The Role of Hypnotherapy in Postoperative Cardiac Surgical Patients, A Scoping Review of Current Literature.

Hypnotherapy has been proposed as an emerging tool that can be implemented in management of different aspects of postoperative cardiac surgical care. This technique involves hypnotic induction to redirect focus and attention away from postsurgical pain. Emerging literature has shown that hypnosis significantly improves emotional distress immediately preceding surgical procedures and these effects have been demonstrated to extend into the postoperative period. The purpose of this scoping review is to summarize current literature on the role of hypnotherapy in the management of perioperative pain, anxiety, and depression in patients undergoing cardiac surgery. A database search was conducted using PubMed, Embase, and Google Scholar. We included all comparative studies (randomized and nonrandomized) that examined the effect of hypnotherapy on pain, anxiety, and depression in patients undergoing cardiac surgery. Included articles were restricted to adult patients and English language only. Literature search yielded a total of 64 articles, of which, 14 duplicates were removed. After title and abstract screening, only 18 articles were included for full-text review. Six studies (with a total number of 420 patients) were included in the final analysis. Of these, 5 were randomized control trials and 1 was a cohort study. Our findings suggest that there may be a potential role for the use of hypnotherapy in the management of pain, anxiety, and depressive symptoms in the perioperative period of cardiac surgery. However, more robust evidence is required to justify its incorporation in the routine perioperative management pathways in this group of patients.

Management of Coronary Artery Disease in CADASIL Patients: Review of Current Literature.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia in adults. It is well-established that CADASIL results in neurocognitive dysfunction and mood disturbance. There is also cumulative evidence that CADASIL patients are more susceptible to ischemic heart disease. The aim of this study is to review the current literature regarding the incidence of coronary artery disease in CADASIL patients with a focus on the various management options and the clinical challenges associated with each of these treatment strategies. We conducted a literature search using Cochrane, MEDLINE, and EMBASE for papers that reported the occurrence of coronary artery disease in patients with CADASIL. We supplemented the search with a manual search in Google Scholar. Only case reports, case series, and original articles were included. The search resulted in six reports indicating the association between coronary artery disease and CADASIL and its management. Evidence suggests that extracranial manifestations of CADASIL may include coronary artery disease, presenting as a more extensive burden of disease in younger patients. Surgical and percutaneous revascularization strategies are feasible, but the incidence of peri-procedural stroke remains significant and should be weighed against the potential benefit derived from either of these strategies. A multidisciplinary approach to therapy, with perspectives from neurologists, cardiologists, and cardiac surgeons, is needed to provide the appropriate treatment to the CADASIL patient with severe coronary artery disease. Future studies should be directed toward the development of targeted therapies that may help with the early detection and prevention of disease progress in these patients.