Perfusion
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Randomized Controlled Trial
Active or passive bio-coating: does it matters in extracorporeal circulation?
Two types of surface coating for cardiopulmonary bypass (CPB) are used: bioactive (heparin, nitric oxide) and biopassive (albumin, polyethyleneoxide (PEO), phosphorylcholine). When haemocompatible coatings are combined with the separation of pleuro-pericardial aspiration, attenuation of both the coagulation and complement cascades, as well as better platelet preservation, has been demonstrated. This study wants to investigate if the combination of a bioactive with a biopassive coating (unfractionated heparin embedded in a phosphorylcholine matrix) combines the beneficial effects of both approaches. ⋯ Based on our results, there is no additional benefit in combining phosphorylcholine with unfractionated heparin in elective patients undergoing coronary artery bypass grafting (CABG). Massive haemodilution leads to enhanced complement activation.
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When cardiopulmonary bypass (CPB) is used, the blood comes into contact with foreign surfaces. To diminish this impact, various types of biocompatibly coated surfaces have been developed. ⋯ No statistically significant differences between both groups were revealed by comparing paired data. In our study, heparin-coated CPB circuits had no significant effect on either fibrinogen level or its function.
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Cardiovascular hypersensitivity is a rare and well-documented side-effect of 5-FU (5-fluorouracil). Besides the common complications such as angina pectoris and myocardial infarction, it can also cause cardiogenic shock, and supraventricular and ventricular arrhythmias. ⋯ In our case, 9 hours after stopping the infusion of 5-FU, the patients developed symptoms and electrocardiographic (ECG) findings consistent with acute myocardial infarction. We intend to share this rare case and discuss whether this late complication after 5-FU infusion is an FU-induced vasospasm or rather an allergic reaction leading to Kounis syndrome.
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Insufflation of carbon dioxide (CO(2)) to the operative field has been used to prevent major organ injury attributed to air embolisms in cardiac surgery. However, it may be preferable to avoid hypercapnia induced by CO(2) insufflation, owing to its potentially harmful effect. To investigate the effectiveness of near-infrared spectroscopy (NIRS) as a possible method for continuous monitoring of arterial CO(2) tension during cardiac surgery, we evaluated the correlation between the change in arterial CO(2) tension and the change in regional cerebral oxygen saturation (rScO(2)) obtained from NIRS in as controlled a condition as possible. ⋯ Since the change in regional cerebral oxygen saturation was correlated with the change in arterial CO(2) tension during mild hypothermic CPB, NIRS might be a possible non-invasive method for monitoring of arterial CO(2) tension without incurring additional cost in this setting.
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Comparative Study Clinical Trial
Effects of combined balanced colloid and crystalloid on rotational thromboelastometry in vitro.
Our objective was to investigate the in vitro effects of a totally balanced fluid concept on whole blood coagulation. Venous blood from 12 healthy volunteers was diluted by 20% and 40% with a combination of an equal amount of colloid (balanced or unbalanced 6% HES 130/0.4, or 4% gelatin) and crystalloid (balanced or unbalanced Ringer's acetate). Blood samples were analyzed with rotational thromboelastometry (ROTEM®). ⋯ In the extrinsic activation test, maximum clot firmness was decreased and clot formation time prolonged after 40 vol% hemodilution with a balanced Ringer's/unbalanced HES combination, more than in the corresponding gelatin hemodilution. In the fibrin-based test, after both 20- and 40 vol% hemodilution with unbalanced Ringer's/gelatin solution, maximum clot firmness was significantly stronger than in the Ringer's/HES-combinations. The combination of balanced colloid and crystalloid has similar coagulation effects in vitro as their respective combination of unbalanced solutions.