Anesthesiology and Intensive Care

    Dual antiplatelet therapy (DAPT) with ASA and P2Y12-receptor  inhibitors (clopidogrel, ticagrelor and prasugrel) (Table) reduces  the risk for thrombotic complications in patients with acute coronary  syndrome (ACS) compared to treatment with ASA only, especially if they undergo percutaneous coronary intervention.  The risk for thrombotic

Type I or “Hypoxemic” Respiratory Failure.  Type I ARF is defined by PaO2 < 60 mm Hg, with normal or decreased PaCO2.   Causes:

    The criteria for MI are divided into two categories: ST-segment elevation MI (STEMI) , and ST-segment depression/T-wave change MI (NSTEMI) . The J point is located at the juncture of the QRS complex and the ST segment, and it is used to measure the magnitude of the ST-segment deflection as compared with the baseline of the ECG.     A new J-point elevation of 0.1 mV or greater is required in all leads except V2 and V3 to meet the criteria for STEMI. J-point elevations of up to 0.25 mV may be seen in leads V2 and V3 in healthy men younger than 40 years of age; however, this finding decreases with age and is less prominent in women. For this reason, a range of J-point elevation criteria for MI are defined for V2 and V3 leads: 0.2 mV or greater for men 40 years old and older, 0.25 mV or greater for men younger than 40 years of age, and 0.15 mV or greater for women. he J-point elevations must be seen in two or more contiguous leads for the satisfaction o...

RELATIVE CONTRAINDICATIONS TO DIAGNOSTIC CARDIAC CATHETERIZATION 1. Uncontrolled ventricular irritability: the risk for ventricular tachycardia/fibrillation during catheterization is increased if ventricular irritability is uncontrolled 2. Uncorrected hypokalemia or digitalis toxicity 3. Uncorrected hypertension: predisposes to myocardial ischemia and/or heart failure during angiography 4. Intercurrent febrile illness 5. Decompensated heart failure, especially acute pulmonary edema 6. Anticoagulation state; international normalized ratio (INR)  >1.8, femoral approach 7. Severe allergy to radiographic contrast agent 8. Severe renal insufficiency and/or anuria, unless dialysis is planned to remove fluid and radiographic contrast load IDENTIFICATION OF THE HIGH-RISK PATIENT FOR CATHETERIZATION Age • Infant: < 1 y old • Elderly: > 70 y old Functional class • Mortality ↑ 10-fold for class IV patients compared with I and II ...

Preoperative Bleeding Risk Factors: Prior bleeding history following surgical procedures Preop coagulopathy Preoperative organ dysfunction Liver disease Kidney disease/renal failure CHF with passive liver congestion  increased LFTs  increased PT History of quantitive or qualitative platelet dysfunction Platelet inhibitors ASA, NSAID GPIIb/IIIa inhibitor Preop anticoagulant use Heparin Warfarin Fibrinolytic administration TPA Streptokinase Urokinase Intraoperative Course: CPB time (over 150 min increases risk) Administration of blood products Transfusion of “pump blood” or autologous blood (heparinized blood) Administration of antifibrinolytics, DDAVP, or serine protease inhibitor Surgical bleeding sites intraoperative Presence of microvascular bleeding at sternal closure

    Acetylsalicylic acid (ASA) is one of the cornerstones for the treatment of acute and chronic cardiovascular disease. Secondary prevention with ASA has been shown to reduce mortality, MI and cerebrovascular events in different subsets of patients with occlusive cardiovascular disease, but also to increase the risk for bleeding complications.     Discontinuation before surgery. A meta-analysis of 13 trials with 2399 patients who had CABG that compared administration of ASA preoperatively versus no treatment or treatment with a placebo showed that treatment with ASA reduced the risk for perioperative MI [(odds ratio (OR) 0.56; 95% confidence interval (CI) 0.33–0.96] but did not reduce the mortality rate (OR 1.16; 95% CI 0.42–3.22). Postoperative bleeding, red cell transfusions and surgical re-exploration were increased with ASA. However, the included studies were of low methodological quality. A recent large randomized controlled trial (RCT) compared the...