Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Aug 2003
Randomized Controlled Trial Comparative Study Clinical TrialThe influence of glucose-insulin-potassium (GIK) on the GH/IGF-1/IGFBP-1 axis during elective coronary artery bypass surgery.
To investigate the influence of glucose-insulin-potassium (GIK) on the growth hormone/insulin-like growth factor-1 axis. ⋯ GIK therapy. Measurements and main results Blood samples were taken repeatedly during the day of surgery. Ejection fraction (EF) was determined by transesophageal echocardiography before and at the end of surgery. Blood samples were taken on the first postoperative day and at discharge (8 am and 8 pm). During coronary artery bypass graft (CABG) surgery, a rapid decrease (44%) in total IGF-1 occurred in both groups. Directly after cessation of extracorporeal circulation, there was a prompt rise in IGFBP-1. The mean peak value in the control group was more than 3 times higher than in the GIK group. GH secretion was stimulated by surgery in both groups and was enhanced by GIK. B-glucose was significantly higher in the control group during surgery. EF ( approximately 55% at baseline) was unchanged in both groups. Postoperatively, there were no differences between the groups (all parameters). At discharge, IGFBP-1 was unchanged, but insulin was elevated compared with preoperative levels. This was seen in both groups, reflecting a hepatic insulin resistance. Conclusions The authors conclude that GIK blunts the rise of IGFBP-1 and thereby increases the bioavailability of IGF-1. GIK also seems to speed up the return of IGF-1 to baseline. Both mechanisms could be of importance to catabolic high-risk patients with low IGF-1. Hence, GIK has favorable effects on the GH/IGF-1 axis during CABG surgery.
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J. Cardiothorac. Vasc. Anesth. · Aug 2003
Randomized Controlled Trial Comparative Study Clinical TrialArrhythmias in off-pump coronary artery bypass grafting and the antiarrhythmic effect of regional ischemic preconditioning.
The authors sought to establish whether regional ischemic preconditioning (IP) reduces ischemic reperfusion arrhythmias in patients who undergo off-pump coronary artery bypass grafting (OPCAB). ⋯ Arrhythmia was a common phenomenon during and after an OPCAB procedure. The present IP protocol significantly suppressed HR elevation, the episodes of SVT, and the incidence of VT after surgery.
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J. Cardiothorac. Vasc. Anesth. · Aug 2003
Randomized Controlled Trial Comparative Study Clinical TrialFenoldopam for renal protection in patients undergoing cardiopulmonary bypass.
To evaluate the possible protective effects of fenoldopam on renal function in patients undergoing cardiopulmonary bypass. ⋯ In this study, fenoldopam was an effective agent in the prevention of renal dysfunction after cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Aug 2003
Comparative StudyA comparison of bleeding and transfusion in patients who undergo coronary artery bypass grafting via sternotomy with and without cardiopulmonary bypass.
To determine whether there is a difference between on-pump cardiopulmonary bypass (CABG) and off-pump coronary artery bypass grafting (OPCAB) without heparin reversal with regard to bleeding, transfusion requirements, and incidence of surgical re-exploration of the mediastinum. ⋯ Despite not reversing the heparin at the end of the OPCAB surgery, OPCAB surgery was associated with an overall reduction in allogeneic transfusion requirements.
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J. Cardiothorac. Vasc. Anesth. · Aug 2003
Comparative StudyA prospective evaluation of hemodynamic instability during off-pump coronary artery bypass surgery.
Despite recognized hemodynamic derangements during cardiac displacement, most patients appear to tolerate the off-pump procedure well. However, some patients unpredictably become hemodynamically unstable requiring emergency cardiopulmonary bypass or intra-aortic balloon pump support. After an experience of 5306 multivessel off-pump coronary artery bypasses (OPCABs), this study was undertaken to determine the factors that would identify the patients who were at a higher risk for the procedure. ⋯ Patients with low left ventricular ejection fraction <25%, myocardial infarction of <1-month duration, congestive heart failure, or preoperative hemodynamic instability constitute the high-risk group for OPCAB.