scholarly journals Influence of multimodal low-opioid anesthesia on the dynamics of аnnexin V in blood plasma during cardiac surgery

2020 ◽  
pp. 20-28
Author(s):  
S.R. Maruniak ◽  
◽  
O.A. Loskutov ◽  
O.M. Druzhyna ◽  
I.R. Malish ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Interleukin 6 ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Control Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Standard Scheme

The aim – to analyze the effect of anesthesia on the dynamics of аnnexin V during coronary artery bypass grafting with сardiopulmonary bypass (CPB), and the dependence of direct clinical results on the expression of аnnexin V. Materials and methods. The study included 30 patients with coronary heart disease who underwent coronary artery bypass grafting with application of 2–3 aortocoronary anastomoses with CPB. According to the anesthetic management, all patients were divided into two groups: the first group (13 patients) – low opioid anesthetic scheme; control group (17 patients) – a standard scheme of anesthetic management. The determination of the level of аnnexin V in the blood was carried out before CPB and after bringing the sternum by enzyme-linked immunosorbent assay. Results. The low-opioid scheme of anesthetic management was associated with significantly (by 1.5 times) lower level of аnnexin V and by 28.38 % lower level of interleukin-6 at the end of the surgery as compared to the standard scheme. A significant negative correlation (r = –0.117, p = 0.523) was found between the levels of аnnexin V and interleukin-6. One-way analysis of variance showed that patients who had low cardiac output syndrome in the postoperative period had a significantly higher level of аnnexin V after CPB (p = 0.001). Conclusions. The use of multimodal low-opioid anesthesia is characterized by relative safety, a sufficient level of analgesia and lower level of аnnexin V compared to the control group. Key words: coronary artery bypass grafting, low-opioid anesthesia, apoptosis, аnnexin V, interleukin-6.

scholarly journals Anesthetic management of a patient with situs inversus totalis undergoing coronary artery bypass grafting surgery: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Chigusa Nakasone ◽  
Masafumi Kanamoto ◽  
Wataru Tatsuishi ◽  
Tomonobu Abe ◽  
Shigeru Saito
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Situs Inversus ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Situs Inversus Totalis ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Intraoperative Management

Abstract Background Anesthetic management of coronary artery bypass grafting surgery (CABG) in a dextrocardia patient with situs inversus totalis is rarely encountered and seldom reported in the literature. Case presentation A 76-year-old Japanese female patient had been diagnosed with situs inversus totalis and coronary artery disease of 3 vessels, and she subsequently underwent elective CABG. A preoperative examination showed almost normal results. ECG showed right deviation with the normal lead position. In the operating room, ECG leads were applied in reverse. Pulmonary artery catheterization was performed via the left internal jugular vein. A transesophageal echocardiography (TEE) probe was introduced without difficulty. A different angle was needed to acquire the desired views because of her atypical anatomy. Conclusion Careful perioperative evaluation, intraoperative management, and inspection of multiplane angle and probe adjustments in TEE are needed for anatomically abnormal patients.

Clinical Effectiveness of Intravenous Exenatide Infusion in Perioperative Glycemic Control after Coronary Artery Bypass Graft Surgery

2017 ◽  
Vol 127 (5) ◽  
pp. 775-787 ◽  
Author(s):  
Guillaume Besch ◽  
Andrea Perrotti ◽  
Frederic Mauny ◽  
Marc Puyraveau ◽  
Maude Baltres ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Blood Glucose Control ◽  
Target Range ◽  
Control Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Abstract Background We aimed to assess the clinical effectiveness of intravenous exenatide compared to insulin in perioperative blood glucose control in coronary artery bypass grafting surgery patients. Methods Patients more than 18 yr old admitted for elective coronary artery bypass grafting were included in a phase II/III nonblinded randomized superiority trial. Current insulin use and creatinine clearance of less than 60 ml/min were exclusion criteria. Two groups were compared: the exenatide group, receiving exenatide (1-h bolus of 0.05 µg/min followed by a constant infusion of 0.025 µg/min), and the control group, receiving insulin therapy. The blood glucose target range was 100 to 139 mg/dl. The primary outcome was the proportion of patients who spent at least 50% of the study period within the target range. The consumption of insulin (Cinsulin) and the time to start insulin (Tinsulin) were compared between the two groups. Results In total, 53 and 51 patients were included and analyzed in the exenatide and control groups, respectively (age: 70 ± 9 vs. 68 ± 11 yr; diabetes mellitus: 12 [23%] vs. 10 [20%]). The primary outcome was observed in 38 (72%) patients in the exenatide group and in 41 (80%) patients in the control group (odds ratio [95% CI] = 0.85 [0.34 to 2.11]; P = 0.30). Cinsulin was significantly lower (60 [40 to 80] vs. 92 [63 to 121] U, P < 0.001), and Tinsulin was significantly longer (12 [7 to 16] vs. 7 [5 to 10] h, P = 0.02) in the exenatide group. Conclusions Exenatide alone at the dose used was not enough to achieve adequate blood glucose control in coronary artery bypass grafting patients, but it reduces overall consumption of insulin and increases the time to initiation of insulin.

scholarly journals Coronary Artery Bypass Grafting in a Patient with Dextrocardia with Situs Inversus

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Kaitlin E. Woods ◽  
J. W. Awori Hayanga ◽  
Daniel Sloyer ◽  
Roy E. Henrickson ◽  
Lawrence M. Wei ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Situs Inversus ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Direct Access ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
The Right

Dextrocardia involves embryologic malformations leading to a right hemithorax heart with rightward apex. Situs inversus encompasses all viscera in mirrored position. A 76-year-old male with dextrocardia with situs inversus presented for coronary artery bypass grafting due to a non-ST elevation myocardial infarction. Management was altered accordingly. Electrocardiography leads and defibrillator pads were reversed. A left internal jugular vein central venous catheter provided direct access to the right atrium. Transesophageal echocardiography confirmation of aortic and venous cannulation required turning the probe right for the right-sided aorta and left for liver visualization, respectively. Proactive surgical and anesthetic management was imperative for the successful and uneventful outcome for this patient.

scholarly journals Effect of the Aortic Root Infusion of Sufentanil on Ischemia-Reperfusion Injury in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Trial

2019 ◽  
Author(s):  
Mohammad Bagher Khosravi ◽  
Mahdi Kahrom ◽  
Mahdi Tahari ◽  
Kambiz Alizadeh ◽  
Ghasem Soltani ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Aortic Root ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Control Group ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Background: Ischemic postconditioning is a novel strategy for attaining cardioprotection. Remarkable evidence from various in vitro and in vivo animal and human studies have shown significant opioid-induced cardioprotection against myocardial ischemia/reperfusion (I/R) injury. The purpose of this study was to assess the cardioprotective effect of sufentanil against I/R injury after on-pump coronary artery bypass grafting (CABG). Methods: Between June 2016 and July 2017, 80 consecutive patients with triple-vessel disease undergoing on-pump CABG were enrolled in this prospective randomized study. The patients assigned to the sufentanil group received a single dose of sufentanil (0.2 μg/kg diluted with 50 cc of saline) 5 minutes before the removal of the aorta cross-clamp, with the sufentanil injected via a cardioplegia needle into the aortic root. In the control group, the same volume of normal saline was injected as a placebo. Cardiac enzymes, the inotrope score, and the outcome data were compared between the 2 groups. Results: The mean age of the patients was 60.48±7.50 years (range=41–69 y), and men comprised 65.0% of the study population. The levels of CK-MB and cardiac troponin I were significantly lower in the sufentanil group (P<0.001). The amount of inotrope use (P<0.001), the incidence of atrial fibrillation (P=0.014), electrical shock (P=0.007), and the mechanical ventilation time (P<0.001) decreased in the sufentanil group compared with the control group. However, the use of intra-aortic balloon pumps (P=0.247) and the ICU length of stay (P=0.867) were not significantly different between the 2 groups. Conclusion: The injection of a single dose of sufentanil into the aortic root prior to aorta cross-clamp removal diminished cardiac injury during on-pump CABG in our patients.   J Teh Univ Heart Ctr 2019;14(4):177-182   This paper should be cited as: Bagher Khosravi M, Kahrom M, Tahari M, Alizadeh K, Soltani G, Ghanad MA. Effect of the Aortic Root Infusion of Sufentanil on Ischemia-Reperfusion Injury in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Clinical Trial. J Teh Univ Heart Ctr 2019;14(4):177-182.

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