scholarly journals Risk assessment of cardial complications in patients with concomitant ischemic heart disease using different regimens of intraoperative fluid therapy

2020 ◽  
pp. 50-51
Author(s):  
Ya.V. Morozova
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Postoperative Complications ◽  
Fluid Therapy ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Enzyme Linked Immunosorbent Assay ◽  
Hemodynamic Parameters ◽  
Normal Limits ◽  
Significant Correction

Objective. To investigate the incidence of postoperative cardiac complications when performing advanced surgical interventions for cancer in patients with concomitant coronary heart disease (CHD) using two different regimens of intraoperative fluid therapy. Materials and methods. The study included 89 patients who underwent advanced surgery under general anesthesia. The division of patients into two groups was performed depending on the chosen way of intraoperative fluid therapy: the first (n=45) with a restrictive regimen (7.0±0.2 ml/kg/h), the second (n=44) – with a liberal (13.9±0,6 ml/kg/h). Groups of patients had no differences in anthropometric data, the volume of surgery, anesthesia. Intraoperatively, continuous monitoring of routine hemodynamic parameters (blood pressure, heart rate) and electrocardiography (ECG), quantitative assessment of biomarkers of myocardial damage (TnI, NTproBNP) by enzyme-linked immunosorbent assay in three stages (before surgery, immediately after and in the early postoperative period 18-24 h) of operation. Results and discussion. None of the patients had critical incidents during anesthesia, some of them had postoperative complications that did not require significant correction, but only more careful monitoring. In all patients of both groups, stable hemodynamic parameters were observed in the perioperative period, which was ensured by the adequacy of anesthesia, fluid therapy and the use of maintenance doses of sympathomimetics (phenylephrine) if necessary. In the 1st group 8 patients (17.8 %) needed support with sympathomimetics, in the 2nd – 3 patients (6.8 %). The study of the dynamics of cardiac biomarkers revealed a slight increase in cardiac troponin I in both groups, which was within the upper limit of normal. A more significant increase in troponin levels (so-called myocardial injury) was found in 5 patients (11.1 %) of the 1st group and in 6 patients (13.6 %) of the 2nd group in the postoperative stage. In the study of the concentration of natriuretic peptide found a more significant increase in patients of group 2 in the postoperative period, but these values were within normal limits. Manifestations of heart failure decompensation were not found in either patient in either group. According to ECG monitoring, no ischemic changes were found in any of the patients, benign arrhythmias were detected in 5 patients (11.1 %) of the 1st group and in 7 patients (15.9 %) of the 2nd group. Signs of acute renal injury were not found in either patient of either group, all had sufficient diuresis and blood creatinine levels within normal limits in the perioperative period. According to the statistical indicators of stay in the intensive care unit and in the hospital, the patients of both groups did not differ from each other. Thus, the study found no significant differences in the frequency of postoperative complications in patients with concomitant CHD when using relatively restrictive and liberal regimens of perioperative infusion therapy. The key point in the management of these patients is, in our opinion, the desire for “zero” balance by the end of the 1st day of the postoperative period and beyond. The main tools of the anesthesiologist are careful accounting of the injected fluid and its losses. This tactic may allow the use of a more liberal infusion regimen if necessary in patients without signs of heart failure. Conclusions. Relatively restrictive and liberal regimens of perioperative fluid therapy can be safely used in patients with concomitant CHD without signs of heart failure, provided adequate monitoring and management within the “zero” fluid balance.

Estimation of the Safety of Intraoperative Fluid Therapy during Great Abdominal Surgery in Patients with Coronary Heart Disease

2020 ◽  
Vol 5 (5) ◽  
pp. 158-163
Author(s):  
V. I. Lysenko ◽  
◽  
E. A. Karpenko ◽  
Ya. V. Morozova
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Fluid Therapy ◽  
Troponin I ◽  
Significant Proportion ◽  
Myocardial Damage ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cardiac Complications ◽  
Fluid Regimen

The study of intraoperative fluid therapy tactics has been of great interest over the past few years, especially in people with concomitant coronary heart disease, as they make up a significant proportion of all surgical patients. The purpose of our study was to assess the risk of intraoperative myocardial damage in patients with concomitant coronary heart disease depending on the fluid regimen used based on monitoring of hemodynamic parameters, electrocardiogram and biomarkers of myocardial damage. Material and methods. The study involved 89 patients, who were divided into two groups depending on the tactics of intraoperative fluid therapy – restrictive and liberal. In order to detect cardiac complications at different stages, we assessed biomarkers of myocardial damage Troponin I, NT-proBNP by solid-phase enzyme-linked immunosorbent assay (ELISA). Results and discussion. Analysis of the obtained data showed that MINS (myocardial injury in noncardiac surgery) incidents were diagnosed in 5 patients (11.1%) in the first group and in 6 patients (13.6%) in the second. In patients of both groups there was an increase in NT-proBNP in the dynamics at all stages, and in the 2nd group, with a liberal regimen of intraoperative fluid therapy, it was more pronounced. It should be noted that the obtained values of NT-proBNP in all patients did not differ significantly from those allowed for this age group; such dynamics of NT-proBNP may indicate a relative risk of complications of liberal fluid therapy in patients with baseline heart failure. One of the important points when choosing the mode of fluid therapy in patients with high cardiac risk is the assessment of the initial volemic status and careful monitoring of water balance in the perioperative period with the desire for "zero" balance. The obtained dynamics of laboratory markers of myocardial damage indicates that in patients with a significant reduction in cardiac reserves compensated for heart failure, a restrictive fluid regimen is preferable, which is also confirmed by slight changes in the concentration of biomarkers. Conclusion. Thus, the study demonstrated the relative safety of selected fluid regimens in patients with concomitant coronary heart disease without signs of congestive heart failure

scholarly journals The level of Brain natriuretic Peptide as a Predictor of the Postoperative Period at Operations with Artificial Blood circulation

2019 ◽  
Vol 3 (6) ◽  
pp. 114-120
Author(s):  
Yu. A. Bakhareva ◽  
Z. Z. Nadiradze ◽  
A. V. Muravskaya
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Natriuretic Peptide ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Results Of Treatment ◽  
Rate Of Increase ◽  
High Level

The level of natriuretic peptide is regarded as a prognostic predictor of postoperative heart failure in modern cardiac surgery, and moreover, this hormone is included in the standards of its early diagnosis around the world. This study was conducted at the Irkutsk Cardiac Surgery Center. The results of treatment of 78 patients were analyzed in order to determine the relationship between the dynamics of brain natriuretic peptides and the course of the early postoperative period in operations with artificial cardiopulmonary bypass. Patients were divided into three groups according to the level of natriuretic peptide elevation in the postoperative period. The study proved the dependence of the postoperative period on the multiplicity of the increase in the level of natriuretic peptide B-type.It was found that the higher the rate of increase in the hormone, the lower the numbers of the cardiac index in the postoperative period, longer duration of inotropic support (p > 0.05) and higher doses of adrenomimetics (p > 0.05). The duration of mechanical ventilation was also longer in the groups where a high level of natriuretic peptide was recorded (p > 0.05). Thus, the multiplicity of natriuretic peptide elevation can be a prognostic criterion for the postoperative period in cardiac patients. It is important to note that a single determination of the level of natriuretic peptide should not be used as a marker of postoperative heart failure and this study confirmed the necessity to monitor the dynamics of brain natriuretic peptide’s level in the perioperative period in patients operated with extracorporeal cardiopulmonary bypass.

scholarly journals Cardiac safety of intraoperative fluid therapy regimens in patients with concomitant coronary heart disease during major abdominal surgery

2021 ◽  
Vol 23 (2) ◽  
pp. 202-206
Author(s):  
Ya. V. Morozova ◽  
V. Yo. Lysenko ◽  
Ye. O. Karpenko ◽  
V. A. Maloshtan
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Abdominal Surgery ◽  
Brain Natriuretic Peptide ◽  
Fluid Therapy ◽  
Postoperative Period ◽  
Troponin I ◽  
Myocardial Damage ◽  
Major Abdominal Surgery ◽  
Cardiac Safety

Myocardial biomarkers such as brain natriuretic peptide (BNP) and brain natriuretic peptide amino-terminal prohormone (NT-proBNP), cardiac troponins (cTn), C-reactive protein (CRP) are considered as key in the strategy of treatment and prognosis for cardiovascular diseases. It is relevant for patients with high cardiological risk during major abdominal surgery and important in the context of preventing cardiac complications in the perioperative period. The aim. To assess the cardiac safety of intraoperative fluid therapy regimens in patients with high cardiac risk after major abdominal surgery by analyzing the dynamics of NTproBNP, Troponin I and CRP indicators. Materials and methods. The study included 89 patients who were divided into two groups depending on the tactics of the intraoperative fluid therapy: liberal and relatively restrictive. Continuous monitoring of macroindicators of cardiovascular system, quantitative assessment of myocardial damage biomarkers (TnI, NTproBNP) and CRP by enzyme-linked immunosorbent assay were performed at three stages - before surgery, immediately after and in the first 18–24 hours. Results. The rate of intraoperative fluid therapy was significantly different in two groups: in the restrictive 7.0 ± 0.2 ml/kg/h (n = 45), liberal 13.9 ± 0.6 ml/kg/h (n = 44). Evaluation of the dynamics of myocardial damage biomarkers revealed no differences in the levels of Troponin I and NP-proBNP at the first stage of the study. In the early postoperative period, the level of NP-proBNP in the second group was significantly higher than that in the first, 123.1 pg/ml and 68.0 pg/ml, respectively. An increase in Troponin I levels in the postoperative period was detected in 5 patients of the first group and in 6 – of the second, and it was diagnosed as myocardial injury after noncardiac surgery (MINS). Conclusions. The study has demonstrated the relative safety of fluid therapy regimens in patients with concomitant coronary heart disease without manifestations of congestive heart failure during major abdominal surgery. The regimen with relative fluid restriction has appeared to be preferable due to less response induction from compensatory mechanisms with normal NT-proBNP values. Adequate monitoring of cardiovascular system parameters and control of the dynamics of myocardial damage biomarkers can be the key in preventing such severe complications as postoperative myocardial infarction.

scholarly journals Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery

2016 ◽  
Vol 17 (5) ◽  
pp. 625-629 ◽  
Author(s):  
Nazel Oliveira Filho ◽  
Rodrigo L. Alves ◽  
Adriano T. Fernandes ◽  
Fernanda S. P. Castro ◽  
José Roberto Tude Melo ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Postoperative Complications ◽  
Postoperative Period ◽  
Pediatric Neurosurgery ◽  
Perioperative Period ◽  
Cns Tumors ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Peak Blood ◽  
Peak Blood Glucose

OBJECTIVE The acute elevation of blood glucose in perioperative pediatric patients subjected to cardiac surgery and in victims of head trauma is associated with higher rates of postoperative complications. Data on the occurrence of hyperglycemia and its association with unfavorable outcomes among patients who have undergone elective neurosurgery are scarce in the literature. This study aimed to determine whether the occurrence of hyperglycemia during the perioperative period of elective neurosurgery for the resection of tumors of the CNS in children is associated with increased morbidity. METHODS This retrospective cohort analysis included 105 children up to 12 years of age who underwent elective neurosurgery for resection of supratentorial and infratentorial CNS tumors between January 2005 and December 2010 at the São Rafael Hospital, a tertiary care medical center in Salvador, Brazil. Demographic data and intraoperative and postoperative information were collected from the medical records. Differences in blood glucose levels during the perioperative period were evaluated with nonparametric tests. RESULTS The patients who developed postoperative complications exhibited higher blood glucose levels on admission to the intensive care unit (ICU) (162.0 ± 35.8 mg/dl vs 146.3 ± 43.3 mg/dl; p = 0.016) and peak blood glucose levels on postoperative Day 1 (171.9 ± 30.2 mg/dl vs 156.1 ± 43.2 mg/dl; p = 0.008). Multivariate analysis showed that peak blood glucose levels on postoperative Day 1 were independently associated with a higher odds ratio for postoperative complication (OR 1.05). The occurrence of hyperglycemia (>150 mg/dl) upon admission to the ICU was associated with longer ICU (p = 0.003) and hospital (p = 0.001) stays. CONCLUSIONS The occurrence of hyperglycemia during the postoperative period after elective pediatric neurosurgery for the resection of CNS tumors was associated with longer hospital and ICU stays. Postoperative complications were associated with higher blood glucose levels upon admission to the ICU and higher peak blood glucose on the first postoperative day.

scholarly journals INFLUENCE OF THE ANESTHESIA METHOD ON THE OUTCOMES OF CARDIAC SURGERY OF DIFFERENT COMPLEXITY IN CHILDREN

2017 ◽  
Vol 11 (4) ◽  
pp. 226-232
Author(s):  
Lyaylya Z. Biktasheva ◽  
I. N Menshugin ◽  
V. A Mazurok ◽  
A. E Bautin
Keyword(s):  
Heart Failure ◽  
Mechanical Ventilation ◽  
Postoperative Complications ◽  
Epidural Anesthesia ◽  
Perioperative Period ◽  
Significant Positive Effect ◽  
Early Activation ◽  
The Mean ◽  
Positive Effect ◽  
A Current

The Aristotle score: a complexity-adjusted method to evaluate surgical results. For an assessment of dynamics of quality of the provided cardio-surgical help, comparison of a perioperative case rate and a mortality depending on the degree of surgical risk at cardiac interventions the Aristotle score is used. Thoracic epidural anesthesia (TEA) in comparison with high-opioids intravenous anesthesia (IVA) contributes to hemodynamics stability and early activation of patients. Objective: To analyze a current of the perioperative period at cardiac interventions in children with various categories of complexity of surgical intervention on «Aristotle score» depending on a type of anesthesia. Materials and methods. The 139 children with congenital heart diseases (CHD) underwent surgical correction. Patients were treated in Federal State Budgetary Institution of the Russian Ministry of Health (Penza), and «Almazov National medical research Centre» from 2008 to 2017 yrs. Patients (139 people, the mean age M (SD) of 7.6 (5.6) months of life) were divided into groups according to the categories of operational complexity presented in the Aristotle score. The group 1 consisted of 85 (61.2%) patients underwent interventions of second category of complexity, the group 2 consisted of 49 (39.8%) patients underwent interventions of 3 and 4 categories of complexity. Results. In cardiosurgical operations of the 2nd category of the Aristotle scale complexity a significant positive effect of TEA on the perioperative period was revealed in the form of a decrease in the severity of intraoperative heart failure and the level of glycaemia, the total number of postoperative complications and the time of patients’ staying on mechanical ventilation, as well as the duration of ICU stay and the decrease thrombocytopenia severity and frequency. In operations of grade 3 and 4, in which the duration of extracorporeal circulation was greater, the use of TEA did not have a significant positive effect on the incidence of postoperative complications, but after epidural anesthesia the mean duration of the patients’ stay on the mechanical ventilation and in the ICU was also significantly less. Apparently, the result is a consequence of a lesser severity of heart failure and early activation of patients by excluding the use of opioids, which have a depressing effect on the central nervous system, cardiac, respiratory and other systems. It can also be assumed that the administration of local anesthetics within 24 hours after the operation maintained sympatholytic and antiarrhythmic effects, and also prevented the complications development as a result of effective analgesia. Sufficiently convincing evidence of high antinociceptive activity of TEA is the possibility of safe extubation of patients in both the 2-d and 3-d categories of surgical complexity demonstrated in our study already in the operating room. Conclusion. Use of high TEA as a component of the combined anesthesia at surgical correction of CHD in young children has positive impact on a current of the perioperative period in the form of decrease in severity of heart and respiratory failure, duration of respiratory support, early activation and reduction of ICU stay.

scholarly journals Comparison of Hand Hygiene Attitudes and Hand Swab Cultures in the Mothers of Children with Heart Disease Before and After Cardiac Surgery

2017 ◽  
Vol 07 (01) ◽  
pp. e27-e31
Author(s):  
Aysu Karaağaç
Keyword(s):  
Heart Disease ◽  
Hand Hygiene ◽  
Postoperative Period ◽  
Cardiovascular Surgery ◽  
Perioperative Period ◽  
Before And After ◽  
Main Factors ◽  
Economic Measure ◽  
Severe Anxiety ◽  
And Training

AbstractNosocomial infections (NI) carry high risk of morbidity and mortality especially for children undergoing surgeries. Hand hygiene (HH) is the most effective and economic measure of NI control. This study was designed to compare the HH practices (HHPs), maternal anxiety scores (MASs), and hand swab cultures (HSCs) in the mothers of children with heart disease before and after cardiovascular surgery (CVS) to determine the factors that raised maternal HH sensitivity for prevention of NI. This prospective study included 120 mothers (age: 20–45 years; mean: 31.6 ± 5.6 years), whose children underwent CVS in the Kartal Koşuyolu Research and Training Hospital, University of Health Sciences between November 2016 and February 2017. HHP of each mother was assessed by a questionnaire, 10 questions in two parts and HH score (HHS) was acquired. Then, HSC was obtained. Beck anxiety inventory was applied to determine MAS. The relations among demographic characteristics, MAS, HSC results, and pre-/postoperative HHS of the mothers were compared statistically. There was a significant increase in the HHS of the mothers in the postoperative period. Cronbach's a coefficient of the questionnaire was 0.84. Maternal HHS was significantly correlated with maternal age (p = 0.001), education (p = 0.002), and MAS (p = 0.001), but not with the income (p = 0.2). Moreover, one mother in the postoperative period (0.8%) versus five mothers in the preoperative (4.2%) had positive HSC. High education level, advanced age, and severe anxiety experienced by the mothers in their children's perioperative period were found to be the main factors that have raised maternal HHS, thereby resulting in better HSC results.

scholarly journals FLUID THERAPY EFFECTS ON THE DYNAMICS OF MYOCARDIAL DAMAGE BIOMARKERS AND CARDIAC COMPLICATIONS IN THE PERIOPERATIVE PERIOD IN PATIENTS WITH ISCHEMIC HEART DISEASE

2020 ◽  
Vol 4 (2) ◽  
pp. 4-6
Author(s):  
V.I. Lysenko ◽  
E.A. Karpenko ◽  
Y. V. Morozova
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Fluid Therapy ◽  
Myocardial Damage ◽  
Perioperative Period ◽  
Ischemic Heart ◽  
Cardiac Complications

FLUID THERAPY EFFECTS ON THE DYNAMICS OF MYOCARDIAL DAMAGE BIOMARKERS AND CARDIAC COMPLICATIONS IN THE PERIOPERATIVE PERIOD IN PATIENTS WITH ISCHEMIC HEART DISEASE

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