Biomedical subjects

Michael E Bourke

Publications and source records attributed to Michael E Bourke.

2 recordsLinked to original sources

PubMed2004

Postoperative naproxen after coronary artery bypass surgery: a double-blind randomized controlled trial.

OBJECTIVE: Non-steroidal anti-inflammatory drugs (NSAIDs) are routinely used after coronary artery bypass surgery (CABG), yet their effects have seldom been evaluated in randomized controlled settings. The aim of this study was to examine the efficacy and safety of a commonly used NSAID, naproxen. We hypothesized that naproxen would reduce postoperative pain following CABG without increasing complications. METHODS: Patients (N=98) undergoing primary CABG were randomized to receive naproxen (500 mg q12hX5 doses via suppository started 1h after operation, followed by oral 250 mg q8hX6 doses) or placebo. Standard analgesic and anti-emetic regimens were available to both patient groups. Interventions were double-blinded. Primary end-points were postoperative pain measured before and after chest physiotherapy by visual analog scale and pulmonary slow vital capacity (SVC). RESULTS: Baseline characteristics were equivalent between the two groups. Over the first 4 postoperative days, naproxen decreased pain by 47+/-17% on average before chest physiotherapy (P=0.034), and 44+/-13% after chest physiotherapy (P=0.0092). Patients who received naproxen also had better preservation of SVC over the first 4 postoperative days (mean loss of SVC from baseline: 2.1+/-0.1 vs. 2.5+/-0.1l, naproxen vs. placebo, P=0.0032). This was concomitant with a lower white blood cell count observed in naproxen patients (9.2+/-0.3 vs. 12.7+/-1.5x10(9)/l, naproxen vs. placebo, P=0.03). Patients who received naproxen had more chest tube drainage after 4h postoperatively, but there was no difference in the incidence or amount of transfusions. There was no difference in medication use, length of stay, or in the incidence of atrial fibrillation, azotemia, and other complications. CONCLUSIONS: Naproxen is an effective and low-cost adjunct for optimization of pain control and lung recovery after CABG. Its use may result in increased chest tube drainage, but no apparent increase in other complications.

Analysis of Variance↗

PubMed2002

Pacemakers, recent directions and developments.

PURPOSE OF REVIEW: Pacemaker and implantable cardiovertor defibrillator utilization is evolving rapidly. Expanding indications are reviewed. RECENT FINDINGS: Current pacemakers are smaller, more dependable, longer lasting and have rate-adaptive features. Implantable cardiovertor defibrillators use transvenous leads and have advanced pacing abilities. Primary pacing indications remain sinus node dysfunction or atrioventricular conduction abnormalities. Dual-chamber pacemakers compared with single chamber ventricular pacemakers, have small quality of life advantages and result in less atrial fibrillation, but decrease stroke rates and mortality. In congestive heart failure patients with delayed ventricular conduction, cardiac resynchronization therapy (atrially timed biventricular pre-excitation) improves physiological parameters, performance indices and quality of life. Atrial arrhythmias may be prevented or treated with appropriate pacing strategies. Pacing-related improvements for symptomatic neurally mediated syncope and symptomatic hypertrophic obstructive cardiomyopathy have been demonstrated. For patients with coronary artery disease and low ejection fractions, implantable cardiovertor defibrillators are well established in the secondary prevention of sudden death, and may be helpful for primary prevention if there are inducible ventricular arrhythmias. Combining cardiac resynchronization and implantable cardiovertor defibrillators in similar patients is under investigation. The role of atrial defibrillators is being defined. Electromagnetic interference remains possible with these devices, particularly in electromagnetically hostile environments. SUMMARY: More pacemakers and implantable cardiovertor defibrillators will be encountered. Despite increasing sophistication, most often only basic anti-bradycardia modes are essential in the perioperative setting. Understanding the indications for implantation will help the anesthesiologist better support the physiological needs of the patient. Existing perioperative pacemaker-related guidelines for the anesthesiologist still apply.

Journal Article↗