Journal of interventional cardiology
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Randomized Controlled Trial Clinical Trial
Evaluation of propofol-ketamine anesthesia for children undergoing cardiac catheterization procedures.
The aim of this study was to assess the safety and efficacy of the continuous intravenous administration of a combination of propofol and ketamine for children undergoing cardiac catheterization procedures (CCP). Thirty-two children scheduled for CCP in a university teaching hospital were included in this prospective randomized study. Patients in group 1 (n = 15) were given a combination of propofol (25 microg/kg per minute) and ketamine (25 microg/kg per minute), whereas patients in group 2 (n = 17) received a combination of propofol (25 microg/kg per minute) and ketamine (12.5 microg/kg per minute) for the maintenance of anesthesia. ⋯ The time to awakening was significantly less in group 2 (P < 0.05). We conclude that a combination of propofol (25 microg/kg per minute) and two different doses of ketamine (25 and 12.5 microg/kg per minute, respectively) are safe and efficacious for CCP in children. Although the time to awaken was more in patients receiving 25 microg/kg per minute of ketamine compared to those receiving 12.5 microg/kg per minute of ketamine, it was well within acceptable limits.
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Drug-eluting stents (DES) constitute a major breakthrough in restenosis prevention after percutaneous coronary intervention (PCI). This study compared the clinical outcomes of PCI using DES versus coronary artery bypass graft (CABG) in patients with multivessel coronary artery disease (MVD) in real-world. ⋯ PCI with DES is a safe and feasible alternative to CABG for selected patients with MVD. The reintervention gap was further narrowed in the era of DES. Aside from restenosis, progression of disease needs to receive substantial emphasis.
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Coronary stent technology has rapidly evolved from a mechanical solution to abrupt vessel closure and elastic recoil following plain balloon angioplasty, to become a vector for local drug delivery and modification of coronary plaque pathophysiology. The advent of drug-eluting stents (DES) has significantly reduced restenosis, although there is increasing concern over the risk of late stent thrombosis, particularly following cessation of antiplatelet therapy. Here we consider the limitations of the current generation of DES, and review recent advances in platform, carrier, and pharmacological technology, and their place in future clinical practice.
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Guidelines are based on a scientific analysis from existing data of randomized controlled trials (RCTs), registry trials, simple registries, case reports, and the personal experience of the task force members. Furthermore, meta-analyses and subgroup analyses are used to derive the strengths of recommendations. Fortunately, the major cardiac societies, i.e., the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC), are essentially using the same definitions for the levels of recommendations. ⋯ For simple registry studies and subgroup analyses, a modified scoring system has been developed (maximum achievable points is 5). The advantage of the suggested new scoring system is its transparency, reproducibility, and ease of use by quickly answering the key quality questions for clinical trials. The new scoring system suggested here should help make decisions regarding which treatment to use and stimulate discussions.
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To evaluate the effect of body mass index (BMI) on in-hospital outcomes in patients undergoing percutaneous coronary intervention (PCI) at a tertiary care hospital center in Ontario, Canada. ⋯ Obesity is not associated with increased risk of adverse postprocedural in-hospital outcomes. These findings, however, do not discount the need for sustained efforts in secondary prevention of obesity and its consequences.