scholarly journals Oxidative stress response in children undergoing cardiac surgery: Utility of the clearance of isoprostanes

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0250124
Author(s):  
Stephanie Hadley ◽  
Debora Cañizo Vazquez ◽  
Miriam Lopez Abad ◽  
Stefano Congiu ◽  
Dmytro Lushchencov ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Near Infrared ◽  
Antioxidant Systems ◽  
Non Invasive ◽  
Post Surgery ◽  
Severe Degree ◽  
Patients Experience ◽  
Pulmonary Bypass

Introduction Cardiac surgery (CS) in pediatric patients induces an overt oxidative stress (OS) response. Children are particularly vulnerable to OS related injury. The immaturity of their organs and antioxidant systems as well as the induction of OS in cardio-pulmonary bypass (CPB) surgery may have an important impact on outcomes. The purpose of this study was to describe the OS response, measured by urinary free 8-iso-PGF2α, in infants undergoing CS and to evaluate the relationship between OS response and post-operative clinical outcomes. Methods Infants with congenital heart disease undergoing CS with or without CPB were eligible for enrollment. Children were classified as neonates (<30 days) or infants (30 days—6 months) based on the age at surgery. Perioperative continuous non-invasive neuromonitoring included amplitude-integrated electroencephalogram and cerebral regional oxygen saturation measured with near-infrared spectroscopy. Urine 8-iso-PGF2α levels were measured before, immediately post-, and 24-hours post-surgery, and the 8-iso-PGF2 clearance was calculated. Results Sixty-two patients (60% neonates) were included. Urine 8-iso-PGF2α levels 24 hours after surgery (8.04 [6.4–10.3] ng/mg Cr) were higher than pre-operative levels (5.7 [4.65–7.58] ng/mg Cr) (p<0.001). Those patients with a severe degree of cyanosis caused by Transposition of the Great Arteries (TGA) had the highest post-operative 8-iso-PGF2α levels. Patients with intra-operative seizures had higher post-operative 8-iso-PGF2α levels. 8-iso-PGF2α clearance at 24 hours post-surgery was different between newborns and infant patients, and it was inversely correlated with days of mechanical ventilation (p = 0.05), ICU LOS (p = 0.05) and VIS score at 24 hours (p = 0.036). Conclusions Children undergoing CS, particularly neonatal patients, experience a significant post-operative OS response that might play an important role in postoperative morbidity. TGA patients undergoing arterial switch operations demonstrate the highest post-operative OS response. Rapid clearance of isoprostanes, which occurs more frequently in older patients with more mature antioxidant systems, might be associated with better clinical outcomes.

Abstract P028: MY Program - Modified Yoga After Cardiac Surgery Reduces Stress, Pain and Anxiety

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Sharon McGonigle ◽  
Rima Styra ◽  
Arianne St.Jacques ◽  
Barbara Bailey ◽  
Michelle Dimas
Keyword(s):  
Cardiac Surgery ◽  
Depression Scale ◽  
Relaxation Techniques ◽  
Breathing Exercises ◽  
Stress Studies ◽  
Post Surgery ◽  
Yoga Class ◽  
Surgical Ward ◽  
Patients Experience ◽  
Age Range

Introduction: Despite the physical benefits associated with cardiac surgery procedures, between 30-60% of all patients experience moderate to high levels of anxiety and/or depression, which can remain elevated up to 6 months post surgery. Traditional postoperative education classes do not provide an avenue for patients and families to deal with their physical and mental stress. Studies indicate that a holistic class, allowing individuals to focus on their inner-self would prove to have positive outcomes. We hypothesized that a modified yoga program (MY Program), tailored to the physical needs of post cardiac surgery patients, would have a positive effect on participants perceived stress, pain and anxiety levels. Method: Postoperative cardiac surgery patients at our institution were eligible to participate in our innovative MY Program during their hospitalization. Sessions were held twice weekly in an education room on the surgical ward, and were led by a certified yoga instructor. Participants were seated, with all positions and postures (asanas) being modified for a seated position. The forty-five minute sessions started and finished with relaxation and meditation, including the incorporation of breathing exercises that are modified to account for post-operative difficulties such as splinting. The patients completed two questionnaires: anxiety questions of the HADS (Hamilton Anxiety and Depression Scale) and a survey regarding their overall experience post-yoga. Results: There were 112 participants, of which 61% ( 68 of 112) were male, age range of 20 to 89. Female patients reported experiencing lower levels of state anxiety compared to men, although not statistically significant ( p = .11). Overall feelings of anxiety were relatively low-moderate amongst the participants post-yoga anxiety scores. Post-yoga questionnaire data analysis indicated that 98.8% (110 of 112) of patients found the session helpful, 91.1% (102 of 112) thought the setting was comfortable, 93.7% (104 of 112) would attend the class again, 100% (112 of 112) of patients would recommend the class to others, 89.2% (99 of 112) found that the session helped with their pain after surgery, 97.4% (109 of 112) reported that the session helped with their stress, and 91.7% (102 of 112) of patients found that their breathing improved after the class. Overall, males and females agreed on their satisfaction with the yoga intervention. Conclusion: Cardiac surgery is physically and mentally challenging for patients and families. Educational sessions do not currently provide adequate stress and anxiety relief. The MY program demonstrated that a holistic yoga class, incorporating breathing exercises, meditation and relaxation techniques reduced levels of stress, pain and anxiety in participants.

scholarly journals Aprotinin Reduces the Procalcitonin Rise Associated With Complex Cardiac Surgery and Cardiopulmonary Bypass

2013 ◽  
pp. 27-33
Author(s):  
P. MARUNA ◽  
A. A. KLEIN ◽  
J. KUNSTÝŘ ◽  
K. M. PLOCOVÁ ◽  
F. MLEJNSKÝ ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Serine Protease Inhibitor ◽  
Heparin Dose ◽  
Post Surgery ◽  
Thromboembolic Pulmonary Hypertension ◽  
Group A ◽  
Group B ◽  
Pulmonary Bypass ◽  
Pro Inflammatory Cytokines

Aprotinin, a nonspecific serine protease inhibitor, has been primarily used as a haemostatic drug in cardiac surgery with cardio-pulmonary bypass (CPB). This study investigated the effect of Aprotinin on the post-operative levels of procalcitonin (PCT) and a set of cytokines in patients undergoing pulmonary artery endarterectomy (PEA). We analyzed 60 patients with chronic thromboembolic pulmonary hypertension undergoing PEA. 30 patients (Group A) were treated with Aprotinin (2000000 IU prior anesthesia, then 2000000 IU in CPB prime and 50000 IU per hour continuously); a further 30 patients (Group B) received Tranexamic Acid (1 g before anesthesia, 1 g after full heparin dose and 2 g in CPB prime). PCT, TNFα, IL-1β, IL-6, and IL-8 arterial concentrations were measured from before until 72 hours after surgery. Aprotinin significantly affected early post-PEA plasma PCT. Patients treated with Aprotinin (Group A) had lower peak PCT levels compared to patients in Group B (1.52 ng/ml versus 2.18, p=0.024). Postoperative peak values of PCT and IL-6 correlated closely in both groups (r=0.78, r=0.83 respectively). Aprotinin attenuates the post-PEA increase of PCT in the same manner as other pro-inflammatory cytokines. Significant correlation between PCT and IL-6 post-surgery may be indicative of an indirect IL-6-mediated pathway of PCT alteration.

scholarly journals Near-infrared spectroscopy

2015 ◽  
Vol 02 (03) ◽  
pp. 221-224
Author(s):  
Virendra Jain ◽  
Hari Dash
Keyword(s):  
Cardiac Surgery ◽  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Paediatric Population ◽  
Limited Data ◽  
Non Invasive ◽  
Technological Advances ◽  
Real Time Information ◽  
Oxygenation Monitoring

AbstractTissue ischaemia can be a significant contributor to increased morbidity and mortality. Conventional oxygenation monitoring modalities measure systemic oxygenation, but regional tissue oxygenation is not monitored. Near-infrared spectroscopy (NIRS) is a non-invasive monitor for measuring regional oxygen saturation which provides real-time information. There has been increased interest in the clinical application of NIRS following numerous studies that show improved outcome in various clinical situations especially cardiac surgery. Its use has shown improved neurological outcome and decreased postoperative stay in cardiac surgery. Its usefulness has been investigated in various high risk surgeries such as carotid endarterectomy, thoracic surgeries, paediatric population and has shown promising results. There is however, limited data supporting its role in neurosurgical population. We strongly feel, it might play a key role in future. It has significant advantages over other neuromonitoring modalities, but more technological advances are needed before it can be used more widely into clinical practice.

Efficacy of Near-Infrared Spectrometry for Monitoring the Cerebral Effects of Severe Dilutional Anemia

2014 ◽  
Vol 17 (3) ◽  
pp. 154 ◽  
Author(s):  
Arıtürk Cem ◽  
Ustalar Serpil ◽  
Toraman Fevzi ◽  
Ökten Murat ◽  
Güllü Ümit ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Surgery ◽  
Blood Lactate ◽  
Near Infrared ◽  
Bypass Graft ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Infrared Spectrometry ◽  
Control Group ◽  
Near Infrared Spectrometry

<p><strong>Introduction:</strong> Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO<sub>2</sub>) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG).</p><p><strong>Methods:</strong> The prospective observational study involved patients who underwent cerebral rSO<sub>2</sub> monitoring by NIRS during elective isolated first-time CABG: an anemic group (<em>N</em>=15) (minimum Hemoglobin (Hb) N=15) (Hb &gt;8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood lactate level, pCO<sub>2</sub>, pO<sub>2</sub> at five time points and cross-clamp time, extracorporeal circulation time were recorded for each patient. Group results statistically were compared.</p><p><strong>Results:</strong> The anemic group had significantly lower mean preoperative Hb than the control group (10.3 mg/dL versus 14.2 mg/dL; <em>P</em> = .001). The lowest Hb levels were observed in the hypothermic period of CPB in the anemic group. None of the controls exhibited a &gt;20% decrease in cerebral rSO<sub>2</sub>. Eleven (73.3%) of the anemic patients required an increase in pump blood flow to raise their cerebral rSO<sub>2</sub>.</p><p><strong>Conclusions:</strong> In this study, the changes in cerebral rSO<sub>2</sub> in the patients with low Hb were within acceptable limits, and this was in concordance with the blood lactate levels and blood-gas analysis. It can be suggested that NIRS monitoring of cerebral rSO<sub>2</sub> can assist in decision making related to blood transfusion and dilutional anemia during CPB.</p>

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