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ABSTRACT: The most important side effect of epidural anesthesia is hypotension with functional hypovolemia. Aggressive infusion therapy can reduce the hypotension effect. However, in conjunction with cardiopulmonary bypass, it can increase acute lung injury. We hypothesized that epidural anesthesia, by reducing cardiac sympathetic tonus, with subsequent better pulmonary flow, does not increase lung interstitial fluids.
Sixty patients undergoing coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) were randomized to combined general anesthesia with epidural anesthesia / analgesia, (EA) group, and to general anesthesia with i/v opiate analgesia, (GA) group. Patients in the EA group received a high thoracic epidural, preoperatively. Intraoperatively, 0.25% bupivacaine 8 mL/h was infused and general anesthesia with sevoflurane was followed by bupivacaine infusion for 48 hours postoperatively. General anesthesia in the GA group was with sevoflurane and fentanyl 10 - 12 microg/kg and analgesia with pethidinum 0.1 - 0.4 mg/kg i.v. postoperatively. Global end-diastolic volume index (GEDI), intrathoracic blood volume index (ITBI) and extravascular lung water index (ELWI) were measured before anesthesia, before CPB and 15, 60, 180, 600 min. and 24 hr after CPB. Duration of mechanical lung ventilation was registered in both groups.
ITBI and GEDI were significantly higher in the EA group at all time points of measurement (ITBI 945.6+/-146.4 ml/m(2) and 870.6+/-146.5 ml/m( 2) vs. 1118+/-153.2 ml/m(2) and 1020+/-174.9 ml/m( 2); GEDI 720+/-96.19 ml/m(2) and 775.0+/-159.5 ml/m( 2) vs. 805.4+/-97.59 ml/m(2) and 888+/-117.3 ml/m( 2)). GEDI was significantly lower in the GA group compared with baseline (801.9+/-132.4 ml/m(2) vs. 695+/-169.2 mL/m(2)). ELWI was significantly higher in the GA group (7.233+/-1.35 ml/kg and 7.333+/-1.32 ml/kg vs. 8.533+/-1.45 ml/kg and 8.633+/-1.71 ml/kg), but without significant changes in the EA group. Duration of mechanical lung ventilation was shorter in the EA group (663.7+/-98.39 min. vs. 362.2+/-33.72 min.).
Epidural anesthesia / analgesia does not increase interstitial lung fluids by increasing intrathoracic blood volume or the amount of infusion fluids in patients undergoing cardiac surgery under cardiopulmonary bypass. There is, also, a decreased duration of mechanical lung ventilation.
Perfusion 10/2009; 24(4):243-8. · 0.92 Impact Factor
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Vaiva Lesauskaite,
Giedre Sinkūnaite,
Rimantas Benetis,
Vilius Grabauskas,
Jolanta Vaskelyte,
Alina Smalinskiene,
Sandrita Simonyte,
Giedre Jariene,
Vacis Tatarūnas,
Jūrate Klumbiene,
Janina Petkeviciene,
Sarūnas Kinduris,
Saulius Giedraitis,
Juozas Sakalauskas,
Ramūnas Bolys,
Edmundas Sirvinskas, Tadas Lenkutis,
Dalia Pangonyte
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ABSTRACT: Matrix metalloproteinase-3 (MMP-3) degrades extracellular matrix and may lead to development of dilatative pathology of ascending thoracic aorta. Expression of MMP-3 depends upon the 5A/6A polymorphism in the promoter region. An increased number of 5A alleles leads to high expression of MMP-3. Thus, objective of the study was to determine whether the 5A/6A polymorphism in the promoter region of MMP-3 gene is associated with the development of dilatative pathology of ascending thoracic aorta. We studied 76 patients (age ranged from 31 to 81 years; median age, 64 years) who underwent aortic reconstruction surgery due to dilatative pathology of ascending thoracic aorta and a random sample of the population (n=604) aged 25-64 years, all from Lithuania. DNA was analyzed by using real-time polymerase chain reaction to genotype polymorphism 5A/6A at a position -1171 of the MMP3 gene promoter. The prevalence of MMP-3 genotypes was similar in the group of dilatative pathology of ascending thoracic aorta and random sample of population. The frequency of 5A allele did not differ significantly between both groups and was 0.506 and 0.514, respectively. Male carriers of 5A/5A genotype were significantly younger compared with those with the 6A/6A genotype. In conclusion, the frequency of MMP-3 promoter 5A/6A genotypes did not differ between the group of patients with dilatative pathology of ascending thoracic aorta and the random sample of population, but the males with dilatative pathology of ascending thoracic aorta and 5A/5A genotype required aortic reconstruction surgery at the younger age than the males carrying 6A/6A genotype in the MMP-3 promoter region.
Medicina (Kaunas, Lithuania) 02/2008; 44(5):386-91. · 0.42 Impact Factor
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ABSTRACT: Autotransfusion of the residual blood from the cardiopulmonary bypass (CPB) circuit is considered to be one of the methods enabling reduction in the need for transfusion, the possible adverse effects of which are well known and documented. The aim of the study was to evaluate the effectiveness of the autologous autotransfusion of centrifuged red blood cells from the residual blood of the CPB circuit in patients following heart surgery. Three groups of patients who underwent heart surgery were examined. The first group (Group 1) consisted of 37 patients who received all of the residual blood in the bypass circuit after CPB (collected into sterile plastic bags) during the early postoperative period. The second group (Group 2) consisted of 45 patients who did not receive the residual blood following CPB. The third group (Group 3) consisted of 42 patients who underwent reinfusion of centrifuged red blood cells from the residual blood remaining in the CPB circuit during the early postoperative period. Hematocrit (Hct) values 12 hours after the operation were found to be higher in Group 3 compared with those of the first and the second groups (by 13.2% and 11.1%, respectively). Blood loss during the first 12 hours after the operation and during the time spent in the intensive care unit did not differ between the groups. The number of transfusions was significantly lower in Group 3 (28.57%) in comparison with that of Groups 1 and 2 (37.83% and 38.10%, respectively). The rate of infective complications in Group 3 was lower in comparison with both Group 1 and Group 2 (9.2% and 18.1%, respectively). The duration of in-hospital stay in Group 3 was 25.8% shorter than Group 1. We conclude that autotransfusion of centrifuged red blood cells processed from the residual blood of the CPB circuit after CPB was effective in increasing Hct values 12 hours postoperatively, reducing the need for donor blood product transfusions, the rate of infective complications and lenght of stay in hospital.
Perfusion 04/2005; 20(2):71-5. · 0.92 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the effect of autologous centrifuged residual cardiopulmonary bypass blood on patients' hematocryte value, donor blood product requirements, postoperative blood loss, hospitalization time and the development of infective complications.
Patients undergoing coronary artery bypass grafting or/and mitral valve procedures were divided into 3 groups. In group I (37 pts.) patients received all blood salvaged from the extracorporeal circuit at the end of cardiopulmonary bypass. In group II (45 pts.) patients blood was not re-infused. In group III (42 pts.) the residual pump blood was collected from the bypass circuit and spun at 2.600 rpm for 10-15 min. The clear upper supernatant was discarded and the remaining concentrated red cells were re-infused back to the patient.
In all three groups hematocryte value during the first hour and postoperative blood loss during the first 12 hours after operation was similar. A higher hematocryte value was found in patients of group III after 12 hours postoperatively as compared with group I and group II (13.2% and 11.1% respectively, p<0.05). Furthermore, 28.57% patients in the group III required a blood transfusion compared with 37.83% patients in the group I and 38.10% patients in the group II (p<0.05). Patients in the group III developed less infective complications as compared with the group II the group I (10.3% and 4.3% respectively). Hospitalization time in group III was decreased in 25.8% as compared with the group I.
We found that autologous centrifuged residual cardiopulmonary bypass blood was useful in avoiding infective complications, decreasing need of donor blood product requirement and postoperative length of stay in the hospital. This method increases hematocryte value after 12 hours postoperatively.
Medicina (Kaunas, Lithuania) 02/2002; 38 Suppl 2:213-6. · 0.42 Impact Factor
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ABSTRACT: The aim of study was to evaluate features for spinal morphine in undergoing coronary artery bypass surgery in early postoperative time and side effects of opioids.
Two groups of patients undergoing coronary artery bypass surgery were analyzed. In first group (15 patients) spinal morphine 2 mg and general anesthesia was used, control group (22 patients) - just general anesthesia. Postoperative pain was analyzed with VAS (Visual Analogical Scale). For analgesia, after surgery, was used piritramide via i/v in both groups. Dose of piritramide, extubation time and side effects was analysed after surgery.
In first group dose of piritramide was 4.5+/-1.1 mg, in control group - 16.5+/-1.1 mg (p<0.05). Extubation time in both groups (354+/-36 min. and 279+/-17 min.) and side effects (nausea and vomiting) was similar.
Spinal morphine decreased pain after cardiosurgery and don't increased extubation time and side effects of opioids.
Medicina (Kaunas, Lithuania) 02/2002; 38 Suppl 2:221-3. · 0.42 Impact Factor
