Low-dose aprotinin in heart valve reoperations.

BACKGROUND AND AIM OF THE STUDY: Aprotinin is effective in promoting hemostasis, notably in cardiac surgery with cardiopulmonary bypass. Its efficacy has been shown in coronary bypass graft operations. However, few reports exist of aprotinin use in valve operations, and in those studies only the full dose was used. Thus, our aim was to evaluate the effects of low-dose aprotinin in patients undergoing heart valve reoperation. METHODS: Eighteen patients having reoperative valve surgery received 10(6) KIU aprotinin after induction of anesthesia, and a further 10(6) KIU in the pump prime. A group of 18 similar patients who were operated on but did not receive aprotinin were used as controls. RESULTS: A significant reduction in postoperative blood loss (approximately 470 ml) occurred in patients receiving aprotinin. These patients also presented less postoperative bleeding than untreated patients in 70.4% of cases. No adverse effects of the drug were noted, except for one case of allergic reaction. CONCLUSION: The systematic use of low-dose aprotinin should be considered in valve reoperation, except in cases of re-exposure to the drug, or allergic reaction.

Anestesia com hipotensao induzida pelo halotano na cirurgia do canal arterial. / Anesthesia with induced hypotension by halothane for surgery of the ductus arteriosus

Os autores relatam a experiencia de 121 (cento e vinte e um) casos submetidos a cirurgia para correcao de persistencia do canal arterial, nos quais se utilizou a tecnica da hipotensao arterial induzida pelo halotano, na fase cirurgica da disseccao e ligadura do canal arterial. E dado enfase a importancia deste anestesico na diminuicao da tensao do canal arterial no momento da ligadura e seccao, evitando o risco de hemorragia. Mostra a seguranca alcancada com a tecnica, dispensando o uso de drogas, como por exemplo os ganglioplegicos. O halotano pelas suas propriedades fisico-quimicas apresenta-se como excelente agente indutor da hipotensao controlad