Preoperative Fasting of More Than 14 Hours Increases the Risk of Time-to-Death after Cardiothoracic Surgery in Children:A Retrospective Cohort Study

Background:Prolonged preoperative fasting can cause hypoglycemia,hyperglycemia,and intravascular volume depletion in children.We aimed to examine whether prolonged preoperative fasting is associated with in-hospital mortality and other morbidities in pediatric cardiothoracic surgery.Methods:This retrospective cohort study included children aged 0–3 years who underwent cardiac surgery between July 2014 and October 2020.The patient demographic data,surgery-related and anesthesia-related factors,and postoperative outcomes,including hypoglycemia,hyperglycemia,sepsis,length of intensive care unit stay,and in-hospital mortality,were recorded.The main exposure and outcome variables were prolonged fasting and time-to-death after surgery,respectively.The associations between prolonged fasting and perioperative death were analyzed using multivariate Cox regression analysis.Results:In total,402 patients were recruited.The incidence of perioperative mortality was 21%(85/402).The proportion of perioperative deaths was significantly higher in the prolonged fasting group than that in the normal fasting group.The proportion of postoperative bacteremia and hypoglycemia was significantly higher in the very prolonged fasting group than that in the prolonged fasting group.After adjusting for preoperative conditions and anesthesia-and surgery-related factors,preoperative prolonged fasting>14.4 h was significantly associated with time-to-death(HR[95%CI]:2.2[1.2,3.9],p=0.036).The 30-day survival rates of fasting time>14.4 h,9.25–14.4 h,and<9.25 h were 0.67(0.55,0.81),0.79(0.72,0.87),and 0.85(0.79,0.91),respectively.Conclusions:Preoperative fasting of more than 14.4 h was associated with a two-fold increase in the hazard rate of time-to-death in children who underwent cardiac surgery.

Evaluation of Glycemic Control with a Pharmacist-Managed Post-Cardiothoracic Surgery Insulin Protocol

Purpose： The purpose of this study is to validate whether a standardized pharmacist-managed protocol improves glycemic control in post-operative patients following cardiothoracic surgery. Methods： The study was conducted via retrospective chart review comparing outcomes from patients treated before and after implementation of a pharmacist-managed insulin protocol. The primary efficacy outcome is defined as the percentage of patients below the target blood glucose level of 200 mg/dL from POD （post-operative day） 1 through POD 2, with secondary outcomes comparing the rates of hypoglycemia, hospital LOS （length of stay）, and the incidences of SSI （surgical-site infections） diagnosed through 30 days post-surgery. Eligible participants included all adult patients who had undergone cardiothoracic surgery during the time frame of the study, but excluded any patients requiring intubation or continuous insulin infusion through 12：00 on POD 1. Results： The incidence of post-operative hyperglycemia was similar in the pre-protocol and post-protocol groups with a non-statistically significant trend toward a lower incidence in the post-protocol （19.5% pre-protocol v 12.3% post-protocol, P = 0.05）. There were no statistically significant differences between both groups with regard to SSI （2.1% vs 4.7%, P = 0.16）, hospital LOS （9.9 days vs 9.6 days, P = 0.46）, or hypoglycemia （0.5% vs 2.1%, P = 0.05）. Conclusion： The pharmacist-managed insulin protocol resulted in similar rates of post-operative hyperglycemia compared to the pre-protocol group.

End-tidal carbon dioxide monitoring revealed severe complications during cardiothoracic surgery

Introduction:With the continuous progress being made in medicine and surgery,increasingly more advanced technology and monitoring equipment are being used in anesthesia,end-tidal carbon dioxide(PETCO_(2))monitoring revealed serious complications of cardiothoracic surgery.Case presentation:A 3-year-old boy with a body weight of 15 kg presented with a>1-month history of a heart murmur.At the moment of arterial catheter ligation,the PETCO_(2) decreased from 37 to 15 mmHg,while the blood pressure,heart rate,and airway resistance did not change significantly.After re-separation of the ligation catheter,the surgeons carefully exposed the ductus and left pulmonary artery again and ligated the ductus arteriosus.Conclusion:This case suggests that PETCO_(2) monitoring reflects the circulatory status and pulmonary blood flow.

Blood glucose management in the patient undergoing cardiac surgery: A review

Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns.