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1.
J Cardiothorac Vasc Anesth ; 33(12): 3358-3365, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30072269

RESUMEN

Anesthesiology, the branch of medicine concerning anesthesia and management of the vital functions of patients undergoing surgery, has played an important role in the development of cardiac surgery. In the middle of the last century, medical professionals had little experience in the treatment of congenital and acquired heart diseases. Progress of cardiac anesthesiology in Russia, as well as in countries across the globe, was due to requests to increase the safety of surgical procedures and to improve survival rates for the increasing number of patients with complex heart diseases. The development of cardiac surgery and anesthesiology in Russia evolved in 2 directions simultaneously in the mid-1950s. Some surgeons widely accepted the use of perfusionless hypothermia (hypothermia caused by surface cooling without perfusion); others were in favor of cardiopulmonary bypass technology. This review focuses on major historic milestones of cardiac anesthesiology in Russia, including its current status and the major problems it faces today.


Asunto(s)
Anestesia/historia , Anestesiología/historia , Procedimientos Quirúrgicos Cardíacos/historia , Cardiología/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Federación de Rusia
2.
J Cardiothorac Vasc Anesth ; 33(12): 3366-3374, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31129071

RESUMEN

Deep hypothermic perfusionless circulatory arrest was the first practical neuroprotective technique used for open-heart surgery. It was refined at the Novosibirsk Medical Research Center in Siberia and was actively used from the mid-1950s until 2001.This review describes the development of this technique and its contribution to our understanding of the dynamic changes in human physiology during induced hypothermia for circulatory arrest without extracorporeal perfusion. Deep hypothermic perfusionless circulatory arrest was an important stepping stone in the development of modern approaches in neuroprotection and monitoring during cardiac surgery.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/historia , Cardiología/historia , Circulación Cerebrovascular/fisiología , Paro Circulatorio Inducido por Hipotermia Profunda/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Federación de Rusia
3.
J Cardiothorac Vasc Anesth ; 28(2): 295-300, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23962460

RESUMEN

OBJECTIVE: The aim of this study was to test the hypothesis that normothermic cardiopulmonary bypass (CPB) is as effective as hypothermic CPB in terms of cardiac protection (cTnI level) and outcome in patients with valvular heart disease. DESIGN: Prospective randomized study. SETTING: A tertiary cardiothoracic referral center. PARTICIPANTS: 140 patients who had valvular heart disease, with/without coronary artery disease, surgically treated under CPB. INTERVENTIONS: The patients were allocated randomly to undergo either hypothermic (temperature [T], 31 °C-32 °C) or normothermic CPB (T>36 °C). MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the dynamics of troponin I. The secondary endpoints were ventilation time, the need for inotropic support, intensive care unit (ICU) and hospital stay durations, complications, and mortality. There were no significant intergroup differences in dynamics of troponin I. Ventilation time was significantly lower in the hypothermic group (6 (5-9) and 8 (5-12); p = 0.01). CONCLUSIONS: Normothermic CPB in patients with valvular heart disease was as effective as hypothermic perfusion in terms of myocardial protection after the surgery assessed by cTnI release. The short ventilation duration in patients who underwent hypothermic CPB needs to be confirmed in a future investigation.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Puente Cardiopulmonar/métodos , Enfermedades de las Válvulas Cardíacas/cirugía , Hipotermia Inducida/métodos , Adulto , Anciano , Temperatura Corporal , Procedimientos Quirúrgicos Cardíacos/mortalidad , Puente Cardiopulmonar/mortalidad , Cardiotónicos/uso terapéutico , Cuidados Críticos , Determinación de Punto Final , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/mortalidad , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Respiración Artificial , Troponina I/sangre
4.
J Cardiothorac Vasc Anesth ; 28(5): 1278-84, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25027101

RESUMEN

OBJECTIVE: To test the hypothesis that perioperative OMEGA-3 polyunsaturated fatty acid infusion would reduce the incidence of postoperative atrial fibrillation in patients after coronary artery bypass grafting as assessed by an implantable continuous cardiac monitor. DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: Tertiary cardiothoracic referral center. PARTICIPANTS: Thirty-nine patients with coronary artery disease who underwent surgery with cardiopulmonary bypass. INTERVENTIONS: Patients were assigned randomly to receive either OMEGA-3 polyunsaturated fatty acids (200 mg/kg/day starting before anesthesia induction for 24 hours followed by 100 mg/kg/day for 7 days) or placebo. The primary outcome was freedom from atrial fibrillation at 2-year follow-up. Reveal(®) cardiac monitor was implanted subcutaneously in all patients. Data from the cardiac monitor were collected on the 10th day and 3, 6, 12, and 24 months postoperatively. MEASUREMENT AND MAIN RESULTS: Postoperative atrial fibrillation developed in 4 (19%) patients in the control group and in 5 (27.8%) patients in the study group at 10-day follow-up (p = 0.88). At 2-year follow-up, 5 (27.8%) patients in the control group and 6 (35.3%) patients in the study group had atrial fibrillation (p = 0.9). Atrial fibrillation duration predicted risk of cardiovascular hospitalization at the 2-year follow-up (regression coefficient estimate = 0.24, standard error 0.02, p<0.0001; R(2) = 0.74). CONCLUSIONS: Infusion of OMEGA-3 polyunsaturated fatty acids failed to prevent the occurrence of atrial fibrillation in 2 years after coronary artery bypass grafting surgery. The cumulative atrial fibrillation duration registered by the continuous cardiac monitor at the 2-year follow-up was a significant predictor of an adverse outcome.


Asunto(s)
Fibrilación Atrial/prevención & control , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ácidos Grasos Omega-3/administración & dosificación , Aceites de Pescado/administración & dosificación , Monitoreo Intraoperatorio/métodos , Complicaciones Posoperatorias/prevención & control , Anciano , Fibrilación Atrial/etiología , Procedimientos Quirúrgicos Cardíacos/tendencias , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Resultado del Tratamiento
5.
J Heart Valve Dis ; 22(2): 239-47, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23798215

RESUMEN

BACKGROUND AND AIM OF THE STUDY: The study aim was to detect the most sensitive nutritional screening tool and to assess its prognostic value with regards to an adverse clinical course in patients with heart valve disease undergoing cardiopulmonary bypass (CPB). METHODS: This prospective cohort study included 441 adult patients who were screened using four nutritional screening tools: Nutritional Risk Screening 2002 (NRS-2002); Malnutrition Universal Screening Tool (MUST); Mini Nutritional Assessment (MNA); and Short Nutritional Assessment Questionnaire (SNAQ). Nutritional assessment was performed using a Subjective Global Assessment (SGA). In-hospital mortality, postoperative complications, and duration of hospital stay were each analyzed. RESULTS: With regards to the detection of malnutrition, the sensitivities of MUST, SNAQ, MNA and NRS-2002 were 100%, 92%, 84.6% and 43.6%, respectively. Malnutrition identified by MUST and MNA were associated with postoperative complications (OR 1.63, p = 0.033 and OR 1.6, p = 0.035) and prolonged hospitalization (OR 1.57, p = 0.048 and OR 1.7, p = 0.02). According to multivariate logistic regression analysis, along with well-known age and duration of CPB, malnutrition identified by MUST and MNA was associated with a risk of development of complications (OR 1.6, p = 0.049 and OR 1.6, p = 0.04, respectively). The sensitivities of SNAQ, MUST, NRS-2002 and MNA with regards to postoperative complications were 26.8%, 28.8%, 10%, and 31.6%, respectively. CONCLUSION: The MUST tool is preferable with regards to the detection of malnutrition. Both, MUST and MNA independently predicted postoperative complications. SNAQ and NRS-2002 proved insensitive with regards to the postoperative course among patients with heart valve disease who were scheduled for cardiothoracic surgery.


Asunto(s)
Puente Cardiopulmonar , Enfermedades de las Válvulas Cardíacas/cirugía , Mortalidad Hospitalaria , Desnutrición/diagnóstico , Evaluación Nutricional , Complicaciones Posoperatorias , Anciano , Estudios de Cohortes , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Desnutrición/complicaciones , Tamizaje Masivo/métodos , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Prospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Encuestas y Cuestionarios
6.
J Cardiothorac Vasc Anesth ; 27(2): 273-82, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22841526

RESUMEN

OBJECTIVE: To test the hypothesis that the infusion of hypertonic solution would decrease extravascular lung water postoperatively and thus improve pulmonary function. DESIGN: Prospective, randomized, blinded trial. SETTING: Tertiary cardiothoracic referral center. PARTICIPANTS: Twenty-six patients with coronary artery disease who underwent surgery with cardiopulmonary bypass (CPB). INTERVENTIONS: Patients were allocated randomly to receive 4 mL/kg of 7.2% NaCl/hydroxyethyl starch, 200/0.5 (HSH group) or an equal volume of 0.9% NaCl (control group) for 30 minutes starting after anesthesia induction. The extravascular lung water index, hemodynamic and biochemical data, and the rate of complications were analyzed. MEASUREMENTS AND MAIN RESULTS: The extravascular lung water index was significantly lower (7 v 9.5 mL/kg) in the HSH group at the first postoperative day (p < 0.01). The index of arterial oxygenation efficiency was significantly higher at 5 minutes and 2 and 4 hours after cardiopulmonary bypass (CPB) in the HSH group (p < 0.05). The alveolar-arterial oxygen tension difference was significantly lower at 5 minutes and 2 and 4 hours after CPB in the HSH group (p < 0.01). The cardiac index was significantly higher at 5 minutes after infusion in the HSH group (p < 0.05). CONCLUSIONS: The infusion of HSH leads to significant decreases in the extravascular lung water index during and after cardiac surgery and is associated with better preservation of pulmonary function and transient increases in the cardiac index. Further trials are needed to clarify the clinical advantages of hypertonic solution administration in patients undergoing surgery with CPB.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Agua Pulmonar Extravascular/efectos de los fármacos , Derivados de Hidroxietil Almidón/uso terapéutico , Sustitutos del Plasma/uso terapéutico , Solución Salina Hipertónica/uso terapéutico , Anciano , Gasto Cardíaco/efectos de los fármacos , Cuidados Críticos , Método Doble Ciego , Femenino , Hemodinámica/fisiología , Humanos , Pulmón/efectos de los fármacos , Pulmón/fisiología , Masculino , Persona de Mediana Edad , Concentración Osmolar , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Periodo Posoperatorio , Estudios Prospectivos , Pruebas de Función Respiratoria , Sodio/sangre , Equilibrio Hidroelectrolítico/fisiología
7.
Heart Lung Circ ; 22(1): 25-30, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22939108

RESUMEN

BACKGROUND: The objective of this study was to investigate the effect of the perioperative use of methylprednisolone in medium doses on markers of endothelial cell activation in patients with coronary artery disease undergoing cardiopulmonary bypass. METHODS: In this prospective, double-blinded, placebo-controlled, randomised study, 44 patients, undergoing a coronary artery bypass graft surgery received either methylprednisolone 20 mg/kg or a placebo intraoperatively after anaesthesia induction. The primary endpoint was endothelin-1, and secondary endpoints were E-selectin, interleukin (IL)-6 and IL-10, PaO(2)/FiO(2) coefficient, and microalbuminuria. RESULTS: Endothelin-1 was higher in the study group postoperatively at 10 min (p=0.0008), 2 h (p=0.02), 4 h (p=0.005), and 24 h (p=0.004). IL-6 was lower in the study group postoperatively at 2 h (p=0.03), 4 h (p=0.04), and 24 h (p<0.0001). IL-10 was higher in the study group postoperatively at 10 min (p<0.0001), 2 h (p=0.009), and 4 h (p=0.001). PaO(2)/FiO(2) was lower in the study group at 24 h after surgery (p=0.03). Microalbuminuria was similar in both groups. CONCLUSION: Despite an obvious anti-inflammatory effect, methylprednisolone causes endothelial cell activation in patients undergoing cardiopulmonary bypass.


Asunto(s)
Antiinflamatorios/administración & dosificación , Puente de Arteria Coronaria , Endotelio Vascular/metabolismo , Metilprednisolona/administración & dosificación , Anciano , Método Doble Ciego , Selectina E/sangre , Endotelina-1/sangre , Endotelio Vascular/patología , Endotelio Vascular/fisiopatología , Femenino , Humanos , Interleucina-10/sangre , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Factores de Tiempo
8.
Heart Lung Circ ; 22(5): 360-5, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23253886

RESUMEN

BACKGROUND: We hypothesised, that perioperative use of N(2)-L-alanyl-L-glutamine confers cardioprotection and improves insulin resistance in diabetic patients with coronary artery disease operated under cardiopulmonary bypass. METHODS: This double-blind, placebo-controlled, randomised study included 64 patients with diabetes mellitus type 2 who were scheduled for on-pump coronary artery bypass graft surgery. The protocol group (32 patients) and the control group (32 patients) glutamine (0.4 g/kg/day of 20% solution of N(2)-L-alanyl-L-glutamine ("Dipeptiven(®)" Fresenius Kabi, Germany)) and placebo (0.9% NaCl), respectively. Perioperative concentration of troponin I in plasma was considered as the primary end-point. Whereas the secondary end-points were insulin resistance, insulin sensitivity, ß-cell function, blood glucose, plasma triglycerides and free fatty acids concentrations. Insulin resistance, insulin sensitivity and ß-cell function were measured using HOMA equation. Thermodilution method was used to measure haemodynamics in all the patients. RESULTS: No differences have been found in perioperative dynamics of troponin I, insulin resistance, insulin sensitivity, ß-cell function, blood glucose, plasma triglycerides free fatty acids concentrations and haemodynamics. CONCLUSION: Our results have failed to confirm the cardioprotective properties and modulatory effect on perioperative insulin resistance that are thought to be attributable to parenteral glutamine administration in dose 0.4 g/kg/day among cardiac patients with DM operated on under CPB.


Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/terapia , Diabetes Mellitus Tipo 2/terapia , Angiopatías Diabéticas/terapia , Dipéptidos/administración & dosificación , Glutamina/administración & dosificación , Anciano , Glucemia/metabolismo , Enfermedad de la Arteria Coronaria/sangre , Diabetes Mellitus Tipo 2/sangre , Angiopatías Diabéticas/sangre , Método Doble Ciego , Ácidos Grasos/sangre , Femenino , Humanos , Resistencia a la Insulina , Células Secretoras de Insulina , Masculino , Persona de Mediana Edad , Triglicéridos/sangre , Troponina I/sangre
9.
J Cardiothorac Vasc Anesth ; 26(4): 596-603, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22051419

RESUMEN

OBJECTIVE: To test the hypothesis that levosimendan is more effective than intra-aortic balloon pump (IABP) support in cardiac surgical patients with low left ventricular ejection fraction to decrease cardiac troponin I levels (primary endpoint) and improve hemodynamics. DESIGN: Prospective randomized trial. SETTING: Tertiary cardiothoracic referral center. PARTICIPANTS: Ninety patients with coronary artery disease and left ventricular ejection fraction <35% who underwent surgery with cardiopulmonary bypass. INTERVENTION: Patients were assigned randomly to 1 of 3 groups. Group A received a prophylactic IABP one day before surgery. Group B received a prophylactic IABP one day before surgery and a levosimendan infusion at a dose of 0.1 µg/kg/min with an initial bolus (12 µg/kg for 10 minutes) after anesthesia induction. Group C received a levosimendan infusion at a dose of 0.1 µg/kg/min with an initial bolus (12 µg/kg for 10 minutes) after anesthesia induction. Hemodynamic and biochemical data and rate of complications were analyzed. MEASUREMENTS AND MAIN RESULTS: The cardiac troponin I level in group C 6 hours after surgery was lower than in group A (p = 0.048). The cardiac index in group A was significantly lower than in groups B and C. The intensive care unit stay was significantly shorter in group C than in groups A and B (p = 0.001). The need for inotropic support, the rate of complications, and mortality among groups did not differ. CONCLUSIONS: The infusion of levosimendan after anesthesia induction in cardiac surgical patients contributes to lower cardiac troponin I levels and improved hemodynamics compared with a preoperative IABP.


Asunto(s)
Cardiotónicos/farmacología , Enfermedad de la Arteria Coronaria/cirugía , Hidrazonas/farmacología , Piridazinas/farmacología , Anciano , Puente Cardiopulmonar , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Hemodinámica , Humanos , Unidades de Cuidados Intensivos , Contrapulsador Intraaórtico , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Simendán , Troponina I/sangre
10.
J Cardiothorac Vasc Anesth ; 25(6): 975-80, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21354824

RESUMEN

OBJECTIVE: The aim of this study was to investigate the prognostic value of the preoperative total lymphocyte count in peripheral blood as a predictor of postoperative complications and mortality in cardiac surgery. DESIGN: A retrospective, observational study. SETTING: The Novosibirsk State Research Institute of Circulation Pathology (single institution). PARTICIPANTS: All adults undergoing primary cardiopulmonary bypass in 2009. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The cohort size was 1,368 patients operated upon with cardiopulmonary bypass. Patient characteristics, hospital mortality, postoperative complications, ventilation time, intensive care unit, and hospital stay were analyzed. A preoperative total lymphocyte count <1,500 cells/µL was associated with significantly higher mortality by univariate (p < 0.0001) and multivariate (p < 0.044) analyses. A low preoperative total lymphocyte count was associated with more frequent inotropic support (p < 0.001); postoperative heart arrhythmia (p < 0.001); dialysis-dependent acute renal failure (p < 0.001); and a prolonged ventilation time (p = 0.001), intensive care unit stay (p < 0.001), and hospital stay (p = 0.007). CONCLUSIONS: A low preoperative total lymphocyte count in peripheral blood is a useful prognostic criterion for the evaluation of a complicated postoperative period in cardiac patients operated under cardiopulmonary bypass.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Recuento de Linfocitos , Complicaciones Posoperatorias/epidemiología , Anciano , Área Bajo la Curva , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/etiología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Puente Cardiopulmonar , Cardiotónicos/uso terapéutico , Estudios de Cohortes , Intervalos de Confianza , Cuidados Críticos/estadística & datos numéricos , Femenino , Humanos , Infecciones/epidemiología , Fallo Hepático Agudo/epidemiología , Fallo Hepático Agudo/etiología , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Hemorragia Posoperatoria/epidemiología , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Pronóstico , Curva ROC , Diálisis Renal , Estudios Retrospectivos , Resultado del Tratamiento
11.
Heart Surg Forum ; 14(6): E384-8, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22167767

RESUMEN

BACKGROUND: The aim of the present study was to investigate the cardioprotective effects of the perioperative use of N(2)-L-alanyl-L-glutamine (GLN) in patients with ischemic heart disease (IHD) who undergo their operations under cardiopulmonary bypass (CPB). METHODS: This double-blind, placebo-controlled, randomized study included 50 patients who underwent cardiac surgery with CPB. Exclusion criteria were a left ventricular ejection fraction <50%, diabetes mellitus, <3 months since the onset of myocardial infarction, and emergency surgery. Patients in the study group (n = 25) received 0.4 g/kg GLN (Dipeptiven, 20% solution) per day. Patients in the control group (n = 25) were administered a placebo (0.9% NaCl). The primary end point was the dynamics of troponin I at the following stages: (1) prior to anesthesia, (2) 30 minutes after CPB, (3) 6 hours after CPB, (4) 24 hours after surgery, and (5) 48 hours after surgery. Secondary end points included measurements of hemodynamics with a Swan-Ganz catheter. RESULTS: On the first postoperative day after the surgery, the median troponin I level was significantly lower in the study group than in the placebo group: 1.280 ng/mL (interquartile range [IQR], 0.840-2.230 ng/mL) versus 2.410 ng/mL (IQR, 1.060-6.600 ng/mL) (P = .035). At 4 hours after cardiopulmonary bypass (CPB), the median cardiac index was higher in the patients in the study group: 2.58 L/min per m2 (IQR, 2.34-2.91 L/min per m2) versus 2.03 L/min per m2 (IQR, 1.76-2.32 L/min per m2) (P = .002). The median stroke index also was higher in the patients who received GLN: 32.8 mL/m2 (IQR, 27.8-36.0 mL/m2) versus 26.1 mL/m2 (IQR, 22.6-31.8 mL/m2) (P = .023). The median systemic vascular resistance index was significantly lower in the study group than in the placebo group: 1942 dyn·s/cm5 per m2 (IQR, 1828-2209 dyn·s/cm5 per m2) versus 2456 dyn·s/cm5 per m2 (IQR, 2400-3265 dyn·s/cm5 per m2) (P = .001). CONCLUSION: Perioperative administration of GLN during the first 24 hours has cardioprotective effects in IHD patients following CPB. This technique enhances the troponin concentration at 24 hours after surgery and is associated with improved myocardial function.


Asunto(s)
Puente Cardiopulmonar , Dipéptidos/uso terapéutico , Isquemia Miocárdica/tratamiento farmacológico , Isquemia Miocárdica/cirugía , Método Doble Ciego , Determinación de Punto Final , Femenino , Humanos , Masculino , Persona de Mediana Edad , Placebos , Estadísticas no Paramétricas , Resultado del Tratamiento , Troponina I/sangre
12.
J Appl Physiol (1985) ; 94(3): 860-8, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12571123

RESUMEN

Effective treatment of vascular gas embolism may be possible with emulsified fluorocarbon compounds. We tested the hypothesis that a fluorocarbon emulsion delivered before gas embolization would enhance bubble motion through the vasculature, favoring more rapid clearance. Air microbubbles were injected into the rat cremaster microcirculation in six groups of rats receiving Perftoran, an emulsified fluorocarbon, or saline immediately before, 2 h before, or after bubble injection. Embolism dimensions and dynamics were observed by using intravital microscopy. Surface area at lodging was equal between groups. Bubbles having smaller volume embolized smaller diameter vessels in the Perftoran pretreatment groups. A higher incidence of bubble dislodgement and larger distal displacement occurred in these two groups, with a 36% decrease in the time to bubble clearance and restoration of blood flow. Intravascular emulsified fluorocarbon administration before gas embolization affected initial bubble conformation, increased bubble dislodgement, and resulted in bubble displacement further into the periphery of the microcirculation. These dynamic events did not occur if embolization preceded fluorocarbon administration.


Asunto(s)
Sustitutos Sanguíneos/farmacología , Embolia Aérea/fisiopatología , Fluorocarburos/farmacología , Algoritmos , Animales , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Capilares/efectos de los fármacos , Capilares/fisiología , Emulsiones , Gases/química , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Masculino , Tono Muscular/fisiología , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/efectos de los fármacos , Músculo Liso Vascular/fisiología , Ratas , Ratas Wistar , Flujo Sanguíneo Regional/efectos de los fármacos , Flujo Sanguíneo Regional/fisiología , Tensión Superficial
13.
Asian Cardiovasc Thorac Ann ; 10(1): 3-7, 2002 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12079961

RESUMEN

Between January 1995 and December 1999, 942 patients (452 males and 490 females) aged 1 to 51 years underwent definitive surgery under perfusionless hypothermia for correction of congenital heart defects, predominantly uncomplicated ventricular or atrial septal defects (80%). Hypothermia of 24 degrees C to 28 degrees C was achieved in 15 to 45 minutes (mean, 25.7 +/- 1.2 minutes) by application of crushed ice over the body and head. Aortic crossclamp time ranged from 10 to 76 minutes (mean, 26.1 +/- 0.25 minutes). Cardiac restoration time ranged from 1 to 10 minutes (mean, 2.1 +/- 0.08 minutes). Eight patients (0.85%) died postoperatively: 4 from acute cardiac insufficiency, 2 as a consequence of technical faults, 1 from persistent pulmonary hypertension, and 1 had sudden cardiac arrest. None of the surviving patients showed any gross neurological deficit. Perfusionless hypothermic cardiac surgery, when applied appropriately, is safe and simple, and might still have a place in treating a selected group of patients with uncomplicated congenital heart defects.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiopatías Congénitas/cirugía , Hipotermia Inducida , Adolescente , Adulto , Distribución por Edad , Niño , Preescolar , Femenino , Paro Cardíaco Inducido , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interventricular/cirugía , Humanos , Lactante , Masculino , Persona de Mediana Edad , Morbilidad , Estudios Retrospectivos , Siberia , Resultado del Tratamiento
14.
Shock ; 41(3): 193-9, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24549094

RESUMEN

BACKGROUND: NaCl 7.2%/6% hydroxyethyl starch (HES) 200/0.5 (HSH) has shown its beneficial effects in cardiac surgery and immunomodulatory values in experiment and human studies. However, there is concern regarding detrimental renal effects of chloride and HES in the intensive care setting. OBJECTIVES: The objective of this study was to evaluate the influence of HSH on kidney integrity and the level of inflammatory mediators in on-pump coronary artery bypass surgery patients. DESIGN: This was a single-center, prospective, randomized, single-blind pilot study. SETTING: This work was performed at a tertiary cardiothoracic referral center during the period from February to August 2012. PATIENTS: Forty patients scheduled for on-pump coronary artery bypass surgery were included. INTERVENTIONS: PATIENTS were randomized to receive once either 7.2% NaCl/6% HES 200/0.5 (HSH group, n = 20) or placebo (0.9% NaCl; control group, n = 20) at a dose of 4 mL·kg for 30 min after anesthesia induction. MAIN OUTCOME MEASURES: The primary end point was the incidence of acute kidney injury (AKI) defined according to the Kidney Disease: Improving Global Outcomes. Secondary end points were peak serum cystatin C, peak urine neutrophil gelatinase-associated lipocalin, plasma levels of interleukin 6 (IL-6), IL-10, intercellular adhesion molecule 1, and endothelial-leukocyte adhesion molecule (E-selectin). RESULTS: The incidence of AKI within 48 h was similar between the groups (HSH: four patients [20%]; control: six patients [30%]). There was a significantly lower peak value for serum cystatin C in the HSH group (0.83 [0.73-0.89] mg·L) compared with the control group (1.02 [0.88-1.15] mg·L; P = 0.001). PATIENTS in both groups had similar peak postoperative urine neutrophil gelatinase-associated lipocalin concentrations. NaCl 7.2%/6% hydroxyethyl starch 200/0.5 significantly reduces levels of IL-6 and IL-10 at 4 h after cardiopulmonary bypass and intercellular adhesion molecule 1 and E-selectin at 4 h after cardiopulmonary bypass and on postoperative day 1 (P < 0.05 for all). CONCLUSIONS: NaCl 7.2%/6% hydroxyethyl starch 200/0.5 does not lead to the increase in AKI incidence when used for the volume therapy in on-pump coronary artery bypass surgery patients. NaCl 7.2%/6% hydroxyethyl starch 200/0.5 usage enhanced neither tubular injury nor alteration of glomerular filtration. In addition, HSH can reduce the level of the inflammatory mediators after surgery.


Asunto(s)
Lesión Renal Aguda/sangre , Lesión Renal Aguda/prevención & control , Puente de Arteria Coronaria/métodos , Derivados de Hidroxietil Almidón/administración & dosificación , Mediadores de Inflamación/sangre , Sustitutos del Plasma/administración & dosificación , Cloruro de Sodio/administración & dosificación , Lesión Renal Aguda/epidemiología , Femenino , Humanos , Incidencia , Riñón/metabolismo , Riñón/patología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Retrospectivos
15.
Nutrition ; 29(2): 436-42, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23200301

RESUMEN

OBJECTIVE: The aim of this study was to assess the prognostic value of different nutritional screening tools in patients undergoing cardiopulmonary bypass with regard to an adverse clinical course. METHODS: This prospective cohort study analyzed 894 adult patients who underwent cardiopulmonary bypass. Patients were screened using four nutritional screening tools: Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), the Mini-Nutritional Assessment (MNA), and the Short Nutritional Assessment Questionnaire (SNAQ). Nutritional status was assessed using the Subjective Global Assessment. In-hospital mortality, postoperative complications, length of stay in the intensive care unit, and length of hospitalization were analyzed. RESULTS: The sensitivities of the SNAQ, MUST, and NRS-2002 to detect the malnutrition confirmed by the Subjective Global Assessment were 91.5%, 97.9%, and 38.3%, respectively, and the MNA showed a sensitivity of 81.8% for the elderly. Malnutrition detected by the SNAQ, MUST, and NRS-2002 was associated with postoperative complications (odds ratios [ORs] 1.75, 1.98, and 1.82, respectively) and a stay in the intensive care unit longer than 2 d (ORs 1.46, 1.56, and 2.8). Malnutrition as detected by the SNAQ and MUST was also associated with prolonged hospitalization (ORs 1.49 and 1.59). According to multivariate logistic regression analysis, postoperative complications were independently predicted by the European System for Cardiac Operative Risk Evaluation (OR 1.1, P < 0.0001), cardiopulmonary bypass time (OR 1.01, P < 0.0001), and malnutrition identified by the MUST (OR 1.2, P = 0.01). CONCLUSION: The MUST independently predicts postoperative complications. The SNAQ and MUST have comparable accuracy in detecting malnutrition. Whether preoperative nutritional therapy would improve the outcome in malnourished patients needs to be studied.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Desnutrición/diagnóstico , Evaluación Nutricional , Complicaciones Posoperatorias/prevención & control , Procedimientos Quirúrgicos Cardíacos/mortalidad , Puente Cardiopulmonar , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Modelos Logísticos , Masculino , Desnutrición/prevención & control , Persona de Mediana Edad , Análisis Multivariante , Estado Nutricional , Oportunidad Relativa , Estudios Prospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Resultado del Tratamiento
16.
Interact Cardiovasc Thorac Surg ; 16(5): 612-8, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23360716

RESUMEN

OBJECTIVES: The aim of this study was to assess the prognostic value of different nutritional screening tools in patients undergoing cardiopulmonary bypass, with regard to adverse clinical outcome. METHODS: This prospective cohort study analysed 1193 adult patients who underwent cardiopulmonary bypass. Patients were screened using five nutritional screening tools: Subjective Global Assessment (SGA), Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Mini-Nutritional Assessment (MNA) and Short Nutritional Assessment Questionnaire (SNAQ). In-hospital mortality, postoperative complications, length of stay in intensive care unit and length of hospitalization were analysed. Multivariate backward logistic regression analysis was used to assess the independent predictive value of the studied screening tools. RESULTS: In accordance with univariate analysis, malnutrition detected by SNAQ, MUST, NRS-2002 and MNA was associated with postoperative complications (odds ratio [OR] 1.8, 95% confidence interval [95% CI] 1.3-2.4; OR 1.9, 95% CI 1.4-2.6; OR 1.8, 95% CI 1.2-2.9 and OR 1.9, 95% CI 1.4-2.6). Malnutrition detected by MUST, NRS-2002, MNA and SGA was associated with intensive care unit stay >2 days (OR 1.5, 95% CI 1.1-2.1; OR 2.3, 95% CI 1.5-3.7; OR 1.7, 95% CI 1.2-2.2 and OR 2.7, 95% CI 1.6-4.6). Prolonged hospitalization (>20 days) was predicted by SNAQ, MUST and MNA (OR 1.4, 95% CI 1-1.9; OR 1.6, 95% CI 1.2-2.2 and OR 1.6, 95% CI 1.2-2.2). In accordance with multivariate analysis, only MUST and MNA independently predicted postoperative complications (OR 1.6, 95% CI 1.1-2.3 and OR 1.6, 95% CI 1.1-2.2). Other independent factors influencing postoperative complications were well-known logistic EuroSCORE (OR 1.06, 95% CI 1-1.1) and the duration of cardiopulmonary bypass in minutes (OR 1.01, 95% CI 1-1.01). CONCLUSIONS: MUST and MNA both have independent predictive values with regard to postoperative complications. Taking into account simplicity, MUST is preferable for the cardiac surgical population.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Desnutrición/diagnóstico , Evaluación Nutricional , Estado Nutricional , Encuestas y Cuestionarios , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/mortalidad , Procedimientos Quirúrgicos Electivos , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Modelos Logísticos , Masculino , Desnutrición/complicaciones , Desnutrición/mortalidad , Desnutrición/fisiopatología , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
17.
Asian Cardiovasc Thorac Ann ; 20(6): 675-81, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23284109

RESUMEN

BACKGROUND AND OBJECTIVES: this prospective study was carried out to evaluate oxidative stress and liver monooxygenase function after cardiac surgery in patients with acquired valvular heart disease. METHODS: 97 patients were studied. Oxidative stress was quantified with malondialdehyde, coupled trienes, hepatocuprein, and catalase activity. Liver monooxygenase function was evaluated with antipyrine pharmacokinetics. For statistical analyses, the Dunnett test and Pearson's correlation coefficient were used. RESULTS: on the 1st-2nd postoperative days, high lipid peroxidation activation (malondialdehyde: 9.6 ± 2.7 vs. 6.9 ± 2.0 nmol mL(-1), p <0.05) and a significant decrease in liver monooxygenase function (antipyrine clearance: 18.3 ± 11.1 vs. 39.0 ± 18.9 mL kg(-1)h(-1), p <0.05) were revealed. On the 3rd-4th and 11th-12th postoperative days, the intensity of oxidative stress decreased and monooxygenase function returned to baseline (antipyrine clearance: 45.6 ± 17.9 vs. 39.0 ± 18.9 mL kg(-1)h(-1)). The analysis showed a negative relationship between oxidative stress and liver monooxygenase function. CONCLUSION: patients undergoing surgery for acquired valvular heart disease have considerable oxidative stress and a decrease in liver monooxygenase function on the 1st-2nd postoperative days. Activation of lipid peroxidation is one of the main reasons for suppression of microsomal monooxygenases activity. A slowdown of liver microsomal oxidation might change the pharmacokinetic response of patients under drug therapy.


Asunto(s)
Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Hígado/enzimología , Oxigenasas de Función Mixta/metabolismo , Estrés Oxidativo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos
18.
Interact Cardiovasc Thorac Surg ; 15(1): 18-22, 2012 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22493101

RESUMEN

Remote ischaemic preconditioning (RIPC) gained attention as a possibility to reduce myocardial injury after a subsequent sustained episode of myocardial ischaemia. This prospective randomized study was carried out to assess whether RIPC reduces myocardial injury in coronary artery bypass grafting patients. Eighty patients were assigned to remote preconditioning or control treatment. Ischaemic preconditioning was induced by three 5-min cycles of upper limb ischaemia and reperfusion after anaesthesia induction. Haemodynamic and markers of myocardial damage were analysed preoperatively and over 48 h postoperatively. The cardiac index was higher immediately after remote preconditioning in the main group. There were no differences in other haemodynamic, troponin I and creatine kinase-MB concentrations at any time point between groups. Thus, short-term remote preconditioning improves haemodynamics and does not reduce myocardial injury after coronary artery bypass surgery. Further study of high-risk patients may be needed to fully evaluate the clinical effect of RIPC.


Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Precondicionamiento Isquémico Miocárdico/métodos , Daño por Reperfusión Miocárdica/prevención & control , Extremidad Superior/irrigación sanguínea , Anciano , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Forma MB de la Creatina-Quinasa/sangre , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Daño por Reperfusión Miocárdica/sangre , Daño por Reperfusión Miocárdica/etiología , Daño por Reperfusión Miocárdica/fisiopatología , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Federación de Rusia , Factores de Tiempo , Torniquetes , Resultado del Tratamiento , Troponina I/sangre , Función Ventricular Izquierda
19.
Asian Cardiovasc Thorac Ann ; 19(2): 154-9, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21471262

RESUMEN

The purpose of our study was to compare the efficiency of levosimendan and preventive intra-aortic balloon pump in high-risk cardiac patients (left ventricular ejection fraction <35%) operated under cardiopulmonary bypass. In 20 patients, intra-aortic balloon pump was started 16-18 h before surgery; another 20 had a levosimendan infusion starting after induction of anesthesia with an initial bolus of 12 µg·kg(-1) for 10 min, followed by 0.1 µg·kg(-1)·min(-1) for 24 h. Postoperative complications, hemodynamics, and markers of cardiac damage were analyzed. In the levosimendan group, cardiac index was significantly higher 5 min after cardiopulmonary bypass, at the end of the operation, 2 and 4 h after perfusion, compared to the intra-aortic balloon pump group. The level of troponin I in the levosimendan group was significantly lower at 6 h after the operation. Intensive care unit stay was significantly shorter in the levosimendan group. It was concluded that the use of levosimendan in high-risk cardiac patients is as effective as intra-aortic balloon pump, in terms of maintaining stable hemodynamic during and after operations under cardiopulmonary bypass. The lower level of troponin I at 6 h postoperatively suggests cardioprotective properties of levosimendan, but requires further investigation.


Asunto(s)
Puente Cardiopulmonar/efectos adversos , Cardiotónicos/administración & dosificación , Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Cardiopatías/prevención & control , Hidrazonas/administración & dosificación , Contrapulsador Intraaórtico , Piridazinas/administración & dosificación , Anciano , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Cardiopatías/sangre , Cardiopatías/etiología , Cardiopatías/fisiopatología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Federación de Rusia , Simendán , Volumen Sistólico , Resultado del Tratamiento , Troponina I/sangre , Función Ventricular Izquierda
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