Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Oct 2009
Multicenter Study Comparative StudyVolatile anesthetics reduce mortality in cardiac surgery.
A recent meta-analysis suggested that volatile anesthetics reduce postoperative mortality after cardiac surgery. Nonetheless, whether volatile anesthetics improve the outcome of cardiac surgical patients is still a matter of debate. The authors investigated whether the use of volatile anesthetics reduces mortality in cardiac surgery. DESIGN, SETTING, AND INTERVENTIONS: A longitudinal study of 34,310 coronary artery bypass graft interventions performed in Italy estimated the risk-adjusted mortality ratio for each center. A survey was conducted among these centers to investigate whether the use of volatile anesthetics showed a correlation with mortality. ⋯ This survey among 64 Italian centers shows that risk-adjusted mortality may be reduced by the use of volatile agents in patients undergoing coronary artery bypass graft surgery.
-
J. Cardiothorac. Vasc. Anesth. · Oct 2009
Randomized Controlled Trial Comparative StudyDesflurane-induced cardioprotection against ischemia-reperfusion injury depends on timing.
The authors tested the hypothesis that desflurane-induced cardioprotection depends on the timing of application and whether desflurane-induced postconditioning is mediated by nitric oxide. ⋯ Desflurane induces pre- and postconditioning but does not confer cardioprotection during ischemia in rabbits. The combination of pre- and postconditioning or continuous application does not provide additional cardioprotection. Furthermore, desflurane-induced postconditioning is mediated by nitric oxide.
-
J. Cardiothorac. Vasc. Anesth. · Oct 2009
Randomized Controlled Trial Comparative StudyMorphine reduces the threshold of helium preconditioning against myocardial infarction: the role of opioid receptors in rabbits.
Brief, repetitive administration of helium before prolonged coronary artery occlusion and reperfusion protects myocardium against infarction. Opioid receptors mediate the cardioprotective effects of ischemic pre- and postconditioning, but whether these receptors also play a role in helium preconditioning is unknown. The authors tested the hypotheses that opioid receptors mediate helium preconditioning and that morphine (a mu(1)-opioid receptor agonist with delta(1)-opioid agonist properties) lowers the threshold of cardioprotection produced by helium in vivo. ⋯ The results indicate that morphine lowers the threshold of helium preconditioning. Opioid receptors mediate helium preconditioning and its augmentation by morphine in vivo.
-
J. Cardiothorac. Vasc. Anesth. · Oct 2009
Randomized Controlled Trial Comparative StudyThe effect of xenon on isoflurane protection against experimental myocardial infarction.
To investigate if the protective effects of xenon and isoflurane against myocardial ischemia-reperfusion damage would be additive. ⋯ Combined isoflurane/xenon anesthesia reduced infarct size but not more than isoflurane alone. Ischemic preconditioning was more effective than the anesthetics.
-
J. Cardiothorac. Vasc. Anesth. · Oct 2009
Comparative StudyMultisite near-infrared spectroscopy predicts elevated blood lactate level in children after cardiac surgery.
To determine if a relationship exists between regional oxyhemoglobin saturation (rSO(2)) measured at various body locations by near-infrared spectroscopy (NIRS) and blood lactate level in children after cardiac surgery. ⋯ Averaged cerebral and renal rSO(2) less than 65% as measured by NIRS predicts hyperlactatemia (>3 mmol/L) in acyanotic children after congenital heart surgery. Hence, this noninvasive, continuous monitoring tool may facilitate the identification of global hypoperfusion caused by low cardiac output syndrome in this population.