Alexey Dyachkov » Вт окт 25, 2011 5:36 pm
Nemnogo pro amiodarone
Prophylactic Amiodarone for Prevention of Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis
Annals of Thoracic Surgery
Volume 82, Issue 5, November 2006, Pages 1927-1937
Bagshaw, S.M.a d g , Galbraith, P.D.b e f , Mitchell, L.B.b e , Sauve, R.d , Exner, D.V.b c d e , Ghali, W.A.c d
a Department of Critical Care Medicine, University of Calgary, Calgary, Alta., Canada
b Department of Cardiac Sciences, University of Calgary, Calgary, Alta., Canada
c Department of Medicine, University of Calgary, Calgary, Alta., Canada
d Department of Community Health Sciences, University of Calgary, Calgary, Alta., Canada
e Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alta., Canada
f Centre for Health and Policy Studies, University of Calgary, Calgary, Alta., Canada
g Department of Intensive Care, Austin Hospital, Melbourne, Vic., Australia
Abstract
Amiodarone has been proposed to decrease atrial fibrillation after cardiac surgery. The literature was systematically reviewed for randomized trials comparing amiodarone with control for prevention of atrial fibrillation. Data were extracted on study characteristics, quality, and incidence of atrial fibrillation, cardiovascular outcomes, and length of hospitalization. Nineteen trials were included. Amiodarone reduced the odds ratio of atrial fibrillation (0.50; 95% confidence interval [CI]: 0.43 to 0.59, p < 0.0001), ventricular tachyarrhythmias (0.39; 95% CI: 0.26 to 0.58, p < 0.0001), and strokes (0.53; 95% CI: 0.30 to 0.92, p = 0.02). Amiodarone reduced hospital stay (0.6 days; 95% CI: 0.4 to 0.8, p < 0.0001). Amiodarone decreased atrial fibrillation, reduced perioperative ventricular tachyarrhythmias and strokes, and reduced duration of hospitalization. The current evidence supports recommending the routine use of perioperative amiodarone for cardiac surgery.
© 2006 The Society of Thoracic Surgeons.
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Amiodarone prophylaxis reduces major cardiovascular morbidity and length of stay after cardiac surgery: A meta-analysis
Aasbo, J.D.a , Lawrence, A.T.a , Krishnan, K.a , Kim, M.H.a , Trohman, R.G.a b
a Rush University Medical Center, Chicago, IL, United States
b Rush University Medical Center, 1750 West Harrison, Chicago, IL 60612, United States
Annals of Internal Medicine
Volume 143, Issue 5, 6 September 2005, Pages 327-336+I-26
Abstract
Background: Although evidence supports the prophylactic use of β-blockade in cardiac surgery, postoperative atrial fibrillation or flutter occurs in 40% to 60% of patients. Trials that assessed whether amiodarone prophylaxis decreases the incidence of post-operative atrial tachyarrhythmias have had mixed results and were not specifically powered to detect changes in cardiovascular morbidity, length of stay, or mortality. Purpose: To see whether prophylactic administration of amiodarone decreases the incidence of major cardiovascular events, length of stay, and mortality after cardiac surgery. Data Sources: English-language and non-English-language publications listed in the MEDLINE, EMBASE, and CINAHL databases and the Cochrane Central Register of Controlled Trials, and bibliographies of published reviews. Sources were searched from the earliest possible dates through February 2005. Study Selection: Double-blind, randomized studies comparing amiodarone with placebo that reported the incidence of supraventricular arrhythmia, atrial fibrillation, or atrial flutter as the primary end point. Data Extraction: Two investigators independently collected all data. Discrepancies were resolved by consensus. Data Synthesis: After DerSimonian-Laird random-effects models were used to combine data from 10 trials involving 1744 patients, amiodarone therapy was found to decrease the incidence of atrial fibrillation or flutter (relative risk, 0.64 [95% CI, 0.55 to 0.75]), ventricular tachycardia and fibrillation (relative risk, 0.42 [CI, 0.28 to 0.63]), stroke (relative risk, 0.39 [CI, 0.21 to 0.76]), and length of stay (weighted mean difference, -0.63 day [CI, -1.03 to -0.23 days]). All studies reported adverse events, but none indicated how these events were assessed. Three studies found significantly more adverse events with amiodarone therapy, including nausea permitting continuation of therapy, bradycardia of unclear clinical significance, and increased intensive care monitoring and support. Limitations: Not all studies used β-blockade, and regimens were not uniform among trials. Few trials met the stringent inclusion criteria, some did not report each type of cardiovascular event, and none reported completeness of follow-up. Conclusions: Amiodarone prophylaxis decreases the occurrence of atrial fibrillation, ventricular tachyarrhythmias, and stroke and length of stay after cardiac surgery. To further evaluate the potential benefits of concomitant prophylaxis with β-blockers and amiodarone, a multicenter, randomized, double-blind trial with cardiovascular outcomes that compares amiodarone with placebo in patients already receiving β-blocker prophylaxis is needed.
© 2005 American College pf Physicians.
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Prophylactic amiodarone versus lidocaine for prevention of reperfusion ventricular fibrillation after release of aortic cross-clamp
European Journal of Anaesthesiology
Volume 26, Issue 12, December 2009, Pages 1056-1060
Ayouba, C.M.a , Sfeirb, P.M.b , Pierre, B.-K.c , Azara, M.a , Haddadind, A.S.d , Harfoucha, D.a , Nasra, V.G.a , El-Khatiba, M.F.a
a Department of Anaesthesiology, American University, Beirut Medical Center, Hamra Street, Beirut 1107-2020, Lebanon
b Department of Surgery, American University, Beirut Medical Center, Beirut, Lebanon
c Department of Internal Medicine, American University, Beirut Medical Center, Beirut, Lebanon
d Department of Anaesthesiology, Yale University School of Medicine, New Haven, CT, United States
Abstract
Background and objective Ventricular fibrillation is common after aortic cross-clamp release in patients undergoing open-heart surgeries. The aim of the study was to evaluate the efficacy of the prophylactic administration of 150mg amiodarone by way of the pump 2 min before release of aortic cross-clamp in preventing ventricular fibrillation. Methods The present study is a prospective, randomized, controlled and blinded study performed at a teaching university hospital where 120 patients undergoing coronary bypass graft surgery were randomly assigned to three groups. Each group received either 150mg of amiodarone or 100mg lidocaine or isotonic saline by way of pump 2 min before release of the aortic cross-clamp. The frequency of occurrence of ventricular fibrillation and the subsequent required defibrillation counter shocks were determined in all groups. Results The frequency of occurrence of ventricular fibrillation was significantly higher in both the amiodarone (48%) and the control group (45%) as compared with the lidocaine group (20%) with no statistically significant difference between the amiodarone and the control groups. Furthermore, when ventricular fibrillation occurred, the percentage of patients requiring defibrillation counter shocks was significantly higher in both the amiodarone (58%) and control (61%) groups as compared with the lidocaine group (13%) with no difference between the amiodarone and the control groups, despite a significant decrease in the defibrillation counter shocks energy requirements in the amiodarone group. Conclusion The present study showed no difference between amiodarone (150 mg) and placebo in preventing ventricular fibrillation after release of aortic cross-clamp. In addition, the use of lidocaine was able to reduce the incidence of ventricular fibrillation as compared with both amiodarone and placebo. Eur J Anaesthesiol 261056-1060
© 2009 European Society of Anaesthesiology.
....Хенсли читаю и перечитываю. еще источники, скиньте....пжст.
