Greater Volume of Acute Normovolemic Hemodilution May Aid in Reducing Blood Transfusions After Cardiac Surgery.

BACKGROUND: Perioperative red blood cell transfusions (RBC) are associated with increased morbidity and mortality after cardiac surgery. Acute normovolemic hemodilution (ANH) is recommended to reduce perioperative transfusions; however, supporting data are limited and conflicting. We describe the relationship between ANH and RBC transfusions after cardiac surgery using a multi-center registry. METHODS: We analyzed 13,534 patients undergoing cardiac surgery between 2010 and 2014 at any of the 26 hospitals participating in a prospective cardiovascular perfusion database. The volume of ANH (no ANH, <400 mL, 400 to 799 mL, ≥ 800 mL) was recorded and linked to each center's surgical data. We report adjusted relative risks reflecting the association between the use and amount of ANH and the risk of perioperative RBC transfusion. Results were adjusted for preoperative risk factors, procedure, body surface area, preoperative hematocrit, and center. RESULTS: The ANH was used in 17% of the patients. ANH was associated with a reduction in RBC transfusions (RRadj [adjusted risk ratio] 0.74, p < 0.001). Patients having 800 mL or greater of ANH had the most profound reduction in RBC transfusions (RRadj 0.57, p < 0.001). Platelet and plasma transfusions were also significantly lower with ANH. The ANH population had superior postoperative morbidity and mortality compared with the no ANH population. CONCLUSIONS: There is a significant association between ANH and reduced perioperative RBC transfusion in cardiac surgery. Transfusion reduction is most profound with larger volumes of ANH. Our findings suggest the volume of ANH, rather than just its use, may be an important feature of a center's blood conservation strategy.

Effect of the combination of music and nature sounds on pain and anxiety in cardiac surgical patients: a randomized study.

BACKGROUND: Postoperative pain and anxiety are common in cardiac surgery patients. Studies have suggested that music can decrease anxiety in hospitalized patients. Primary Study Objective This study focused on the efficacy and feasibility of special music, which included nature sounds, for pain and anxiety. METHODS/DESIGN: In this randomized controlled trial, postoperative cardiovascular surgery patients were randomly assigned to a music group to receive 20 minutes of standard postoperative care and music twice daily on postoperative days 2 through 4 or to a control group to receive 20 minutes of standard care with a quiet resting period twice daily on postoperative days 2 through 4. SETTING: Cardiovascular surgical unit of Saint Marys Hospital, Rochester, Minnesota. PARTICIPANTS: One hundred patients completed the study (music group, n = 49; control group, n = 51). Intervention The music was delivered through CD players in the patients' rooms. PRIMARY OUTCOME MEASURES: Pain, anxiety, satisfaction, and relaxation were evaluated from visual analog scales. RESULTS: Data showed a significant decrease in mean (SD) pain scores after the second session of day 2 for the music group (change, ?1.4 [1.4]) compared with the control group (change, ?0.4 [1.4]) (P = .001). Mean relaxation scores improved more at the first session of day 2 for the music group (change, 1.9 [2.7]) compared with the control group (change, 0.3 [2.9]) (P = .03). The music group also showed lower anxiety and increased satisfaction overall, but these differences were not statistically significant. No major barriers to using the therapy were identified. CONCLUSION: Recorded music and nature sounds can be integrated into the postoperative care of cardiovascular surgery patients. The recordings may provide an additional means for addressing common symptoms of pain and anxiety while providing a means of relaxation for these patients.

Massage therapy after cardiac surgery.

Cardiac surgery presents a life-saving and life-enhancing opportunity to hundreds of thousands of patients each year in the United States. However, many patients face significant challenges during the postoperative period, including pain, anxiety, and tension. Mounting evidence demonstrates that such challenges can impair immune function and slow wound healing, in addition to causing suffering for the patient. Finding new approaches to mitigate these challenges is necessary if patients are to experience the full benefits of surgery. Massage therapy is a therapy that has significant evidence to support its role in meeting these needs. This paper looks at the data surrounding the use of massage therapy in cardiac surgery patients, with a special focus on the experience at Mayo Clinic.

Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study.

Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery.

Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study.

OBJECTIVES: To assess the role of massage therapy in the cardiac surgery postoperative period. Specific aims included determining the difference in pain, anxiety, tension, and satisfaction scores of patients before and after massage compared with patients who received standard care. DESIGN: A randomized controlled trial comparing outcomes before and after intervention in and across groups. SETTING: Saint Marys Hospital, Mayo Clinic, Rochester, Minnesota. SUBJECTS: Patients undergoing cardiovascular surgical procedures (coronary artery bypass grafting and/or valvular repair or replacement) (N=58). INTERVENTIONS: Patients in the intervention group received a 20-minute session of massage therapy intervention between postoperative days 2 and 5. Patients in the control group received standard care and a 20-minute quiet time between postoperative days 2 and 5. OUTCOME MEASURES: Linear Analogue Self-assessment scores for pain, anxiety, tension, and satisfaction. RESULTS: Statistically and clinically significant decreases in pain, anxiety, and tension scores were observed for patients who received a 20-minute massage compared with those who received standard care. Patient feedback was markedly positive. CONCLUSIONS: This pilot study showed that massage can be successfully incorporated into a busy cardiac surgical practice. These results suggest that massage may be an important therapy to consider for inclusion in the management of postoperative recovery of cardiovascular surgical patients.

Efficacy of acupuncture in prevention of postoperative nausea in cardiac surgery patients.

BACKGROUND: Coronary artery bypass graft and cardiac valve surgeries are frequently performed in medical facilities in the United States, and postoperative nausea (PON) is a prevalent problem in this patient population. The purpose of this study was to evaluate the efficacy of a single preoperative acupuncture treatment in the prevention of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery, or both. METHODS: Ninety participants presenting for coronary artery bypass graft or cardiac valve surgery, or both, were recruited for this study. Patients were randomly assigned to receive either one preoperative acupuncture and standard postoperative care (acupuncture group) or solely standard postoperative care (control group). Acupuncture was performed 0.5 to 3 hours before surgery. The PON incidence and severity on postoperative day (POD) 2 and POD 3 were measured with validated nausea tools. RESULTS: The acupuncture group had a significantly lower incidence of nausea compared with the control group (POD 2, odds ratio [OR], 0.38; p = 0.05; and POD 3, OR, 0.26; p = 0.01). The acupuncture group also had a significantly lower score of nausea severity than the control group (POD 2, OR, 0.29; p = 0.01; and POD 3, OR, 0.25; p = 0.01). No adverse effects due to acupuncture treatment were reported. Antiemetics, pain medications, and anesthetics administered intraoperatively did not differ between the two groups and did not influence study results. CONCLUSIONS: A single preoperative acupuncture treatment decreased incidence and severity of PON in patients undergoing coronary artery bypass graft or cardiac valve surgery, or both, and caused no adverse effects.

Creation of a healing enhancement program at an academic medical center.

There has been a growing emphasis on evaluating and improving the experience of the hospitalized patient. In 2004, the Cardiovascular Surgery team at Mayo Clinic Rochester, though achieving a high level of technical expertise and clinical outcomes, recognized that patients were not rating their overall hospital experience as highly as was expected. After a systematic evaluation of the hospital experience, tension, stress, pain, and anxiety were identified as key challenges for patients. A multidisciplinary team was created to evaluate pain management practices and explore methods for reducing pain, anxiety, and tension. An extensive review of the literature and site visits to other institutions provided the foundation for the program. The term "Healing Enhancement" was coined to identify the goals of this emerging paradigm that focused on all aspects of the patient's experience-mind, body, and spirit. Integrated therapies such as music, massage, guided imagery, and relaxation training were explored to measure their role in patient care.