Background: Although several dexamethasone phosphate preparations are commercially available and frequently administered with octreotide acetate, their compatibility remains unknown. Aim: We investigated the effect of pH and sodium bisulphate on the stability of octreotide acetate. Measurement design: Octreotide acetate percentage was measured 3 and 10 days after it was mixed with 2 dexamethasone phosphate preparations containing different concentrations of sodium bisulphate as an additive, and in one that did not contain sodium bisulphate. Solutions were also analysed after they were prepared using phosphate buffer to achieve pH values of 4.0, 7.0, and 9.0. The initial octreotide acetate concentration was 41.7 g/mL. High-performance liquid chromatography was used for measurement. Results: The octreotide acetate percentage in the mixture with dexamethasone phosphate without sodium bisulphate was maintained at 95% for up to 10 days. However, mixing octreotide acetate with the other 2 agents resulted in a significant decrease to 85%. The octreotide acetate percentage was ＜90% after sodium bisulphate-containing solution was stored at room temperature under light-protected conditions for 3 days. The percentage of octreotide acetate in the pH 7.0 solution was ＜90% three days after preparation; however, in the pH 4.0 solution, it was maintained at 95% for up to 10 days. Conclusions: Our results suggest that octreotide acetate is hydrolysed in the presence of sodium bisulphate, leading to a decrease in the percentage of octreotide acetate in the solution, which can be avoided using sodium bisulphate-free dexamethasone phosphate preparations.

Background: Despite the recent increase in the number of institutions introducing nurse practitioners to perioperative management following cardiovascular surgery, limited reports have evaluated their performance. Objective: The current study aimed to evaluate nurse practitioners' intervention based on perioperative outcomes following cardiovascular surgery. Methods: We performed a retrospective visualization of perioperative data following open-heart surgeries conducted at our hospital from April 1, 2019 to May 31, 2021, with the NP (99 patients) and DR (109 patients) groups consisting of patients whose first assistant was a nurse practitioner and physician, respectively. Results: No significant differences in patient characteristics were observed between the two groups. There were no significant differences in the operative time (304.4±92.7 vs. 301.4±86.8: min; p=0.947), death within 30 days (n)(2 vs. 2; p=0.923), and ICU stay (5.72±4.42 vs. 6.65±5.43: days; p=0.302), between the two groups. No significant difference was observed in the occurrence of postoperative complications between the two groups. The NP group had significantly shorter hospital stay (18.6±6.7 vs. 23.0±9.8: days; p<0.001) and duration of ventilator management (19.7±22.6 vs. 28.8±50.2: h; p=0.047) than the DR group. Discussion: The NP and DR groups exhibited comparable surgical outcomes. Perioperative management by a team including nurse practitioners, rather than by physicians alone, has been considered to reduce the duration of time spent on ventilator management and enable earlier hospital discharge, resulting in shorter hospital stays. This suggests that nurse practitioners, including surgical assistants under the direct supervision of physicians, may be able to safely perform perioperative management.

A 74-year-old male with exertional breathlessness was referred to our hospital by his general physician. Echocardiography revealed severe mitral regurgitation. An aortic and coronary computed tomography scan revealed aortic arch thrombosis and coronary artery stenosis in the left anterior descending (LAD) artery. In consideration of the risk of embolization, the patient underwent emergency surgery on the same day. The surgical procedure involved the replacement of the aortic arch with a fenestrated frozen elephant trunk, mitral valvuloplasty, and coronary artery bypass graft for the LAD artery. Blood tests revealed no underlying coagulopathy. The patient did not develop any postoperative complications. He was discharged home on his own on postoperative day 19. One year after the surgery, no recurrence of thrombosis or heart failure was observed. Severe mitral regurgitation complicated with intraaortic thrombosis is rare. This case report indicates that intraaortic thrombosis can occur even in patients without any underlying blood coagulation abnormalities. We report this case with a review of the literature.