RESUMEN
(1) Background: Cardiac surgery may evoke a generalized inflammatory response, typically magnified in complex, combined, redo, and emergency procedures with long aortic cross-clamp times. Various treatment options have been introduced to help regain control over post-cardiac surgery hyper-inflammation, including hemoadsorptive immunomodulation with CytoSorb®. (2) Methods: We conducted a single-center retrospective observational study of patients undergoing complex cardiac surgery. Patients intra-operatively treated with CytoSorb® were compared to a control group. The primary outcome was the change in the vasoactive-inotropic score (VIS) from pre-operatively to post-operatively. (3) Results: A total of 52 patients were included in the analysis, where 23 were treated with CytoSorb® (CS) and 29 without (controls). The mean VIS increase from pre-operative to post-operative values was significantly lower in the CS group compared to the control group (3.5 vs. 5.5, respectively, p = 0.05). In-hospital mortality in the control group was 20.7% (6 patients) and 9.1% (2 patients) in the CS group (p = 0.26). Lactate level changes were comparable, and the median intensive care unit and hospital lengths of stay were similar between groups. (4) Conclusions: Despite notable imbalances between the groups, the signals revealed point toward better hemodynamic stability with CytoSorb® hemoadsorption in complex cardiac surgery and a trend of lower mortality.
RESUMEN
PURPOSE: An audit of our first 151 cases of conscious off pump coronary artery bypass (COPCAB) surgery with epidural anesthesia as sole anesthetic. METHODS: Patients underwent conscious off pump coronary artery bypass (OPCAB) surgery using high thoracic epidural anesthesia. The epidural catheter was inserted on the day before the surgery. RESULTS: There were 118 male and 33 female patients. The incision was via midsternotomy except in 3 patients. Single graft was performed in 25 patients, double in 61, triple in 46, quadruple in 19. Twenty-nine patients developed pneumothorax. Three patients required conversion to general anesthesia. In one patient cardiopulmonary bypass (CPB) was instituted. There was no mortality in the group. CONCLUSION: Our experience shows that conscious OPCAB surgery can be performed safely in selected patients.
Asunto(s)
Anestesia Epidural , Puente de Arteria Coronaria Off-Pump/métodos , Estado de Conciencia , Femenino , Humanos , Tiempo de Internación , Masculino , Auditoría Médica , Persona de Mediana Edad , Selección de Paciente , Neumotórax ArtificialRESUMEN
BACKGROUND: Cardiothoracic surgery has been previously performed successfully under thoracic epidural anesthesia alone. Between October 2001 and December 2003, we performed 123 conscious off-pump coronary artery bypass surgeries using epidural anesthesia as the sole anesthetic. This technique is an alternative to cardiothoracic surgery performed under general anesthesia. Certain modifications in the technique facilitate the process. METHODS AND RESULTS: There were 24 female patients and 99 male patients with mean age of 58.6 +/- 6.2 years; 12 patients underwent repeat coronary artery bypass surgery. All the patients underwent epidural catheterization on the evening before surgery. Out of the 123 patients scheduled for coronary artery bypass graft surgery, 120 underwent off-pump coronary artery bypass graft surgery successfully; 4 patients underwent off-pump surgery via left thoracotomy and the rest through mid sternotomy. These patients received 295 grafts in all (single graft in 26 patients, double in 42 patients, triple in 35 patients, and quadruple in 20 patients). Three patients required conversion to general anesthesia and one to cardiopulmonary bypass. There was no mortality in the group. CONCLUSIONS: Our experience suggests that by modifying the surgical techniques, we can accomplish conscious coronary artery bypass surgery.