Background: Recent evidence suggests that early extubation after cardiac surgery can be performed without increased morbidity, resulting in economic advantages. However, most studies on this subject exclude patients with preoperative risk factors described as predictors for prolonged mechanical ventilation. The purpose of our prospective clinical trial was to decide whether early extubation is feasible independent of preoperative patient status, in particular independent of preoperative risk factors. Methods: From 12/96 to 6/97, 266 patients underwent cardiac surgery, most commonly CABG and valve replacement. 65 patients (24.4%) formed the risk group, showing preoperatively at least one of the following risk factors: emergency surgery, severe left-ventricular dysfunction, previous heart surgery, recent myocardial infarction, age 75 years or older, history of several myocardial infarctions. The remaining 201 patients (75.6%) formed the control group. The percentage of patients extubated within 12 hours represented the primary endpoint. 38 patients (10 risk, 28 control) had to be excluded from further analyses due to intra- or perioperative complications. Results: No differences between 55 risk patients and 173 control patients could be detected in extubation rate within 12 hours (100% vs 100%), mean extubation time (6:04 h vs 6:01 h), and incidence of complications after extubation (5.5% vs 5.2%). Risk patients were discharged 0.33 days later from the intensive care unit (2.00 d vs 1.67 d; p = 0.047). Conclusions: 1. All patients are basically suitable for early extubation, with the presence of preoperative risk factors used in this study being poor predictors of prolonged ventilation. 2. The necessity of prolonged ventilation is primarily determined by intra- or perioperative complications.

Nonthoracotomy lead systems for implantable cardioverter defibrillators (ICDs) have reduced operative mortality and morbidity as compared to epicardial lead systems but are usually associated with higher defibrillation thresholds (DFTs). The purpose of this prospective randomized trial was to investigate if the second defibrillation electrode in the left subclavian vein can increase defibrillation efficacy and decrease DFT as compared to the superior vena cava (SVC) position in nonthoracotomy lead systems for ICDs. Seventeen patients (mean age: 49.9 +/- 11.3 years, mean ejection fraction: 46.1% +/- 15.8%) were implanted with an investigational unipolar electrode (Medtronic 13001) used as the defibrillation anode. DFT testing was started in the SVC (n = 10, group A) or the left subclavian vein (n = 7, group B), and repeated in the alternative position starting at the DFT of the initial position. Fifteen patients were eligible for analysis (group A: n = 9, group B: n = 6). With the electrode in the SVC, ventricular fibrillation could be successfully terminated in 9 out of 15 patients (60%). In the left subclavian vein the success rate was 100% (P < 0.01). Mean DFT in the SVC was 13.0 +/- 5.2 J and in the left subclavian vein 10.2 +/- 4.9 J. DFTs in the left subclavian vein were either lower (group A: n = 5/9, group B: n = 5/6) or equal to the results in the SVC position (P < 0.001). Thus, the left subclavian vein appears to be a superior alternative for positioning of the defibrillation anode as compared to the SVC for nonthoracotomy lead systems using two separate leads.

HomeCirculationVol. 68, No. 4The influence of selective thromboxane synthetase inhibition with a novel imidazole derivative, UK-38,485, on prostanoid formation in man. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBThe influence of selective thromboxane synthetase inhibition with a novel imidazole derivative, UK-38,485, on prostanoid formation in man. S Fischer, M Struppler, B Böhlig, C Bernutz, W Wober and P C Weber S FischerS Fischer , M StrupplerM Struppler , B BöhligB Böhlig , C BernutzC Bernutz , W WoberW Wober and P C WeberP C Weber Originally published1 Oct 1983https://doi.org/10.1161/01.CIR.68.4.821Circulation. 1983;68:821–826 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Sathler P, Santana M, Lourenço A, Rodrigues C, Abreu P, Cabral L and Castro H (2013) Human thromboxane synthase: comparative modeling and docking evaluation with the competitive inhibitors Dazoxiben and Ozagrel, Journal of Enzyme Inhibition and Medicinal Chemistry, 10.3109/14756366.2013.817403, 29:4, (527-531), Online publication date: 1-Aug-2014. 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October 1, 1983Vol 68, Issue 4 Advertisement Article InformationMetrics Copyright © 1983 by American Heart Associationhttps://doi.org/10.1161/01.CIR.68.4.821 Originally publishedOctober 1, 1983 PDF download Advertisement