RESUMEN
BACKGROUND: Some studies have been performed to assess the effects of levosimendan on cardiac function when administered to cardiac surgery patients with low cardiac output syndrome (LCOS) in the immediate postoperative period. Levosimendan is an inotropic agent for the treatment of low cardiac output syndrome that seems to have a protective effect on renal function. METHODS: It is a quasi-experimental study. A total of 100 patients with LCOS received either beta-agonists or levosimendan. We assessed the incidence of postoperative kidney failure in cardiac surgery patients. In patients who had kidney failure at diagnosis of LCOS, we examined whether differences existed in the evolution of kidney failure based on the treatment administered for LCOS. The parameters measured included haemodynamics, oxygen supply, and renal function as assessed by the AKI scale. ANOVA, Student's t-test and Wilcoxon or Friedman tests were used. RESULTS: Up to 30% of cardiac surgery patients had kidney failure at diagnosis of LCOS. Kidney failure at discharge from the ICU was more frequent in patients who received beta-agonist drugs as compared to those who received levosimendan (p < 0.05). CONCLUSION: The incidence of kidney failure decreased with the postoperative administration of levosimendan to cardiac surgery patients with LCOS, as compared to beta-agonists. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 46058317. Date of registration: 7/10/2019. Retrospectively registered.
Asunto(s)
Agonistas Adrenérgicos beta/administración & dosificación , Gasto Cardíaco Bajo/tratamiento farmacológico , Procedimientos Quirúrgicos Cardíacos/métodos , Cardiotónicos/administración & dosificación , Simendán/administración & dosificación , Anciano , Anciano de 80 o más Años , Gasto Cardíaco Bajo/fisiopatología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Insuficiencia Renal/epidemiología , Insuficiencia Renal/prevención & controlRESUMEN
Inodilators are a heterogeneous group of drugs with vasodilatory and inotropic effects. The cardioprotective effect of levosimendan is multifactorial, but now research on levosimendan is focused on the organ-protective properties of this drug in different settings, the regimen that seems to provide the greatest cardiologic and systemic benefits is early administration of levosimendan. We try to answer four questions in this review, which type of patients need this drug? what is the best time to start with it? and the best way that we could give it and finally the reasons for use it.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiotónicos/administración & dosificación , Atención Perioperativa/métodos , Complicaciones Posoperatorias/prevención & control , Simendán/administración & dosificación , Vasodilatadores/administración & dosificación , Animales , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Cardiotónicos/efectos adversos , Toma de Decisiones Clínicas , Esquema de Medicación , Humanos , Selección de Paciente , Atención Perioperativa/efectos adversos , Atención Perioperativa/mortalidad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Factores de Riesgo , Simendán/efectos adversos , Resultado del Tratamiento , Vasodilatadores/efectos adversosRESUMEN
The implementation of cardioprotective strategies involving pre-, intra-, and postoperative interventions is key during cardiac surgery requiring extracorporeal circulation (ECC). The primary goal of this study was to review the physiopathology and protection strategies against myocardial damage secondary to ECC during cardiac surgery. The administration halogenated anesthetics for cardiac anesthesia is common place due to their well-known cardioprotective effects and their capacity to ensure hypnosis. An optimal myocardial protection strategy requires that a comprehensive approach should be adopted to cover pre-, intra-, and post-operative interventions. Pre-conditioning and post-conditioning share numerous pathways, mainly based on mitochondrial signaling, antiapoptotic pathways, and reduced inflammatory mediators. However, volatile anesthetic can also be administered during ECC, in which mechanism of action has been scantly investigated, during this period and its biology is still unknown.
Asunto(s)
Anestesia por Inhalación , Anestésicos por Inhalación/administración & dosificación , Procedimientos Quirúrgicos Cardíacos , Oxigenación por Membrana Extracorpórea , Hidrocarburos Halogenados/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Anestesia por Inhalación/efectos adversos , Anestesia por Inhalación/mortalidad , Anestésicos por Inhalación/efectos adversos , Animales , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Oxigenación por Membrana Extracorpórea/efectos adversos , Oxigenación por Membrana Extracorpórea/mortalidad , Humanos , Hidrocarburos Halogenados/efectos adversos , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Factores de Riesgo , Resultado del TratamientoRESUMEN
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
PURPOSE: The benefits of intraoperative administration of halogenated agents in patients undergoing cardiac surgery have been shown by numerous studies. The mechanisms of preconditioning and postconditioning appear to be the cause of these benefits. The possibility of maintaining the early postoperative sedation with halogenated agents, after its intraoperative administration, can increase their benefits. PATIENTS AND METHODS: This is a prospective trial with 60 patients undergoing coronary artery bypass graft surgery divided into 3 groups according to the administration of hypnotic drugs in the intraoperative and postoperative periods (sevoflurane, sevoflurane: SS, sevoflurane-propofol: SP, propofol-propofol: PP). For the first 48 hours, hemodynamic parameters, the need for inotropic drugs, N-terminal pro-brain natriuretic peptide, and troponin I plasmatic concentrations were obtained. RESULTS: There were significant differences between group SS and the other 2 groups in the levels of N-terminal pro-brain natriuretic peptide (SS [501±280 pg/mL] compared with SP [1270±498 pg/mL] and PP [1775±527 pg/mL] [P<.05]) and troponin I (SS [0.5±0.4 ng/mL] compared with SP [1.61±1.30 ng/mL] and PP [2.27±1.5 ng/mL] [P<.05]) and a lower number of inotropic drugs. CONCLUSION: Sevoflurane administration in patients undergoing off-pump coronary artery bypass graft, in the operating room and the intensive care unit, decreases myocardial injury markers compared with patients who only received sevoflurane in the intraoperative period, but both were a better option to decrease levels of myocardial markers when compared with the propofol group.