Preoperative Risk Prediction Score for and In-Hospital Clinical Outcomes of Reperfusion Ventricular Fibrillation After Release of Aortic Cross-Clamps: A Retrospective Study.

Reperfusion ventricular fibrillation (VF) is a common arrhythmia after cardiac surgery. Predictors of reperfusion VF and its relationships with the adverse prognosis are still unclear. This study aimed to identify a risk score model to predict reperfusion VF and its effect on in-hospital outcomes. The authors enrolled 1,024 consecutive patients undergoing cardiac surgery, and a total of 823 patients were included in the study. A novel risk score model was developed following logistic regression analysis of the predictors of reperfusion VF. The receiver operating characteristic curve was used to validate this model, and the effect of VF on prognosis was later identified in multivariate or Kaplan-Meier analyses. Risk factors for reperfusion VF occurrence included weight >55 kg, preoperative left ventricular ejection fraction <50%, prior stroke, hypertension, aortic valve replacement, HTK solution, and the use of ≥3 grafts in coronary artery bypass grafting. A novel risk score model was developed using the abovementioned variables, and points were assigned to each risk factor according to its odds ratio. A high score (>6) predicted greater than 65% of patients with VF occurrence. Reperfusion VF increased the risk of in-hospital cardiovascular death (p = 0.03) and renal replacement therapy postoperatively (p = 0.022). More attention should be given to reperfusion VF due to an adverse postoperative prognosis, and the developed risk score model may predict this risk.

S-ketamine used during anesthesia induction increases the perfusion index and mean arterial pressure after induction: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Abnormal peripheral perfusion and postinduction hypotension are associated with postoperative adverse outcomes. S-ketamine may stimulate blood circulation by activating the sympathetic nervous system. This study aimed to identify whether S-ketamine may improve the hemodynamic profile, relative to saline. METHODS: 115 patients were assessed for eligibility for participation in this study. A total of 100 patients were included. The patients (n = 50 for each group) were randomly allocated to the Test group, treated with S-ketamine plus propofol, cisatracurium and sufentanil, and to the Control group, treated with saline plus propofol, cisatracurium, and sufentanil. Maintenance of anesthesia in both groups was accomplished with sevoflurane. The perfusion index (PI) was recorded at intervals of 1 min, and mean arterial pressure (MAP) and heart rate (HR) were collected continuously at intervals of 3 min. The number of patients with MAP < 60 mmHg was also analyzed. RESULTS: The PI remained higher in the Test group than in the Control group at the following time points: initial induction (mean difference: 1.01 [95% CI: 0.27-1.74]; P = 0.007), preintubation (mean difference: 1.46 [95% CI: 0.57-2.34]; P = 0.001) and postintubation (mean difference: 1.28 [95% CI: 0.26-2.30]; P = 0.014), before (mean difference: 2.66 [95% CI: 1.22-4.1]; P < 0.001) and after making the skin incision (mean difference: 1.03 [95% CI: 0.28-1.78]; P = 0.007). Compared with Control group, a higher MAP trend from preintubation to postincision appeared in patients assigned to S-ketamine (P = 0.003). The number of patients with MAP < 60 mmHg in the Test group was lower than Control group (10.0% vs. 34.0%, P < 0.003) in the preincision. The HR was similar throughout the test, with no statistical difference. CONCLUSIONS: During anesthesia induction and maintenance, the use of S-ketamine may improve the peripheral perfusion and blood pressure as compared to the Control group. CLINICAL TRIAL NUMBER: ChiCTR2100051167.