2009 ACCF/AHA Focused Update on Perioperative Beta Blockade A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Society for Vascular Medicine.
Circulation (Impact Factor: 14.43). 11/2009; 120(21):2123-51. DOI: 10.1161/CIRCULATIONAHA.109.192689
Source: PubMed
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    • "heart disease; CAD = coronary artery disease; HTN = hypertension * ESC high-risk surgery = aortic and major vascular surgery or peripheral vascular surgery ACCF/AHA clinical risk factors = history of ischemic heart disease, compensated heart failure, cerebrovascular disease, diabetes mellitus, and renal insufficiency (preoperative serum creatinine [ 2 mgÁdL -1 ) § ACCF/AHA Intermediate risk surgery = cardiac risk 1 – 5% = intraperitoneal and intrathoracic surgery, carotid endarterectomy, head and neck surgery, orthopedic surgery, prostate surgery ** ESC Intermediate risk surgery = cardiac risk 1 – 5% = abdominal, carotid, peripheral arterial angioplasty; endovascular aneurysm repair; head and neck surgery; major neurological/orthopedic (hip and spine) surgery; transplant (lung, liver renal); and major urologic surgery ESC Low risk surgery = \ 1% cardiac risk = breast, dental, endocrine, eye, gynecologic, reconstructive, minor orthopedic (knee), and minor urologic surgery } ESC risk factors = ischemic heart disease, heart failure, cerebrovascular disease, diabetes mellitus requiring insulin, renal dysfunction/ hemodialysis, and age Adapted with permission from Table 2 Fleischmann et al. 2009 and Poldermans et al. 2009 (Table page 16) variety of surgical and patient risk strata. 15-17 Nevertheless, it was likely apparent to the ACCF/AHA group that there is insufficient evidence to date for implementation of this potentially expensive and logistically complex process in the United States with its ''diverse'' health care system (complicated by the lack of substantial data from studies conducted in the United States). "

    Canadian Anaesthetists? Society Journal 04/2010; 57(4):301-12. DOI:10.1007/s12630-010-9273-9 · 2.53 Impact Factor
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    ABSTRACT: MEDICATION SAFETY Overlooked Renal Dosage Adjustments A retrospective analysis of 647 patients at hospital discharge com-pared required renal dosage adjust-ments to dosage actually prescribed. This study was conducted at VieCuri Medical Centre in Venlo, Netherlands. Patient demographics and renal function data were col-lected, and dosage adjustment needs were assessed via the pharmacy-supported discharge counseling ser-vice. The incidence of inappropriate dosing based on renal function was measured at hospital discharge. Thirty-seven percent of patients evaluated during the study period (237/647) had a creatinine clear-ance less than 51 mL/min/1.73 m 2 ; dosage adjustment was warranted in 23.9% (411/1,718) of prescrip-tions. When dosage adjustment should have been performed, more than 40% of prescriptions (169/411; 41.1%) were inappropri-ate for renal function (9.8% of pre-scriptions overall; 169/1,718). Fur-thermore, 60.4% (102/169) of inappropriate prescriptions pos-sessed the potential for moderate or severe clinical consequences, as evaluated by a panel of two clinical pharmacologists and one nephrolo-gist. Study authors also noted a lack of standardized dosing guidelines for agents requiring renal dosage adjustment. The authors also sug-gested that augmenting medication systems by adding dynamic renal dosing alerts would improve moni-toring. Summary: A comparison of suggested renal dosing and actual dosing at hospital discharge revealed that appropriate prescribing may be overlooked. van Dijk EA, Drabbe NRG, Kruijtbosch M, De Smet PAGM. Drug dosage adjust-ments according to renal function at hos-pital discharge. Ann Pharmacother. 2006;40:1254-1260.
    Hospital pharmacy 12/1122; 41(7). DOI:10.1310/hpj4311-937
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    ABSTRACT: Long-standing practice has been to view a longitudinal slot in a broad wall of a rectangular waveguide as a shunt element. This becomes a more questionable assumption as the b dimension of the guide is decreased and/or the slot offset is increased. A symmetrical T or pi model of the slot is more accurate. A procedure for developing the parameter values of the T or pi is described. The further complication of accounting for external mutual coupling is also discussed.
    Antennas and Propagation Society International Symposium, 1986; 07/1986
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