Glucose Homeostasis during the Perioperative Period of Cardiac Surgery: A Narrative Review

2021 ◽  
Vol 05 (01) ◽  
Author(s):  
Sébastien Redant ◽  
David De Bels ◽  
Benoit Villet ◽  
Rachid Attou ◽  
Patrick M Honore ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Glucose Homeostasis ◽  
Perioperative Period ◽  
Narrative Review

scholarly journals Local Anesthetics and Recurrence after Cancer Surgery-What’s New? A Narrative Review

2021 ◽  
Vol 10 (4) ◽  
pp. 719
Author(s):  
Sarah D. Müller ◽  
Jonathan S. H. Ziegler ◽  
Tobias Piegeler
Keyword(s):  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Local Anesthetics ◽  
Experimental Studies ◽  
Perioperative Period ◽  
Cancer Surgery ◽  
Narrative Review ◽  
Future Research ◽  
Inflammatory Stress ◽  
Research Activities

The perioperative use of regional anesthesia and local anesthetics is part of almost every anesthesiologist’s daily clinical practice. Retrospective analyses and results from experimental studies pointed towards a potential beneficial effect of the local anesthetics regarding outcome—i.e., overall and/or recurrence-free survival—in patients undergoing cancer surgery. The perioperative period, where the anesthesiologist is responsible for the patients, might be crucial for the further course of the disease, as circulating tumor cells (shed from the primary tumor into the patient’s bloodstream) might form new micro-metastases independent of complete tumor removal. Due to their strong anti-inflammatory properties, local anesthetics might have a certain impact on these circulating tumor cells, either via direct or indirect measures, for example via blunting the inflammatory stress response as induced by the surgical stimulus. This narrative review highlights the foundation of these principles, features recent experimental and clinical data and provides an outlook regarding current and potential future research activities.

Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽  
2017 ◽  
Vol 32 (7) ◽  
pp. 547-553 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Marina Pieri ◽  
Francesco De Simone ◽  
Alcira Rodriguez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Necrosis ◽  
Perioperative Period ◽  
Cardiac Surgical Procedures ◽  
Control Group ◽  
Volatile Anaesthetics ◽  
Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

scholarly journals Remimazolam anesthesia for cardiac surgery with cardiopulmonary bypass: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kota Saito ◽  
Sho Ohno ◽  
Makishi Maeda ◽  
Naoyuki Hirata ◽  
Michiaki Yamakage
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Oxygen Saturation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Maze Procedure ◽  
Intraoperative Awareness ◽  
Case Presentation ◽  
Venous Oxygen Saturation ◽  
Index Value

Abstract Background Remimazolam has less cardiovascular depressant effects than propofol in non-cardiac surgical patients. However, the efficacy and safety of remimazolam in cardiac surgery with cardiopulmonary bypass (CPB) have not been reported. We present a case of successful anesthetic management using remimazolam in cardiac surgery with CPB. Case presentation A 76-year-old female was scheduled for mitral valve repair, tricuspid annuloplasty, maze procedure, and left atrial appendage closure. We used remimazolam in induction (6.0 mg/kg/h) and maintenance (0.6–1.0 mg/kg/h) of general anesthesia, and the bispectral index value was maintained in the range of 36 to 48 including the period of CPB. Hemodynamics, mixed venous oxygen saturation, and bilateral regional cerebral oxygen saturation were maintained within acceptable ranges. There was no intraoperative awareness/recall or serious complications associated with remimazolam throughout the perioperative period. Conclusions Remimazolam can be used the same as other existing anesthetics in cardiac surgery with CPB.

Epicardial Adipose Tissue and Postoperative Atrial Fibrillation

2021 ◽  
Author(s):  
Petraglia Laura ◽  
Conte Maddalena ◽  
Comentale Giuseppe ◽  
Cabaro Serena ◽  
Campana Pasquale ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Cardiac Surgery ◽  
Epicardial Adipose Tissue ◽  
Perioperative Period ◽  
Postoperative Atrial Fibrillation ◽  
Serum Samples ◽  
Monocyte Chemoattractant Protein 1 ◽  
Elective Cardiac Surgery ◽  
Increased Risk

Abstract Background. Atrial fibrillation (AF) often occurs after cardiac surgery and is associated to increased risk of stroke and mortality. Several evidence support the important role of inflammation in the pathogenesis of postoperative atrial fibrillation (POAF). It is known that an increased volume and a pro-inflammatory phenotype of epicardial adipose tissue (EAT) are both associated with AF onset in non surgical context. In the present study, we aim to evaluate whether also POAF occurrence may be triggered by an exalted production of inflammatory mediators from EAT.Methods. The study population was composed of 105 patients, with no history of paroxysmal or permanent AF, undergoing elective cardiac surgery. After clinical evaluation, all patients performed an echocardiographic study including the measurement of EAT thickness. Serum samples and EAT biopsies were collected before surgery. Levels of 10 inflammatory cytokines were measured in serum and EAT conditioned media. After surgery, cardiac rhythm was monitored for 7 days.Results. Forty-four patients (41.3%) developed POAF. As regard to cardiovascular therapy, only statin use was significantly lower in POAF patients (65.1% vs. 84.7%; p-0.032). Levels of Monocyte Chemoattractant Protein-1 (MCP-1), in both serum and EAT, were significantly higher in POAF patients (130.1 pg/ml vs. 68.7 pg/ml; p = < 0.001; 322.4 pg/ml vs. 153.4 pg/ml; p = 0.028 respectively). EAT levels of IL-6 were significantly increased in POAF patients compared to those in sinus rhythm (126.3 pg/ml vs. 23 pg/ml; p = < 0.005).ConclusionHigher EAT levels of IL6 and MCP1 are significantly associated with the occurrence of POAF. Statin therapy seems to play a role in preventing POAF. These results might pave the way for a targeted use of these drugs in the perioperative period.

scholarly journals Association between serum biomarkers and postoperative delirium after cardiac surgery

2019 ◽  
Vol 26 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Mindaugas Gailiušas ◽  
Judita Andrejaitienė ◽  
Edmundas Širvinskas ◽  
Darijus Krasauskas ◽  
Milda Švagždienė ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Delirium ◽  
Neuronal Damage ◽  
Artery Bypass ◽  
Neuron Specific Enolase ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Blood Levels ◽  
Increased Risk ◽  
The Individual

Background. In cardiac surgery, patients face an increased risk of developing postoperative delirium (POD) that is associated with poor outcomes. Neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) have shown some promising results as potential tools for POD risk stratification, diagnosis, monitoring, and prognosis. Methods. Prospective single-centre study enrolled 44 patients undergoing elective coronary artery bypass grafting (CABG) and/ or valve procedures using cardiopulmonary bypass (CPB). The patients were assessed and monitored preoperatively, during surgery, and in the early postoperative period. The blood levels of NSE and GFAP were measured before and after surgery. The early POD was assessed by CAM-ICU criteria and patients were assigned to the POD group (with POD) or to the NPOD group (without POD) retrospectively. Results. The incidence of POD was 18.2%. After surgery, NSE significantly increased in the whole sample (p = 0.002). Comparing between groups, NSE significantly increased in the POD group after surgery (p = 0.042). ΔGFAP (before/after operation) for the whole sample was statistically significant (p = 0.022). There was a significant correlation between ΔGFAP and the lowest MAP during surgery in the POD group (p = 0.033). Conclusions. Our study demonstrated that NSE and GFAP are associated with early POD. An increase in NSE level during the perioperative period may be associated with subclinical neuronal damage. Serum GFAP levels show the damage of glial cells. Further studies are needed to find the factors influencing the individual limits of optimal MAP during surgery.

scholarly journals Regional oxymetry provides safety of the patient during cardiaс surgery

2015 ◽  
Vol 18 (3) ◽  
pp. 53 ◽  
Author(s):  
B. A. Akselrod
Keyword(s):  
Cardiac Surgery ◽  
Vascular Surgery ◽  
Oxygen Transport ◽  
State Of The Art ◽  
Perioperative Period ◽  
Risk Groups ◽  
The State ◽  
Ischemic Damage

The state-of-the-art regional oxygenation evaluation during perioperative period in cardiac surgery is presented. The importance of a regional oxymetry method based on NIRS and used to assess hemodynamic efficiency during anesthesia is demonstrated. This method helps to increase the safety of patients during cardiac and vascular surgery due to a decrease of tissue ischemic damage. Regional oxymetry enables to evaluate oxygen transport adequacy, identify the risk groups and modify the therapy used. Disadvantages and limitations of the regional oxymetry method are also discussed.

Sign in / Sign up

Export Citation Format

Share Document