery) guideline December 2006, β-Blockers should routinely be used as the first choice for the prophylaxis of atrial fibrillation (AF) in all patients undergoing cardiac surgery, if not contraindicated (IB). To compare the contemporary practice with the recommended standard retrospective data of consecutive 400 patients treated with isolated CABG between July 2015 and June 2017 were collected. Those patients who received β-blockers on the day of surgery or the following morning (Continued and Restarted on 1st POD) met the standard guidelines. Thus, according to the data (12% + 20%) 32% of the patients met the standard. To compare the rate of Postoperative Atrial fibrillation, we divided the patients into two groups. Group A, who followed the guideline (128 patients) and Group B, who resumed β-Blockers 48 hours onwards (272 Patients). In group A, only 8 patients developed postoperative AF whereas in group B 88 patients developed postoperative AF which is also statistically significant (P β-blockers use at perioperative period.展开更多
Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare ca...Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare cause of massive haemothorax and associated with high mortality.?We are presenting this?32-year-old gentleman who sustained a thoracic stab wound and had an emergency right anterior mini-thoracotomy?by extending the stab wound rather than standard thoracotomy or sternotomy.?This case of isolated penetrating IMA injury managed with mini-thoracotomy is the only documented case so far. We are publishing this case report with patient’s both written and informed consent and institutional approval.?This potentially life-threating injury can be managed by mini-thoracotomy with enhanced recovery;however, it is case specific and needs proper judgement.展开更多
文摘New-onset postoperative atrial fibrillation (POAF) following Coronary artery bypass graft (CABG) surgery has been described in up to 15% to 40% of patients in the initial postoperative period. POAF is related with higher mortality, increased hospital resource utilization, postoperative extra ITU hours and hospital days, consequently increasing hospital-related budgets. Beta blocker administration decreases the rate of POAF from 30% - 40% to 12% - 16% after CABG. According to the EACTS (European Association of Cardiothoracic Surgery) guideline December 2006, β-Blockers should routinely be used as the first choice for the prophylaxis of atrial fibrillation (AF) in all patients undergoing cardiac surgery, if not contraindicated (IB). To compare the contemporary practice with the recommended standard retrospective data of consecutive 400 patients treated with isolated CABG between July 2015 and June 2017 were collected. Those patients who received β-blockers on the day of surgery or the following morning (Continued and Restarted on 1st POD) met the standard guidelines. Thus, according to the data (12% + 20%) 32% of the patients met the standard. To compare the rate of Postoperative Atrial fibrillation, we divided the patients into two groups. Group A, who followed the guideline (128 patients) and Group B, who resumed β-Blockers 48 hours onwards (272 Patients). In group A, only 8 patients developed postoperative AF whereas in group B 88 patients developed postoperative AF which is also statistically significant (P β-blockers use at perioperative period.
文摘Penetrating injuries to anterior chest may result in life-threatening complications such as massive haemothorax,?as a result of injury to the internal mammary artery.?Isolated internal mammary injury is a very rare cause of massive haemothorax and associated with high mortality.?We are presenting this?32-year-old gentleman who sustained a thoracic stab wound and had an emergency right anterior mini-thoracotomy?by extending the stab wound rather than standard thoracotomy or sternotomy.?This case of isolated penetrating IMA injury managed with mini-thoracotomy is the only documented case so far. We are publishing this case report with patient’s both written and informed consent and institutional approval.?This potentially life-threating injury can be managed by mini-thoracotomy with enhanced recovery;however, it is case specific and needs proper judgement.
