Journal of cardiothoracic and vascular anesthesia
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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.
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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.
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J. Cardiothorac. Vasc. Anesth. · Oct 2009
Meta Analysis Comparative StudyEsmolol reduces perioperative ischemia in cardiac surgery: a meta-analysis of randomized controlled studies.
beta-Blockers were associated with a reduction of mortality and morbidity in noncardiac surgery until recently when the POISE trial showed that beta-blockers could be harmful in the perioperative period because of hypotension and bradycardia. Esmolol is an ultra-short-acting beta-blocker mostly used in emergency and high-risk patients. The authors performed a meta-analysis to evaluate the clinical effects of esmolol in cardiac surgery. ⋯ Esmolol reduces the incidence of myocardial ischemia and arrhythmias in cardiac surgery. An increase in bradycardia was noted as well.
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J. Cardiothorac. Vasc. Anesth. · Oct 2009
Randomized Controlled Trial Comparative StudyDesflurane-induced preconditioning has a threshold that is lowered by repetitive application and is mediated by beta 2-adrenergic receptors.
An optimal administration protocol to induce a maximal effect of anesthetic preconditioning has not been evaluated to date. In this study, desflurane preconditioning was characterized with respect to its threshold, dose dependency, and continuous versus repetitive application. Furthermore, the role of beta(2)-adrenergic receptors in anesthetic preconditioning was tested. ⋯ beta(2)-Adrenergic receptors mediate desflurane-induced preconditioning. Desflurane-induced preconditioning has a threshold that can be lowered by repetitive administration.