Hypomagnesemia and low alkaline phosphatase activity in patients' serum after cardiac surgery.

1989 ◽  
Vol 35 (4) ◽  
pp. 664-667 ◽  
Author(s):  
G Lum ◽  
C Marquardt ◽  
S F Khuri
Keyword(s):  
Alkaline Phosphatase ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
General Anesthesia Group ◽  
Alp Activity ◽  
Anesthesia Group ◽  
Group 3 ◽  
Group 2 ◽  
Post Cardiac Surgery ◽  
Group 1

Abstract Significant decreases in magnesium (Mg) concentration and alkaline phosphatase (ALP, EC 3.1.3.1) activity in serum were seen in patients after cardiac surgery with cardiopulmonary bypass (Group 1), as compared with non-cardiac-surgery patients after general anesthesia (Group 2) or only spinal anesthesia (Group 3). Mean changes for Mg and ALP by the first postoperative day, compared with pre-operative baseline values, were as follows: Group 1: Mg -7.5 mg/L (-38.3%), ALP -46U/L (-48.4%); Group 2: Mg -3.3 mg/L (-17.4%), ALP -17 U/L (-16.5%); and Group 3: Mg -1.9 mg/L (-10.0%), ALP -15 U/L (-14.0%). The decreases in Mg and ALP observed in post-cardiac-surgery patients appear to be a consequence of the cardiac surgery and the cardiopulmonary bypass pump. Measurement of Mg and ALP in a subgroup of 10 cardiac-surgery patients for 10 days postoperatively showed initial decreases, with gradual recovery to near-normal values by the 10th day. That the changes in Mg and ALP seen postoperatively were not attributable to hemodilution alone was confirmed by measuring total-protein concentrations before and after operation. ALP requires Mg ion in vitro for optimal activity, but addition of Mg in the appropriate amounts to sera with low ALP activity did not restore ALP activity. The low ALP activity seen in post-cardiac surgery patients in vivo may perhaps be related to factors other than Mg that were removed by the cardiopulmonary bypass pump.

Development and Validation of the Questionnaire of Satisfaction with Perioperative Anesthetic Care for General and Regional Anesthesia in Taiwanese Patients

2011 ◽  
Vol 114 (5) ◽  
pp. 1064-1075 ◽  
Author(s):  
Wui-Chiu Mui ◽  
Chia-Ming Chang ◽  
Kong-Fah Cheng ◽  
Tak-Yu Lee ◽  
Kwok-On Ng ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Patient Satisfaction ◽  
Regional Anesthesia ◽  
Anesthetic Care ◽  
Anesthesia Group ◽  
Confounding Variables ◽  
Group 3 ◽  
Group 2 ◽  
Nomological Validity ◽  
Group 1

Background To fulfill the increasing demand of service quality improvement in recent years, it is imperative to develop a proper instrument to evaluate patient satisfaction with perioperative anesthetic care for many institutes in Taiwan. Methods We used a six-factor 32-item pilot questionnaire developed in our previous study as our starting point in this study. Exploratory factor analysis of the pilot questionnaire for factor structure generation was performed in general anesthesia patients (group 1, n = 320) and resulted in the generation of the Patient Satisfaction with Perioperative Anesthetic Care questionnaire (PSPACq). Confirmatory factor analysis of the PSPACq in general anesthesia (group 2, n = 565) and regional anesthesia (group 3, n = 225) patients was performed for validation and cross-validation of the PSPACq model, respectively. The confounding variables and the patient loyalty effects on PSPACq scores were analyzed to evaluate the nomological validity of the PSPACq. Result Exploratory factor analysis of the pilot questionnaire in group 1 resulted in the development of the PSPACq (a seven-factor 30-item model). The standardized coefficients and indexes for the assessment of fit of the PSPACq model in group 2 (validation) and group 3 (cross-validation) patients revealed a well-fitting model. The results of the loyalty scores and confounding variables support the nomological validity of the PSPACq. Conclusions A valid and reliable questionnaire (PSPACq) with Taiwanese culture characteristics was developed and is suitable for testing of patient satisfaction with perioperative anesthesia care for patients receiving general or regional anesthesia for their surgery.

scholarly journals Effect of cardiac surgery on maternal and perinatal outcome in rheumatic heart disease with pregnancy: a comparative study

2018 ◽  
Vol 7 (3) ◽  
pp. 1123
Author(s):  
Vikas Yadav ◽  
J. B. Sharma ◽  
Garima Kachhawa ◽  
Alka Kriplani ◽  
Reeta Mahey ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Valve Replacement ◽  
Perinatal Outcome ◽  
Surgery Group ◽  
Group 3 ◽  
Group 2 ◽  
Rheumatic Heart ◽  
Group 1

Background: Rheumatic heart disease remains the commonest heart disease in India with mitral stenosis being the most common lesion and is associated with significant maternal and perinatal mortality and morbidity. The objective of this study was to compare maternal and perinatal outcome in women with rheumatic heart valvular disease who had no surgery or had percutaneous balloon mitral valvuloplasty (PBMV) or had valvular replacement surgery.Methods: It was a retrospective study in 113 women with rheumatic heart disease with various valvular lesion admitted in the hospital in previous 10 years. There were 58 (51.35%) patients without cardiac surgery (Group 1), 24 (21.23%) with PTMC (Group 2) and 31 (27.43%) with valve replacement surgery (Group 3). Maternal and perinatal outcome were compared in three groups.Results: The baseline characteristics were similar in the three group. In cardiac complications New York Heart Association (NYHA) deterioration was significantly higher (24.1%) in non-operated group (Group 1) as compared to Group 2 (12.3%) and Group 3 (16.1%). There was no difference in Group 2 and Group 3. Need of cardiac medication (digoxin) was also highest (67.2%) in Group 1 as compared to Group 2 (24.6%) (p = 0.002) and Group 3 (38.7%) (p = 0.001) but no difference in Group 2 and Group 3. Anticoagulant were given to significantly higher number (54.8% of cases in Group 3 (valve replacement) as compared to Group 1 (3.4%) and Group 2 (12.5%). There was no significant difference in obstetric events and mode of delivery in the three groups. Similarly, there was no difference in fetal outcome in the three groups as regard to mean birth weight, APGAR score, fetal growth restriction, fetal or neonatal death or congenital anomalies in the three groups.Conclusions: Cardiac surgery before or during pregnancy did not significantly improve maternal or perinatal outcome. Only cardiac events and need of medication was reduced with surgery. Hence surgery should be performed judiciously in selected cases.

scholarly journals Comparative evaluation of blood salvage techniques in patients undergoing cardiac surgery with cardiopulmonary bypass

Perfusion ◽  
2017 ◽  
Vol 33 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Serdar Gunaydin ◽  
Craig Robertson ◽  
Ali Baran Budak ◽  
Terence Gourlay
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Cells ◽  
Randomized Study ◽  
White Blood Cells ◽  
Cell Saver ◽  
Blood Salvage ◽  
Group 2 ◽  
Intraoperative Blood Salvage ◽  
Group 1

Background: The primary objective of this study was to test and compare the efficacy of currently available intraoperative blood salvage systems via a demonstration of the level of increase in percentage concentration of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in the end product. Methods: In a prospective, randomized study, data of 80 patients undergoing elective cardiac surgery with cardiopulmonary bypass in a 6-month period was collected, of which the volume aspirated from the surgical field was processed by either the HemoSep Novel Collection Bag (Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased from 23.05%±2.7 to 43.02%±12 in Group 1 and from 24.5±2 up to 55.2±9 in Group 2 (p=0.013). The mean number of platelets rose to 225200±47000 from 116400 ±40000 in the HemoSep and decreased from 125200±25000 to 96500±30000 in the cell-saver group (p=0.00001). The leukocyte count was concentrated significantly better in Group 1 (from 10100±4300 to 18120±7000; p=0.001). IL-6 levels (pg/dL) decreased from 223±47 to 83±21 in Group 1 and from 219±40 to 200±40 in Group 2 (p=0.001). Fibrinogen was protected significantly better in the HemoSep group (from 185±35 to 455±45; p=0.004). Conclusions: Intraoperative blood salvage systems functioned properly and the resultant blood product was superior in terms of red blood cell species. The HemoSep group had significantly better platelet and leukocyte concentrations and fibrinogen content.

scholarly journals Personalised Warfarin Dosing in Children Post-cardiac Surgery

2019 ◽  
Vol 40 (8) ◽  
pp. 1735-1744 ◽  
Author(s):  
Basma Zuheir Al-Metwali ◽  
Peter Rivers ◽  
Larry Goodyer ◽  
Linda O’Hare ◽  
Sanfui Young ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Target Range ◽  
Control Group ◽  
Historical Case ◽  
Median Percentage ◽  
Genotype Information ◽  
Warfarin Dosing ◽  
Group 2 ◽  
Post Cardiac Surgery ◽  
Group 1

Abstract Warfarin dosing is challenging due to a multitude of factors affecting its pharmacokinetics (PK) and pharmacodynamics (PD). A novel personalised dosing algorithm predicated on a warfarin PK/PD model and incorporating CYP2C9 and VKORC1 genotype information has been developed for children. The present prospective, observational study aimed to compare the model with conventional weight-based dosing. The study involved two groups of children post-cardiac surgery: Group 1 were warfarin naïve, in whom loading and maintenance doses were estimated using the model over a 6-month duration and compared to historical case-matched controls. Group 2 were already established on maintenance therapy and randomised into a crossover study comparing the model with conventional maintenance dosing, over a 12-month period. Five patients enrolled in Group 1. Compared to the control group, the median time to achieve the first therapeutic INR was longer (5 vs. 2 days), to stable anticoagulation was shorter (29.0 vs. 96.5 days), to over-anticoagulation was longer (15.0 vs. 4.0 days). In addition, median percentage of INRs within the target range (%ITR) and percentage of time in therapeutic range (%TTR) was higher; 70% versus 47.4% and 83.4% versus 62.3%, respectively. Group 2 included 26 patients. No significant differences in INR control were found between model and conventional dosing phases; mean %ITR was 68.82% versus 67.9% (p = 0.84) and mean %TTR was 85.47% versus 80.2% (p = 0.09), respectively. The results suggest model-based dosing can improve anticoagulation control, particularly when initiating and stabilising warfarin dosing. Larger studies are needed to confirm these findings.

Albumin priming improves the efficiency of the Minntech HPH Jr. hemoconcentrator

Perfusion ◽  
2018 ◽  
Vol 33 (7) ◽  
pp. 520-524
Author(s):  
Jeffrey L. Burnside ◽  
Todd M. Ratliff ◽  
Ann Salvator ◽  
Ashley B. Hodge
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Study Groups ◽  
Heparin Group ◽  
Fluid Removal ◽  
Priming Volume ◽  
Priming Process ◽  
Flow Through ◽  
Group 2 ◽  
Group 1

The desired use of the HPH Jr. is optimal due to the low priming volume; however, the lower rate of volume removal necessitates utilization of a larger hemofilter. Larger hemofilters carry a higher prime volume, which is impactful in the pediatric setting. Pediatric cardiac surgery patients under 18 kilograms requiring cardiopulmonary bypass were randomly assigned to one of two study groups. Group 1 (coated) contained an HPH Jr. hemofilter that was primed with the addition of 25% albumin and heparin. Group 2 (non-coated) contained an HPH Jr. hemofilter that was primed with only Normosol-R®. After cardioplegia delivery, zero balance ultrafiltration (ZBUF) was initiated and maintained for thirty consecutive minutes. The flow through the hemofilter was standardized at 70 ml/min and the vacuum applied to the effluent line was set at -150 mmHg. Effluent fluid removal was measured at the termination of thirty minutes and compared between the groups. Group comparisons between the coated vs non-coated hemofilter groups were assessed using two-sample t-tests or the Mann-Whitney U test, when appropriate. Forty-two patients were included in the analysis. There were 22 patients who had the non-coated hemofilter and 20 patients with a coated hemofilter. The differences between the two groups are illustrated in Table 1. There was a statistically significant higher ultrafiltration volume with the coated hemofilter group (p=0.008) (Figure 1). These results illustrate the improved efficiency of the HPH Jr. with the addition of 25% albumin and heparin during the priming process.

scholarly journals Surgeries in Neonates and Small-Weight Babies With Congenital Heart Diseases: Challenges and Gratification

2020 ◽  
Vol 1 (2) ◽  
pp. 70-76
Author(s):  
Anil Kumar Dharmapuram ◽  
Nagarajan Ramadoss ◽  
Vejendla Goutami ◽  
Sudeep Verma ◽  
Nanda Kishor Kumar Vuppali ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Hospital Death ◽  
Coarctation Of Aorta ◽  
Transposition Of Great Arteries ◽  
Small Weight ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Complex cardiac surgery in neonates and small-weight babies is a challenge. In addition to the surgical expertise and skill required, accurate diagnosis, management of anesthesia, perfusion, and postoperative critical care are equally challenging. Methods: We have analyzed the data of 4 different examples of complex cardiac surgery in neonates and small-weight babies from February 2012 to July 2019 in our unit. The first group included 118 cases of arterial switch operations for transposition of great arteries with and without ventricular septal defect (group 1). The second group included 52 patients of aortic arch repair from midline using selective cerebral perfusion avoiding total circulatory arrest (group 2). The third group included 75 patients of repair of coarctation of aorta from thoracotomy using the modified end-to-side technique (group 3). The fourth group included 40 neonates and small-weight babies who underwent repair of total anomalous pulmonary venous connection (group 4). Results: In group 1, there was hospital mortality in 6 babies. In group 2, there was no hospital mortality. In group 3, there was 1 hospital death; in group 4, there were 5 hospital deaths. The major contributing cause of death was respiratory or blood-borne infection causing respiratory issues leading to prolonged ventilation. Left diaphragm palsy contributed to morbidity and eventual death in 2 babies. Only 2 patients required tracheostomy to wean off the ventilator. Conclusions: In the present day, it is possible to achieve satisfactory results with acceptable mortality in neonatal cardiac surgery. Morbidity associated with very early repair in neonatal age, low weight, and infection-related issues is manageable with good outcomes.

Adjustment of sweep gas flow during cardiopulmonary bypass

Perfusion ◽  
2002 ◽  
Vol 17 (5) ◽  
pp. 353-356 ◽  
Author(s):  
Hasan Karabulut ◽  
Fevzi Toraman ◽  
Sümer Tarcan ◽  
Önder Demirhisa ◽  
Cem Alhan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Gas Flow ◽  
Surgical Techniques ◽  
Blood Gas Analysis ◽  
Carbon Dioxide Production ◽  
Gas Analysis ◽  
Lung Mechanics ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Cardiopulmonary bypass (CPB) is one of the major tools of cardiac surgery. However, no clear data are available for the ideal value of sweep gas flow to oxygenator during CPB. The aim of this study was to determine the best value for sweep gas flow during CPB. Thirty patients undergoing isolated CABG were randomly and equally allocated into three groups. Sweep gas flow to oxygenator was kept at 1.35 l/min/m2 in group 1, 1.60 l/min/m2 in group 2, and 2.0 l/min/m2 in group 3. All patients were operated on under the same anaesthetic regime and surgical techniques. Samples for blood gas analysis were collected at T1: before CPB; T2: 5 min after the initiation of CPB; T3: just before rewarming; and T4: at the end of rewarming. Five minutes after the initiation of CPB (T2), pCO2 decreased significantly in groups 2 and 3 compared to group 1 ( p < 0.02). With the addition of hypothermia (T3), the changes in the pH and pCO2 became more profound and, in this period, the levels in group 3 patients outranged the physiologic limits, with pCO2 and pH values being 28± 3 mmHg and 7.50± 0.04, respectively. At the end of the rewarming period (T4), in spite of increased carbon dioxide production, pCO2 values were below the physiologic limits in groups 2 and 3. We conclude that sweep gas flow to the oxygenator should be kept between 1.35 and 1.60 l/min/m2 during CPB to avoid hypocapnia, which results in alkalosis and has hazardous effects on lung mechanics, cerebral blood flow, and the cardiovascular system.

scholarly journals A new surgical technique to treat corneal perforations using amniotic membrane and surgical adhesive

2014 ◽  
Vol 66 (3) ◽  
pp. 655-664 ◽  
Author(s):  
K.C.S. Pontes ◽  
A.P.B. Borges ◽  
R.B. Eleotério ◽  
A.C.N. Frazão ◽  
D.P.D. Machado ◽  
...  
Keyword(s):  
Amniotic Membrane ◽  
Surgical Techniques ◽  
Lesion Group ◽  
General Anesthesia Group ◽  
Group 4 ◽  
Anesthesia Group ◽  
Surgical Adhesive ◽  
Group 3 ◽  
Group 2 ◽  
Adhesive Application

The objectives of this study were to compare surgical techniques and the effects of using n-butyl 2-cyanoacrylate and bovine amniotic membrane to repair perforated lesions in corneas. Penetrating keratoplasty was performed in sixty New Zealand White rabbits under general anesthesia. Group 1 (G1) was treated with n-butyl 2-cyanoacrylate, group 2 (G2) received a fragment of amniotic membrane through the anterior chamber and application of n-butyl 2-cyanoacrylate over the lesion, group 3 (G3) was treated with the same technique as G2 with the addition of an amniotic membrane bandage covering the cornea and sutured in the limbus region, and group 4 (G4) was treated with an amniotic membrane sutured to the lesion and an amniotic membrane bandage sutured in the limbus region. Clinical, histological and histomorphometric examinations of the corneas were performed. The membrane acted as a barrier for aqueous humor in G2 and G3, thereby keeping the surface dry for adhesive application; it also prevented the adhesive from contacting intraocular structures. The groups treated with amniotic membrane and surgical adhesive showed better results than the groups treated with either material alone. Thus, the combination of the membrane with the adhesive is recommended for this type of lesion.

Adjusting Oxygen Fraction to Avoid Hyperoxemia during Cardiopulmonary Bypass

2007 ◽  
Vol 15 (4) ◽  
pp. 303-306 ◽  
Author(s):  
Fevzi Toraman ◽  
Serdar Evrenkaya ◽  
Sahin Senay ◽  
Hasan Karabulut ◽  
Cem Alhan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Oxygen Fraction ◽  
Wide Range ◽  
Group 3 ◽  
Group 2 ◽  
Inspired Oxygen ◽  
Group 1

Although an adverse influence of hyperoxemia during cardiopulmonary bypass is well documented, there is a wide range of oxygen settings during cardiopulmonary bypass, based mostly on trial and error. The aim of this study was to determine the optimal inspired oxygen fraction during cardiopulmonary bypass. Ninety patients undergoing isolated coronary artery bypass operations were randomly allocated to one of 3 groups of 30 each. In group 1, cardiopulmonary bypass was started with an inspired oxygen fraction of 0.40, increased to 0.60 during rewarming. These settings were 0.40 and 0.50 in group 2, and 0.35 and 0.45 in group 3. Samples for blood gas analysis were collected at defined time periods during the operation. PaO2 was significantly higher in groups 1 and 2 compared to group 3. All patients in group 1 and 88% of patients in group 2 suffered at least one episode of hyperoxemia during cardiopulmonary bypass, compared to 30% of patients in group 3. The differences were significant, and we concluded that to avoid hyperoxemia, inspired oxygen fraction should be kept at 0.35 during cardiopulmonary bypass and increased to 0.45 during rewarming.

Cephradine and cefazolin plasma levels during cardiac surgery

Perfusion ◽  
1986 ◽  
Vol 1 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Sergio V Moran ◽  
Francisco Montiel ◽  
Guillermo Acuña ◽  
Jeanette Vergara ◽  
Manuel J Irarrazaval ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Plasma Levels ◽  
Early Postoperative Period ◽  
Good Choice ◽  
Double Blind Study ◽  
Double Blind ◽  
Postoperative Course ◽  
Group 2 ◽  
Group 1

A prospective, randomized, double-blind study was carried out to evaluate two prophylactic regimes in patients undergoing cardiac surgery with cardiopulmonary bypass. Antibiotic plasma levels were measured in fifty consecutive adult patients undergoing valve and coronary surgery. They were divided into two comparable groups of 25 patients, each matched in age, sex, type of operation and duration of cardiopulmonary bypass. Group 1 received 1 g of cephradine with the anaesthetic premedication, 1 g in the prime of the oxygenator and 1 g every six hours during the first 72 hours of the postoperative course. Group 2 received cefazolin following the same protocol except that they received 1 g every eight hours during the postoperative course. There were no allergic or toxic reactions and no infections up to two months follow-up in both groups. Antibiotic plasma levels were significantly higher (p < 0·001) in the cefazolin group in four out of five sampling periods. Antibiotic plasma levels for group 1 versus group 2 were as follows: initial level 11·7 ± 5.2 mcg/ml vs 31 4 ± 35·4 mcg/ml. During cardiopulmonary bypass 26·6 ± 9·5 mcg/ml vs 51·7 ± 21 ·1 mcg/ml. Final levels 13·6 ± 7·0 mcg/ml vs 32·2 ± 17·8 mcg/ml. Baseline levels 2·7 ± 2·3 mcg/ml vs 6·· ± 7·7 mcg/ml and peak level 44·0 ± 16·2 mcg/ml vs 51·2 ± 23·4 mcg/ml (NS). The results of this study demonstrate that cefazolin achieved significantly higher plasma levels during the different phases of the operation and early postoperative period. Also, cefazolin and cephradine levels are above the minimal inhibitory concentrations for the gram positive and gram negative susceptible bacteria, except for the basal levels obtained by cephradine. The favourable pharmacokinetic characteristics of cefazolin, makes it a good choice for prophylactic use during cardiac surgery.

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