Archivos de cardiología de México
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Review Comparative Study
[Reperfusion and postconditioning in acute ST segment elevation myocardial infarction. A new paradigm for the treatment of acute myocardial infarction. From bench to bedside?].
After prolonged periods of ischemia and energy depletion, the ischemic myocardial cell can be jeopardized by specific causes within the reperfusion period. These causes can be viewed as unwanted aspects of the recovery process itself limiting its efficiency. Three potential initial causes of immediate reperfusion injury, aside from oxygen radicals, have been experimentally investigated in detail, and are briefly discussed: 1. re-energization; 2. rapid normalization of tissue pH; and 3. rapid normalization of tissue osmolality. ⋯ It has been reported very recently, that postconditioning patients with ST segment elevation AMI, during coronary angioplasty protects the human heart in this clinical scenario. Obtaining such a beneficial effect by a simple manipulation of reperfusion is of major potential clinical interest. Now more than ever, mechanistic and pharmacological research in the field of reperfusion injury appears to be necessary and clinically relevant.
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Comparative Study
[Operating room extubation (ultra fast-track anesthesia) in patients undergoing on-pump and off-pump cardiac surgery].
The potential benefit of immediate operating room extubation after cardiac surgery remains controversial. Since safety and effectiveness of ultra fast-track anesthesia is mandatory, we developed this work to identify preoperative and operative variables associated to failed extubation after on-pump and off-pump cardiac surgery. ⋯ Preoperative and operative factors associated to failed extubation could be used as guidelines to improve safety in ultra fast-track cardiac anesthesia. Especially, patients undergoing on-pump surgery with antecedents of heart failure or difficult cardiopulmonary by-pass weaning should not be extubated in the operating room. In the same way, immediate extubation should be avoided in obese patients with hemodynamic compromise during off-pump coronary surgery.