Cardiac surgery

Some authors believe that the use of PCA plus a basal infusion may result in a better control of pain and decrease of additional requests [9,10]. Others state that basal infusion could increase medication consumption, side effects with no difference in pain relief as compared to PCA alone [1,6,11]. However, previous studies did not investigate these two different modalities of PCA in cardiac surgery patients. Our findings give a better view in this particular group of patients.

In the present study, we have shown that the occurrence of AKI after cardiac surgery had a negative influence on mortality and survival of the affected patients. Like other authors, we found that age, valve replacement, a history of cardiac surgery, and the use of vasoactive drugs in the postoperative period were independent predictors of the development of AKI after cardiac surgery in a population of patients with near-normal renal function. Thus, our findings underscore the importance of identifying risk factors for the development of AKI after cardiac surgery, which can further the development of effective renoprotective strategies.

Methods: A total of 216 patients underwent robotic- assisted cardiac surgery between January 2013 and April 2017. Cardiopulmonary bypass was performed via femoral artery, jugular, and femoral vein cannulation, and a Chitwood clamp was used for aortic occlusion. A total of 192 patients attended the outpatient follow-up, and femoral arterial and venous flow pattern was examined using Doppler ultrasound (DUS) in 145 patients.

ventricular systolic dysfunction and it has been utilized in the diagnosis of acute coronary syndrome, heart failure, and other cardiac disorders. Research had examined its use as a biomarker for cardiac events in patients undergoing non-cardiac surgery. Novo et al. [14] examined N-terminal fragment of proBNP (NT- proBNP) levels in 82 consecutive patients undergoing elective non- cardiac surgery and found that a pre-operative elevated NT- proBNP level was independently associated with postoperative cardiac events (odds ratio 1.2, 95% confidence interval 1.0–1.4, P = 0.01). Similarly, Kim et al. [15] in a study of 163 patients without a history of cardiovascular disease undergoing non-cardiac surgery reported that preoperative BNP levels were significantly higher in patients who experienced postoperative cardiac events than in those who did not. Mercantini et al. [16] studied 205 patients undergoing major abdominal surgery who received routine cardiac risk assessment and preoperative BNP levels, and reported that a preoperative BNP level .36 pg/mL was the only effective predictor of adverse cardiac events. The ongoing DECREASE-VI study is designed to determine the role of NT- proBNP levels in patients undergoing major vascular surgery [17]. Compare to BNP, the role of HO-1 as prognostic factor may be restricted to the cardiac events that derived from ischemic damage.

Air bubbles entering the cerebral circulation intra-operatively have potential to obstruct blood flow, and are thought to be a source of endothelial irritation and inflammation.[1,2] Although bubbles entering the circulation during heart surgery have long been implicated as a possible cause of post-operative cognitive decline, the potential for adverse clinical sequelae due to bub- bles in the bloodstream remains controversial.[2–5] Potential alternative explanations for cog- nitive decline include the effects of age, pre-existing cognitive decline, and pre-existing cardiovascular disease, combined with peri-operative stressors, such as the use of anaesthesics, haemodynamic changes during cardiopulmonary bypass, impact of particulate emboli, im- paired regulation of cerebral blood flow, and inflammatory responses. Although studies of de- compression sickness[1] and experiments on animals[6] clearly demonstrate the potential for clinical symptoms if bubbles are present in sufficient quantities, interventional trials conducted in a cardiac surgery setting find no cognitive benefit in reducing the volume of air entering the bloodstream during surgery [3,7]. Since there is currently no method for determining the size distribution and volume of bubbles reaching the cerebral circulation, it is difficult to assess whether quantities of air typically introduced during surgery are high enough to result in cognitive decline.

this complication because it is one of the most detri- mental for the recovery of patients in the postopera- tive period after cardiac surgery. As no consensus was found in the literature on how to evaluate it, nor studies with the same purpose as this article, we assumed and used the markers of tissue perfu- sion, as hemodynamic instability is directly related to poor perfusion of the target organ. Target organ perfusion is routinely assessed in ICUs by means of tissue perfusion markers.

Dobutamine and epinephrine were the first choice, followed by PDE-III inhibitors in case of hypotension caused by low cardiac output syndrome. In case of failing responsiveness to this first line therapy, PDE-III Inhibitors were the second line choice, followed by epinephrine and levosimendan or vasopressin. This is in accordance with previous surveys regarding the use of catechol- amines in cardiothoracic surgery patients. In 2006 Kastrup and colleagues published a postal survey asking for the first line catecholamine used in postoperative low cardiac output syndrome (LCOS) in Germany. Epinephrine (41.8%), dobutamine (30.9%) and PDE-III inhibitors (14.5%) were the most common drugs [15]. In a follow up survey in 2008 epinephrine still was the first line catecholamine used for the treatment of LCOS in cardiotho- racic surgery patients [14]. Williams and colleagues investigated the use of catecholamines in patients with LCOS after coronary artery bypass grafting in a high risk patient population and found a high inter-hospital variability in the use of vasoactive agents with similar patient outcome [20]. The S3 guideline for intensive care in cardiac surgery patients [13] as well as European recommen- dations for management of heart failure in cardiac surgery patients [21] both recommend use of catecholamines in the management of LCOS, including epinephrine, dobutamine and PDE-III inhibitors (among others), without advocating one specific substance. However, several clinical trials with patients cardio- genic [22] and septic shock [23,24] have shown that epinephrine is inferior concerning lactic acidosis, tachycardia/arrhythmia and gastric mucosal perfusion. Therefore, the administration of dobutamine plus norepinephrine appears to be preferable, but more clinical studies are warranted in this respect. In case of vasoplegia almost all responding centers in the present survey (96%) consistently and quite frequently use norepinephrine infusion as the first line catecholamine to restore adequate perfusion pressures. This is again in line with previous surveys regarding this issue in cardiac surgical patients by Kastrup and colleagues [14,15]. The role of norepinehprine infusion in case of vasoplegia has been validated in various studies, including severe infection/sepsis, systemic inflammatory response syndrome (SIRS) and postperfusion syndrome after cardiac surgery [25–28] and thus is also recommended as the first and only vasopressor in the S3 guideline for intensive care in cardiac surgery patients [13].

Retrograde autologous priming (RAP) has been routinely applied in cardiac pediatric cardiopulmonary bypass (CPB). However, this technique is performed in pediatric patients weighing more than 20 kg, and research about its application in pediatric patients weighing less than 20 kg is still scarce. This study explored the clinical application of RAP in CPB in pediatric patients undergoing cardiac surgery. Sixty pediatric patients scheduled for cardiac surgery were randomly divided into control and experimental groups. The experimental group was treated with CPB using RAP, while the control group was treated with conventional CPB (priming with suspended red blood cells, plasma and albumin). The hematocrit (Hct) and lactate (Lac) levels at different perioperative time- points, mechanical ventilation time, hospitalization duration, and intraoperative and postoperative blood usage were recorded. Results showed that Hct levels at 15 min after CPB beginning (T2) and at CPB end (T3), and number of intraoperative blood transfusions were significantly lower in the experimental group (Po0.05). There were no significant differences in CPB time, aortic blocking time, T2-Lac value or T3-Lac between the two groups (P40.05). Postoperatively, there were no significant differences in Hct (2 h after surgery), mechanical ventilation time, intensive care unit time, or postoperative blood transfusion between two groups (P40.05). RAP can effectively reduce the hemodilution when using less or not using any banked blood, while meeting the intraoperative perfusion conditions, and decreasing the perioperative blood transfusion volume in pediatric patients.

The main limitation of the study is the differen- ce between the number of participants in each group. In the health service where the data were collected, the seasonality of hospitalization varied. When the service had many severe and chronic patients, pa- tients who would undergo the first cardiac surgery were summoned. Considering that there is no recom- mendation in the literature not to make intergroup comparisons, despite this numerical difference, we consider that this information will be important to prepare future projects considering these two groups of patients, which to date are nonexistent.

In conclusion, despite its various limitations, our study is clinically valuable because it revealed that carvedilol leads to lower incidence of POAF than control and appears to be superior to metoprolol as the current study clearly delineated. Carvedilol may effectively reduce the incidence of POAF in patients undergoing cardiac surgery. On the basis of this encouraging finding, we believe that research on the field is promising and should be continued. At least the ongoing COMPACT [24], which is a prospective, multi-center, randomized, open-label, active-con- trolled trial, will answer the question of whether or not carvedilol is more superior to metoprolol in preventing POAF in patients undergoing CABG.

1548 patients on mechanical ventilation admitted to a surgical ICU. In this prospective, randomized study, 62% of the patients underwent cardiac surgery and only 13% had a history of diabetes. Patients were randomized into a conventional therapeutic group, in which insulin was administered only if the blood glucose level was > 215 mg/dL to maintain a target of 180- 200 mg/dL, and into another group that received continuous infusion of insulin to maintain glucose levels between 80 and 110 mg/dL. Intensive insulin therapy resulted in a significant reduction in mortality (10% vs. 20%, P=0.005). Cardiac surgery mortality was only reduced in those patients who required three days of ICU care. Hospital mortality for all cardiac surgery patients, regardless of ICU stay, was reduced from 5.1% to 2.1% (P<0.05). Intensive glycemic management had no effect on the morbidity and mortality of patients who stayed more than three days in the ICU. In another study to identify patients who could benefit more from strict glycemic management, D’Alessandro et al. [14] sought

Objective: to analyze the frequency of anxiety and depression in the preoperative period of cardiac surgery in the scientific literature. Methods: this is an integrative review, whose corpus of analysis consisted of 17 articles, in a search carried out on the platforms MEDLINE (Pubmed), SCOPUS, CUIDEN, and SciELO. Results: the highest prevalences were 41.5% for anxiety and 28.3% for depression. Most of the studies on anxiety were developed from 2011; nine cohorts evaluated the negative repercussion of preoperative pain anxiety, postoperative anxiety, postoperative morbidity and mortality in the follow-up of up to 7.6 years. Conclusion: most studies reported anxiety and depression as significant conditions in the preoperative period.

This is a single-institution, nonrandomized study. As in many observational studies, we acknowledge that indication bias is a particular problem in our study. However, we attempted to minimize this by use of restriction and high-quality data. Enrollment in our study was restricted to patients referred for CMR study by the cardiologists and cardiac surgeons. Evalua- tion of RVEF was performed as a pre-operative risk assessment in those patients. Thus, both groups were similar with respect to most characteristics, comorbid conditions and type of pro- cedures. The quality of data was complete and accurate as obtained from electronic and admin- istrative databases, as well as phone interviews by a cardiologist. Due to our limited patient cohort, we were unable to perform detailed subset analysis using RVEF to predict outcomes on patients with preoperative pulmonary hypertension undergoing cardiac surgery, in order to draw a meaningful conclusion. As in all observational studies compounded by our limited patient cohort, associations could reflect confounding by unmeasured or poorly measured con- founders. It is also possible that our results might not be generalizable to patients undergoing straightforward CABG or valve procedures. Future well-powered randomized studyes can ade- quately these problems.

Objective: This in an article of caregiving ways in cardiac surgery as a mean of establishing a practice based on scientific knowledge. Methods: To carry out this study the following phases were done: identification and localization of data to be studied through searches in sites such as Lilacs, Medline, Scielo and Pubmed; printing, collection and file of data related to the aim of this study; results analysis and interpretation based on Coelho’s referential. Results: The results showed 12 different and specific ways of care involving subjectivity with objectivity in a continuous and individualized process. Conclusion: Nursing in heart surgery includes a thousand ways to do that require agility, skill and sensitivity to implement the care process. Descriptors: Nursing, Nursing care, Cardiac surgery.

J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 4/ Issue 23/ Mar 19, 2015 Page 4030 A cardiologist opinion was sought and it was decided to do the surgery under high risk consent. The boy was kept nil per oral for 6 hours duration. Infective endocarditis prophylaxis was given to the boy 1 hour before the procedure and IV crystalloids started at a rate of 50ml per hour. His room air saturation was 81-83% only. He was given midazolam 0. 5mg iv and was shifted to the operating room and all monitors including pulse oximeter, non-invasive blood pressure, and electrocardiogram and capnogram were attached. He was preoxygenated, ketamine 45mg, fentanyl 15 mic and inj atracurium 7. 5mg were given iv and was intubated with 5 size cuffed RAE tube. Bilateral air entry was checked and tube was fixed at 14cm.

attributed to the study drug was observed. With respect to mortality, there were 3 deaths in the T group: one during hemodialysis and two due to sepsis (endocarditis and medias- tinitis); all of them occurred more than 30 days after surgery. These 2 patients under- went re-operation during the late postopera- tive period. Other major postoperative com- plications were similar in both groups (3 patients in the NT group and 2 in the T group presented heart failure and 1 patient in the NT group developed acute renal failure). These patients, however, had a favorable outcome and were discharged from the hos- pital.

Assessment based on well defined clinical parameters, anthropometric and biochemical, may positively perform the malnutrition diagnose. More important, however, is identification of the nutritional parameters associated to the morbidity increase. This could enable a correct nutritional support to these children during a certain period before the surgery, improving their nutritional conditions so that they may face surgical trauma in more favorable conditions. In this study, the nutritional assessment enabled identification, within a group of patients basically malnutritioned and under high surgical risk, a subgroup of children with an additional

CABG surgery with hypothermic CPB, on the other hand, induces profound alter- ations in propranolol pharmacokinetics. When extracorporeal circulatory assistance is started, a volume of 1500 to 2000 ml of crystalloid prime solution is acutely added to the blood volume, leading to a 40-50% de- crease in plasma protein and a 50% decrease in the plasma levels of propranolol as a direct consequence of hemodilution (11,24). Lipid-soluble drugs with a high volume of distribution may be more readily taken up by bypass equipment, further contributing to a decrease in plasma levels. This initial fall in concentration at the start of CPB may be more readily counteracted by back diffusion into plasma if large tissue stores have accu- mulated (25). The decrease in plasma pro- teins also contributes to compensating the effect of CPB on plasma drug concentration by increasing the free fraction of drugs with a high plasma protein binding capacity, such as propranolol. Wood et al. (26) reported an increase in the free fraction of propranolol in plasma from 6.6 to 13.5% after institution of CPB. During hypothermia, microsomal en- zyme and hepatic propranolol elimination is reduced, as well as the apparent distribution volume and total body clearance, resulting in plasma levels higher than predicted from kinetic patterns derived under normother- mic conditions (9,10).

Não foi encontrada relação estatisticamente significante entre os estressores percebidos pelos pacientes (escore total da Escala de Avaliação de Estressores em Unidade de Terapia Inte[r]

The sample size was chosen by considering the proportion of the population in cardiac surgery (2%) in Alagoas with accuracy of the absolute estimate of 5% and a significance level of 5%. Patients were approached in the wards of hospitals at the time of the visit of the researcher, and those who met the inclusion criteria of the research were enrolled. We included 33 patients of both genders, older than 18 years, 13 women and 20 men who underwent heart surgery and who were admitted on the 5th or 6th postoperative day under physical therapy treatment. All patients were under the Unified Health System (SUS) medical assistance agreement. The patients were explained about the research objectives, and those willing to participate were asked to sign the Free Written Informed Consent after reading the document.