RESUMEN
PURPOSE: Pre and post-operative administration of sevoflurane in myocardial revascularization surgery provides enhanced cardioprotective effects exerted by pharmacologic pre- and post-conditioning, as compared to propofol. The identification of the enzymes involved in conditioning mechanisms is crucial to the understanding of the effects of sevoflurane in cardiac surgery patients. The impact of sevoflurane on another crucial target organ-the kidney-was also assessed. METHODS: Ninety patients undergoing off-pump myocardial revascularization surgery were allocated to receive either intra- and postoperative sevoflurane (SS), intraoperative sevoflurane and postoperative propofol (SP), or intra- and postoperative propofol (PP)). Troponin I and hemodynamic parameters were monitored during the first 48 postoperative hours; blood and urine samples were collected at baseline and at 24h to determine Akt, ERK1/2, PKG, iNO, bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. RESULTS: The enzymes were overexpressed in the SS group, remained unchanged in the SP group, and decreased in the PP group. Renal function was best preserved in the SS group. CONCLUSIONS: The overexpression of enzymes induced by intraoperative anesthesia and postoperative sedation with sevoflurane reduces myocardial damage and improves renal function in patients undergoing off-pump myocardial revascularization surgery.
Asunto(s)
Cardiotónicos/administración & dosificación , Enfermedad de la Arteria Coronaria/cirugía , Éteres Metílicos/administración & dosificación , Revascularización Miocárdica/métodos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Propofol/administración & dosificación , Anciano , Anestésicos Intravenosos/administración & dosificación , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sevoflurano , Resultado del TratamientoRESUMEN
The Acute Kidney Injury Network (AKIN) classification considers SCr values, urea and urine output in order to improve timely diagnose ARF and improve patient prognosis by early treatment. Preoperative levosimendan is a new way for cardiac and kidney protection, we try to evaluate this drug in fifteen patients comparing values of AKIN scale parameters pre and post cardiac surgery in patients with right ventricle dysfunction.
Asunto(s)
Hidrazonas/uso terapéutico , Riñón/efectos de los fármacos , Piridazinas/uso terapéutico , Disfunción Ventricular Derecha/fisiopatología , Lesión Renal Aguda , Anciano , Antiarrítmicos/uso terapéutico , Procedimientos Quirúrgicos Cardíacos , Femenino , Humanos , Pruebas de Función Renal , Masculino , Persona de Mediana Edad , Bloqueo Neuromuscular , Complicaciones Posoperatorias/prevención & control , Periodo Preoperatorio , SimendánRESUMEN
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