Impact of pericardial calcification on early postoperative outcomes after pericardiectomy: a retrospective observational study.

BACKGROUND: Owing to the lack of understanding of the clinical significance of pericardial calcification during pericardiectomy, whether pericardial calcification should be considered when determining the optimal timing for pericardiectomy is debatable. We aimed to investigate the effect of pericardial calcification on early postoperative outcomes in patients who underwent pericardiectomy for constrictive pericarditis. METHODS: Altogether, 44 patients who underwent pericardiectomy for constrictive pericarditis were enrolled. After excluding three patients who underwent concurrent surgeries, a total of 41 patients were categorized into two groups based on the presence of pericardial calcification as determined by preoperative computed tomography and pathological examination. Preoperative clinical and imaging characteristics, intraoperative data, and early postoperative outcomes were compared between the two groups. A multivariable analysis was performed to identify the factors associated with postoperative complications. RESULTS: The group with and without PC comprised 21 and 20 patients, respectively. No significant differences were observed in 30-day mortality (n = 1 [5%]) in the group with pericardial calcification and no mortality in the group without pericardial calcification (p > 0.999). Other early postoperative outcome variables did not demonstrate any significant differences between the two groups. However, the use of cardiopulmonary bypass was associated with postoperative complications (p < 0.009, odds ratio: 63.5, 95% confidence interval: 5.13-3400). CONCLUSIONS: Pericardial calcification did not significantly affect the postoperative outcomes after pericardiectomy. Further comprehensive studies, including those with larger sample sizes and longitudinal designs, are necessary to determine whether pericardial calcification can significantly influence the timing of surgical intervention.

Comparative analysis of del Nido cardioplegia versus blood cardioplegia in isolate coronary artery bypass grafting.

BACKGROUND: This study examined the efficacy of del Nido cardioplegia compared with traditional blood cardioplegia in adult cardiac surgery for isolated coronary artery bypass grafting by evaluating the early postoperative outcomes. METHODS: A total of 119 patients who underwent isolated conventional coronary artery bypass grafting were enrolled and divided into two groups (del Nido cardioplegia group [n = 36] and blood cardioplegia group [n = 50]) based on the type of cardioplegia used. This study compared the preoperative characteristics, intraoperative data, and early postoperative outcomes. Further subgroup analyses were conducted for high-risk patient groups. RESULTS: The 30-day mortality and morbidity rates were not significantly different between groups. The del Nido cardioplegia group exhibited advantageous myocardial protection outcomes, demonstrated by a significantly smaller rise in Troponin I levels post-surgery (2.8 [-0.4; 4.2] vs. 4.5 [2.9; 7.4] ng/mL, p = 0.004) and fewer defibrillation attempts during weaning off of cardiopulmonary bypass (0.0 ± 0.2 vs. 0.4 ± 1.1 times, p = 0.011) when compared to the blood cardioplegia group. Additionally, the del Nido group achieved a reduction in surgery duration, as evidenced by the reduced aortic cross-clamping time (64.0 [55.5; 75.5] vs. 77.5 [65.0; 91.0] min, p = 0.001) and total operative time (287.5 [270.0; 305.0] vs. 315.0 [285.0; 365.0] min, p = 0.008). Subgroup analyses consistently demonstrated that the del Nido cardioplegia group had a significantly smaller postoperative increase in Troponin I levels across all subgroups (p < 0.05). CONCLUSIONS: del Nido cardioplegia provided myocardial protection and favorable early postoperative outcomes compared to blood cardioplegia, making it a viable option for conventional coronary artery bypass grafting. Establishing a consensus on the protocol for Del Nido cardioplegia administration in adult surgeries is needed.

Influence of Preoperative COVID-19 Vaccination on Outcomes After Coronary Artery Bypass Grafting-A Propensity Score-Matched Analysis.

BACKGROUND: Reports of intravascular thrombosis and cardiac complications have raised concerns about the safety of COVID-19 vaccinations, particularly in patients with high cardiovascular risk. Herein, we aimed to analyze the impact of preoperative COVID-19 vaccination on outcomes after coronary artery bypass grafting (CABG). METHODS AND RESULTS: Among 520 patients who underwent isolated CABG from 2020 to 2022, 481 patients (mean±SD age: 67±11 years, 86 women) whose COVID-19 vaccination status could be confirmed were included. A total of 249 patients who had not received any COVID-19 vaccine before CABG (never vaccinated group) and 214 patients who had completed primary vaccination (fully vaccinated group) were subjected to 1:1 propensity score matching, and 156 pairs of patients were matched. There was no significant difference in early mortality between the 2 groups after matching. After matching, overall survival (P=0.930) and major adverse cardiovascular and cerebrovascular event-free survival (P=0.636) did not differ between the 2 groups. One-year graft patency also did not differ significantly between the 2 groups; all patent grafts in 85/104 patients (82%) and 62/73 patients (85%) in the never vaccinated and fully vaccinated groups, respectively (P=0.685). Subgroup analysis showed equivalent overall and major adverse cardiovascular and cerebrovascular event-free survival among AstraZeneca and Pfizer vaccine recipients and between those with ≤30 days versus >30 days from vaccination to CABG. CONCLUSIONS: Despite the very high cardiovascular risk for patients undergoing CABG, COVID-19 vaccination did not affect major outcomes after CABG. Therefore, there is no reason for patients with coronary artery disease requiring CABG to avoid preoperative COVID-19 vaccination.

Acute type A aortic dissection features and outcomes in octogenarians: a propensity score analysis.

OBJECTIVES: The clinical characteristics and early outcomes of surgical repair in octogenarians with acute type A aortic dissection were compared with those in nonoctogenarians. METHODS: All patients who underwent emergency surgical repair for acute type A aortic dissection in our institution between 2003 and 2022 were included in this study. The patients were divided into an octogenarian group and a nonoctogenarian group. The patients in the 2 groups were propensity score matched at a ratio of 1:1. Before matching, the baseline characteristics were compared between 2 groups. The major complication and 30-day mortality rates were compared in the matched population. RESULTS: A total of 495 patients were screened, and 471 were included in the analysis, with 48 in the octogenarian group and 423 in the nonoctogenarian group. Before matching, DeBakey type II dissection was significantly more prevalent in the octogenarians (42% vs 14% in the octogenarians and nonoctogenarians, respectively, P < 0.001). Additionally, intramural haematomas (39.6% vs 14.4%, P < 0.001) were more prevalent in the octogenarians. However, severe aortic regurgitation (4.2% vs 15.4%, P = 0.046) and root enlargement (0% vs 13.7%, P = 0.009) were less prevalent in the octogenarians. After matching (36 pairs), the incidence of postoperative delirium was higher in the octogenarians (56% vs 25%, P = 0.027). However, there were no significant differences in 30-day and in-hospital mortality rates, intensive care unit stay or major complications, including stroke, paraplegia, respiratory complications, mediastinitis and haemodialysis. CONCLUSIONS: The octogenarians with acute type A aortic dissection had higher incidences of DeBakey type II dissection and intramural haematomas and lower incidences of severe aortic regurgitation and aortic root enlargement than the nonoctogenarians. Being an octogenarian was not associated with an increased risk of early major complications or mortality after surgery for acute type A aortic dissection.

Thrombocytopenia after Aortic Valve Replacement Using Sutureless Valves.

Background: Sutureless valves are widely used in aortic valve replacement surgery, with Perceval valves and Intuity valves being particularly prominent. However, concerns have been raised about postoperative thrombocytopenia with Perceval valves (Corcym, UK). We conducted a comparative analysis with the Intuity valve (Edwards Lifesciences, USA), and assessed how thrombocytopenia affected patient and transfusion outcomes. Methods: Among 595 patients who underwent aortic valve replacement from June 2016 to March 2023, sutureless valves were used in 53 (Perceval: n=23; Intuity: n=30). Platelet counts were monitored during hospitalization and outpatient visits. Daily platelet count changes were compared between groups, and the results from patients who underwent procedures using Carpentier Edwards Perimount Magna valves were used as a reference group. Results: Compared to the Intuity group, the Perceval group showed a significantly higher amount of platelet transfusion (5.48±1.64 packs vs. 0.60±0.44 packs, p=0.008). During the postoperative period, severe thrombocytopenia (<50,000/µL) was significantly more prevalent in the Perceval group (56.5%, n=13) than in the Intuity group (6.7%, n=2). After initial postoperative depletion, daily platelet counts increased, with significant differences observed in the extent of improvement between the Perceval and Intuity groups (p<0.001). However, there was no significant difference in early mortality or the incidence of neurological complications between the 2 groups. Conclusion: The severity of postoperative thrombocytopenia differed significantly between the Perceval and Intuity valves. The Perceval group showed a significantly higher prevalence of severe thrombocytopenia and higher platelet transfusion volumes. However, thrombocytopenia gradually recovered during the postoperative period in both groups, and the early outcomes were similar in both groups.

The Neuroprotective Effects of Ginsenoside Rd Pretreatment in a Rat Model of Spinal Cord Ischemia-Reperfusion Injury

ABSTRACT Introduction: Paraplegia may develop as a result of spinal cord ischemia-reperfusion injury in patients who underwent thoracoabdominal aortic surgery. The objective of this research is to determine the neuroprotective effects of ginsenoside Rd pretreatment in a rat model of spinal cord ischemia-reperfusion injury. Methods: Sprague-Dawley rats (n=36) were randomly assigned to three groups. The sham (n=12) and control (n=12) groups received normal saline orally. The Rd group (n=12) received ginsenoside Rd (100 mg/kg) orally 48 hours before the induction of spinal cord ischemia. Spinal cord ischemia was induced by aortic occlusion using a Fogarty balloon catheter in the Rd and control groups. A neurological assessment according to the motor deficit index and a histological evaluation of the spinal cord were performed. To evaluate the antioxidant activity of ginsenoside Rd, malondialdehyde levels and superoxide dismutase activity were determined. Further, the tissue levels of tumor necrosis factor-alpha and interleukin-1 beta were measured. Results: The Rd group showed significantly lower motor deficit index scores than did the control group throughout the entire experimental period (P<0.001). The Rd group demonstrated significantly greater numbers of normal motor neurons than did the control group (P=0.039). The Rd group exhibited decreased malondialdehyde levels (P<0.001) and increased superoxide dismutase activity (P=0.029) compared to the control group. Tumor necrosis factor-alpha and interleukin-1 beta tissue levels were significantly decreased in the Rd group (P<0.001). Conclusion: Ginsenoside Rd pretreatment may be a promising treatment to prevent ischemia-reperfusion injury in patients who undergo thoracoabdominal aortic surgery.

Efeitos do fentanil sobre a adrenalina e noradrenalina plasmáticos e do miocárdio: estudo experimental no cäo / Effects of fentanyl on plasma adrenaline and noradrenaline and of the myocardium: experimental study in dogs

Estudou-se em 24 cäes os efeitos do pentobarbital sódico (30mg.kg*-1 de peso corpóreo) e do Fentanil (0,005; 0,05 e 0,1mg.kg*-1 de peso corpóreo) sobre as catecolaminas plasmáticas e do miocárdio. O estudo foi complementado com determinaçöes da pressäo arterial média, da freqüência cardíaca, da pressäo venosa da cava inferior, do hematócrito, da temperatura retal, do pHa, da PaO2 e da PaCO2. Os resultados obtidos demonstraram que 1) O pentobarbital sódico determinou boa estabilidade dos atributos cardiocirculatórios e sanguíneos estudados; 2) O Fentanil em pequenas doses (0,005mg.kg*-1) näo alterou os níveis da adrenalina plasmática e da noradrenalina miocárdica e determinou queda pouco acentuada da pressäo arterial média e da freqüência cardíaca; 3) O Fentanil em grandes doses (0,005 e 0,1mg.kg*-1) näo alterou os níveis da adrenalina e noradrenalina plasmática, mas diminuiu significativamente a pressäo arterial média e a freqüência cardíaca

Bloqueio subaracnóideo com bupivacaína pesada a 0,5%: efeitos da adiçäo de adrenalina / Subarachnoid block with 0,5% bupivacaine: effects of adrenaline addiction

Estudaram-se em 48 pacientes os efeitos da bupivacaína pesada a 0,5% (15mg) associada ou näo à adrenalina 1:1.000(0,2mg) no bloqueio subaracnóideo. Os atributos estudados foram tempo de início do bloqueio sensitivo, tempo de latência, altura do bloqueio analgésico, grau do bloqueio motor, grau do relaxamento muscular, tempos de início da regressäo do bloqueio motor e de regressäo do bloqueio analgésico em 2, 4 e 6 metâmeros. Os valores da pressäo arterial e da freqüência de pulso completaram o estudo. Os resultados obtidos com os bloqueios realizados com a associaçäo bupivacaína-adrenalina, em comparaçäo com os realizados apenas com a bupivacaína, mostraram diminuiçäo significante dos tempos de início do bloqueio sensitivo (47%) e de latência (20%) e aumento, também significativo, dos tempos de início da regressäo do bloqueio motor (50%) e do bloqueio analgésico em 2(15%), 4(17,5%) e 6 metâmeros (19%). Quanto aos demais atributos, näo houve diferença significativa nos grupos estudados

Alteraçöes do equilíbrio ácido-básico e hidrelectrolítico em cäes submetidos a hipercapnia / Changes in the acid base and water-electrolyte equilibrium in dogs subjected to hypercapnia

Foram estudadas as alteraçöes do equilíbrio ácido-básico e hidroeletrolítico em 12 cäes submetidos a hipercapnia com diferentes níveis de CO2 na mistura inalada (10% e 15%). Foram analisados os seguintes parâmetros pH sangüíneo, pressäo parcial de gás carbônico no sangue arterial, pressäo parcial de oxigênio no sangue arterial, bicarbonato de sódio plasmático, sódio plasmático, potássio plasmático, volume urinário, excreçäo urinária de sódio, excreçäo fracionária de sódio, depuraçäo de sódio, reabsorçäo de sódio, excreçäo urinária de potássio, excreçäo fracionária de potássio, depuraçäo de postássio, osmolaridade urinária, depuraçäo osmolar e depuraçäo de água livre. Os valores de pH sangüíneo apresentam uma queda significativa, tendendo a retornar aos níveis iniciais no fim do experimento. O bicarbonato plasmático e a diurese aumentam significativamente quando a concentraçäo inspirada de CO2 é de 15%. Ocorre tendência à queda da excreçäo urinária de sódio, na excreçäo fracionária de sódio e na depuraçäo de sódio e, contrariamente, uma tendência a aumento na reabsorçäo de sódio. Com a excreçäo fracionária e com a depuraçäo de potássio ocorre tendência a queda. Os parâmetros restantes näo apresentam variaçöes significantes. É ainda discutida a fisiopatologia das alteraçöes observadas em cada parâmetro estudado

Efeito da quetamina no equilíbrio ácido-base / Effect of Ketamine in acid-base balance

Os autores estudaram os efeitos da quetamina (6 mg. kg-1) como dose inicial e a seguir, (0,3 mg. kg-1) sobre o equilíbrio ácido-básico em 10 cäes. A investigaçäo foi complementada com a determinaçäo da excreçäo urinária de amônia (UNH4 V) e da acidez titulável da urina (ACTu). Os estudos foram feitos em quatro momentos: M1 - Controle (antes do uso de quetamina); M2 - Imediatamente após a anestesia com quetamina; M3 - 15 minutos após o início da anestesia; M4 - 45 minutos após o início da anestesia. Os resultados mostraram: a quetamina näo alterou o pH arterial (pHa), o pH venoso (pHv), a pressäo parcial de O2 do sangue arterial (PaO2), a pressäo parcial de O2 do sangue venoso (PvO2), a pressäo parcial de CO2 do sangue arterial (PaCO2), a pressäo parcial de CO2 do sangue venoso (PvCO2), a saturaçäo arterial de oxigênio (SaO2), o sódio plasmático (Nap), o potássio plasmático (Kp), o déficit de base (DB) e o bicarbonato plasmático (HC03p); aumenta a freqüência cardíaca (FC) e a pressäo arterial média (PAM); produziu queda do débito urinário (DU), da pressäo venosa periférica (PVP), da excreçäo urinária de sódio (UNa V), da excreçäo urinária de potássio (UK V), da excreçäo urinária de amônia (UNH4 V) e da acidez titulável da urina (ACTu). Demonstrou-se que o uso de quetamina em cäes diminui a excreçäo de ácidos fixos do organismo, embora näo alterarem aparentemente no equilíbrio ácido-base

O ensino de anestesiologia na Faculdade de Medicina de Botucatu - UNESP / The anesthesiology education in the Faculdade de Medicina de Botucatu - UNESP

Faz-se um pequeno histórico da evoluçäo do ensino de Anestesiologia para o Curso de Graduaçäo da Faculdade de Medicina de Botucatu. Discorre-se sobre os critérios estabelecidos para a formaçäo do médico generalista. É demonstrado de forma detalhada o plano de ensino com seu conteúdo programático, sua carga horária e seus critérios de avaliaçäo