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Related Concept Videos

Cardiomyopathy VII: Pre and Post Operative Nursing Management01:28

Cardiomyopathy VII: Pre and Post Operative Nursing Management

Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
Indirect-Acting Cholinergic Agonists: Pharmacological Actions01:30

Indirect-Acting Cholinergic Agonists: Pharmacological Actions

Indirect-acting cholinergic agonists, also known as anticholinesterases, exert their pharmacological effects by enhancing cholinergic transmission in various body parts, including the neuromuscular junction, autonomic cholinergic synapses, and the brain.
At the neuromuscular junction, these agents work by inhibiting the breakdown of acetylcholine, allowing it to remain bound to the receptor and bind to nearby receptors. This process leads to repetitive firing of the endplate, causing muscle...
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
Direct-Acting Cholinergic Agonists: Therapeutic Uses01:11

Direct-Acting Cholinergic Agonists: Therapeutic Uses

Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren syndrome.
Cholinergic Antagonists: Therapeutic Uses01:26

Cholinergic Antagonists: Therapeutic Uses

Antimuscarinic drugs have various therapeutic applications by inhibiting parasympathetic stimulation in different systems. Here are the key therapeutic uses of antimuscarinics:    
Respiratory Tract: Ipratropium, aclidinium, and tiotropium treat asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). They protect against bronchoconstriction caused by irritants like cigarette smoke, sulfur dioxide, and ozone. They also help reduce nasopharyngeal secretions in common...
Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
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Related Experiment Videos

Anticholinergic Burden as a Modifiable Risk Factor in Cardiac Surgery: A Randomized Controlled Study.

Muhammed Cobas1, Zeliha Aslı Demir1, Aslıhan Aykut1

  • 1Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey.

Journal of Cardiothoracic and Vascular Anesthesia
|June 10, 2026
PubMed
Summary
This summary is machine-generated.

Reducing anticholinergic medications in older heart surgery patients significantly improved their functional recovery and reduced complications. This deprescribing strategy enhances outcomes for elderly individuals undergoing coronary artery bypass grafting (CABG).

Keywords:
Clinical Frailty ScaleKatz Indexanticholinergic burdencoronary artery bypass graftingfunctional recoverypostoperative complications

Related Experiment Videos

Area of Science:

  • Geriatric Medicine
  • Cardiothoracic Surgery
  • Pharmacology

Background:

  • Older adults undergoing coronary artery bypass grafting (CABG) often experience anticholinergic medication burden.
  • Anticholinergic drugs can negatively impact cognitive function and functional recovery.
  • The preoperative Anticholinergic Cognitive Burden (ACB) score helps identify at-risk patients.

Purpose of the Study:

  • To evaluate if reducing perioperative anticholinergic medication use improves functional recovery in elderly CABG patients.
  • To assess the impact of a deprescribing strategy on functional outcomes and complications.

Main Methods:

  • Prospective randomized controlled study involving 122 patients aged ≥60 years with ACB scores ≥3.
  • Intervention group received a deprescribing strategy avoiding perioperative anticholinergic anesthetic and analgesic drugs.
  • Control group received standard anesthetic and/or analgesic care including anticholinergic drugs.

Main Results:

  • Significantly more patients in the deprescribing group achieved full independence (Katz Index score of 6) by postoperative day 90 (75.0% vs 41.1%, p < 0.001).
  • Frailty scores were significantly lower in the deprescribing group at 90 days (median 3 vs 4, p < 0.001).
  • Perioperative anticholinergic use was an independent predictor of 90-day complications (OR 2.430, p = 0.042).

Conclusions:

  • Immediate perioperative deprescribing of anticholinergic medications improved 90-day functional recovery in older CABG patients.
  • This strategy was associated with fewer cardiac and pulmonary complications.
  • Reducing anticholinergic burden is a modifiable risk factor to optimize outcomes in elderly surgical patients.