RESUMO
We report the case of a patient with a cerebral aneurysm, located in the left middle cerebral artery. During the clipping of this aneurysm, the bispectral index (BIS) increased for no apparent reason. This was then interpreted as intraoperative non-convulsive status epilepticus. This clinical condition may have negative impact in the prognosis of the patient, so it is very important to be able to detect this conditions as early as possible. Measuring the BIS while the patient is anaesthetised could be useful in this situation, considering that an increase in values greater than 60, associated with acidosis and without any other peri-anaesthetic explanation, may provide evidence of a convulsive equivalent state, allowing appropriate action to be taken.
Assuntos
Aneurisma Intracraniano/cirurgia , Complicações Intraoperatórias/diagnóstico , Monitorização Neurofisiológica Intraoperatória , Convulsões/diagnóstico , Monitores de Consciência , Feminino , Humanos , Monitorização Neurofisiológica Intraoperatória/instrumentação , Pessoa de Meia-Idade , Medição de RiscoRESUMO
OBJECTIVE: Modified ultrafiltration (MUF) reduces some of the complications associated with cardiopulmonary bypass (CPB) in pediatric cardiac surgery. However, we have observed hypokalemia and hypomagnesemia in children when MUF is used. Such alterations may elicit severe arrhythmias in the postoperative period. To date, no studies have focused on the effects MUF may have in plasma levels of potassium (K) and magnesium (Mg). The objective of our study was to determine if there is any variation in plasma levels of K (plK) and Mg (plMg) after MUF in children undergoing cardiac surgery with CPB. PATIENTS: Sixteen children scheduled for cardiac surgery with CBP and MUF were prospectively studied. Anesthetic, CPB and MUF management were standardized for all patients, the latter lasting for 10 minutes. RESULTS: Plasma K average levels before and after MUF were 4.16 mmol/L and 3.58 mmol/L, respectively. The average plasma Mg levels before and after MUF were 4.82 mmol/L and 4.81 mmol/L, respectively. CONCLUSIONS: The plasma level of K is reduced by 13.7% after MUF (p<0.0001). The reduction in Mg at the same period of time was not statistically significant (p<0.970).
Assuntos
Ponte Cardiopulmonar , Procedimentos Cirúrgicos Cardiovasculares , Magnésio/sangue , Potássio/sangue , Ultrafiltração/métodos , Arritmias Cardíacas/epidemiologia , Humanos , Hipopotassemia/complicações , Hipopotassemia/diagnóstico , Hipopotassemia/etiologia , Lactente , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Ultrafiltração/efeitos adversosRESUMO
BACKGROUND: Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention. AIM: To asses surgical complications and mortality in octogenarians treated for AAA. SUBJECTS AND METHODS: Patients aged 80 years older, treated consecutively between 1984-2001 were retrospectively analyzed. RESULTS: Sixty one patients were male, and their age ranged from 80 to 95 years. All were treated with open surgery. The operation was elective in 58 and as an emergency in 22 patients (symptomatic or ruptured AAA). Aortic diameter was 6.8 +/- 1.4 cm in asymptomatic patients and 7.7 +/- 1.8 cm in emergency cases (p = 0.024). Thirty days postoperative mortality was 5.1% in elective surgery compared to 40.6% in emergency operations (p < 0.01). Five years survival rate was 44.7% in asymptomatic patients compared to 10.4% in the emergency cases (p < 0.023). CONCLUSIONS: Elective surgery for asymptomatic AAA can be performed with low operative mortality in octogenarians. However, surgery in emergency cases has an 8 fold increase in risk. Accordingly, octogenarian patients should be considered for elective AAA repair in a selective basis.
Assuntos
Humanos , Masculino , Feminino , Idoso , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Dissecção Aórtica/mortalidade , Aneurisma da Aorta Abdominal/mortalidade , Análise de Sobrevida , Estudos Retrospectivos , Procedimentos Cirúrgicos Eletivos , Tratamento de EmergênciaRESUMO
BACKGROUND: Heart transplantation currently provides the most effective treatment for advanced heart failure. However, medical therapy for this condition has also improved, heart donors are scarce and the cost of the procedure is high. Therefore the indications and management of these patients need reevaluation. AIM: To analyze the results of 24 patients submitted to heart transplantation for end-stage heart failure needing repeated hospitalizations and i.v. inotropes for compensation. PATIENTS AND METHODS: The group was comprised by 21 men and 3 women with a mean age of 36.8 years, mean left ventricular ejection fraction 19 +/- 4.5%, mean systolic pulmonary artery pressure 48 +/- 13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood Units (1-5). Fourteen patients (58%) had a previous median sternotomy. Immunosuppression did not include induction therapy and steroids were discontinued early. RESULTS: Operative mortality was 4% at 30 days. Actuarial survival at one year was 90% and at 5 years 72%. Freedom from rejection at one year was 76% and at 5 years 50%. Freedom from infection was 70% at one year and 56.5% at five years. All patients with more than 3 months of follow-up were in functional class I. CONCLUSIONS: These results justify the proposed modifications for transplantation protocols.
Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Análise Atuarial , Adolescente , Adulto , Protocolos Clínicos , Intervalo Livre de Doença , Feminino , Seguimentos , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/imunologia , Humanos , Terapia de Imunossupressão/métodos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Endarterectomy is the treatment of choice for internal carotid artery critical stenosis. Some authors have proposed that the use of regional anesthesia has advantages over general anesthesia. AIM: To report our initial experience with carotid endarterectomy under regional anesthesia. PATIENTS AND METHODS: Between 1998 and 1999, patients with critical carotid artery stenosis, asymptomatic or with transient and recovered symptoms, were selected. A C2, C3, C4 root deep cervical block and superficial block was performed, using a mixture of lidocaine and bupivacaine. A carotid endarterectomy with patch and without routine shunt insertion, with standard and neurological monitoring, was performed. RESULTS: During the study period, 94 carotid endarterectomies were done, 22 under regional anesthesia in 21 patients (12 male, age range 58-90 years old). Ninety five percent had hypertension, 52% smoked and 38% had renal dysfunction. One patient was converted to general anesthesia. Seventeen patients were discharged within 48 hours of the procedure and the rest, within 72 hours. There was no mortality or complications. CONCLUSIONS: Endarterectomy under regional anesthesia is less invasive, has excellent results and is well accepted by patients.
Assuntos
Anestesia por Condução/métodos , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: There is a growing interest to perform a left internal mammary artery (LIMA) graft to the left anterior descending coronary artery (LAD) on a beating heart through a minimally invasive access to the chest cavity. AIM: To report the experience with minimally invasive coronary artery surgery. PATIENTS AND METHODS: Analysis of 11 patients aged 48 to 79 years old with single vessel disease that, between 1996 and 1997, had a LIMA graft to the LAD performed through a minimally invasive left anterior mediastinotomy, without cardiopulmonary bypass. A 6 to 10 cm left parasternal incision was done. The LIMA to the LAD anastomosis was done after pharmacological heart rate and blood pressure control and a period of ischemic pre conditioning. Graft patency was confirmed intraoperatively by standard Doppler techniques. Patients were followed for a mean of 11.6 months (7-15 months). RESULTS: All patients were extubated in the operating room and transferred out of the intensive care unit on the next morning. Seven patients were discharged on the third postoperative day. Duplex scanning confirmed graft patency in all patients before discharge; in two patients, it was confirmed additionally by arteriography. There was no hospital mortality, no perioperative myocardial infarction and no bleeding problems. After follow up, ten patients were free of angina, in functional class I and pleased with the surgical and cosmetic results. One patient developed atypical angina on the seventh postoperative month and a selective arteriography confirmed stenosis of the anastomosis. A successful angioplasty of the original LAD lesion was carried out. CONCLUSIONS: A minimally invasive left anterior mediastinotomy is a good surgical access to perform a successful LIMA to LAD graft without cardiopulmonary bypass, allowing a shorter hospital stay and earlier postoperative recovery. However, a larger experience and a longer follow up is required to define its role in the treatment of coronary artery disease.
Assuntos
Doença das Coronárias/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Anastomose de Artéria Torácica Interna-Coronária , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoAssuntos
Procedimentos Cirúrgicos Cardíacos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/fisiopatologia , Insuficiência Renal/prevenção & controle , Insuficiência Renal/fisiopatologia , Humanos , Rim/efeitos dos fármacos , Rim/fisiologia , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/etiologiaRESUMO
This review focuses on weaning from cardiopulmonary bypass, a very critical time for patients and anaesthetists and frequently requiring major therapeutic effort. Few novel strategies for weaning have been described recently. Most drugs or approaches described during the review period are already well established. Emphasis is placed on the importance of non-cardiac factors, and on the importance of diastolic ventricular function as opposed to systolic function.
RESUMO
OBJECTIVE: Intensive care and operating room monitors generate data that are not fully utilized. False alarms are so frequent that attending personnel tends to disconnect them. We developed an expert system that could select and validate alarms by integration of seven vital signs monitored on-line from cardiac surgical patients. METHODS: The system uses fuzzy logic and is able to work under incomplete or noisy information conditions. Patient status is inferred every 2 seconds from the analysis and integration of the variables and a unified alarm message is displayed on the screen. The proposed structure was implemented on a personal computer for simultaneous automatic surveillance of up to 9 patients. The system was compared with standard monitors (SpaceLabs PC2), using their default alarm settings. Twenty patients undergoing cardiac surgery were studied, while we ran our system and the standard monitor simultaneously. The number of alarms triggered by each system and their accuracy and relevance were compared. Two expert observers (one physician, one engineer) ascertained each alarm reported by each system as true or false. RESULTS: Seventy-five percent of the alarms reported by the standard monitors were false, while less than 1% of those reported by the expert system were false. Sensitivity of the standard monitors was 79% and sensitivity of the expert system was 92%. Positive predictive value was 31% for the standard monitors and 97% for the expert system. CONCLUSIONS: Integration of information from several sources improved the reliability of alarms and markedly decreased the frequency of false alarms. Fuzzy logic may become a powerful tool for integration of physiological data.
Assuntos
Sistemas Inteligentes , Complicações Intraoperatórias/diagnóstico , Monitorização Intraoperatória , Integração de Sistemas , Gasometria , Procedimentos Cirúrgicos Cardíacos , Eletrocardiografia , Reações Falso-Positivas , Lógica Fuzzy , Hemodinâmica , Humanos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Processamento de Sinais Assistido por ComputadorRESUMO
There is no conclusive evidence that any pharmacological intervention is able to offer effective protection for the kidneys during cardiac surgery. More research is needed into the underlying mechanisms of postoperative renal failure, specifically with regard to the possible role played by endothelial factors and inflammatory response.
RESUMO
We determined the arterial pressure-flow relationship experimentally by means of step changes of blood flow in 30 adult patients undergoing cardiopulmonary bypass (CPB). Anesthesia technique was uniform. CPB was nonpulsatile; hypothermia to 25-28 degrees C, and hemodilution to 18%-25% hematocrit were used. During stable bypass, mean arterial pressure was recorded first with blood flow 2.2 L.min-1.m-2. Flow was then increased to 2.9 L.min-1.m-2 for 10 s and reverted to baseline for 1 min. Then it was decreased to 1.45 L.min-1.m-2 for 10 s, and reverted to baseline for 1 min. Subsequently, it was decreased to 0.73 L.min-1.m-2 for 10 s and then reverted to baseline. Similar sets of measurements were repeated after 0.25 mg of phenylephrine and once the patient was rewarmed. The pressure-flow function was individually determined by regression, and the critical pressure estimated by extrapolation to zero flow. All patients had zero-flow critical pressure during hypothermia, with a mean value of 21.8 +/- 6.4 mm Hg (range 8.8-38.9). It increased after 0.25 mg phenylephrine to 25.4 +/- 7.2 mm Hg (range 12.2-43.9, P < 0.001). During normothermia, critical pressure was 21.2 +/- 5 mm Hg (range 13.4-30.9), not significantly different from hypothermia. During hypothermia, the slope of the pressure-flow function (i.e., resistance) was 14.9 +/- 3.5 mm Hg.L-1.min-1.m-2 (range 7.6-22.1). It increased significantly (P < 0.001) after phenylephrine, to 19.7 +/- 6.2 mm Hg.L-1.min-1.m-2 (range 11.4-40.5), and returned to 15.4 +/- 3.4 mm Hg.L-1.min-1.m-2 (range 10.1-24.2) during normothermic bypass. Systemic vascular resistance appeared to vary reciprocally with blood flow, although this finding may represent a mathematical artifact, which can be avoided by using zero-flow critical pressure in the vascular resistance equation.
Assuntos
Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Ponte Cardiopulmonar , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos , Feminino , Humanos , Hipotermia Induzida , Masculino , Pessoa de Meia-Idade , Resistência VascularRESUMO
BACKGROUND: Coronary bypass grafts made with internal mammary artery have better long-term results than those made with saphenous vein. It is possible that the use of both mammary arteries would lead to even better results. AIM: To compare the long-term survival and the incidence of new coronary events of patients, in whom one or two mammary arteries were used as coronary bypass grafts. PATIENTS AND METHODS: One hundred and eight randomly selected patients who received one mammary artery for myocardial revascularization and 108 patients, matched for prognostic factors, who received two mammary arteries were studied. These patients were followed for a mean of 4 years (range 1 to 12 years). Operative complications, hospital mortality and long-term probability of being free of disease were compared in both groups. RESULTS: Operative mortality was similar in both groups (0.9%). Patients that received two mammary arteries had a higher frequency of operative wound complications. Long-term survival was 84% in patients who received one and 83% in patients who received two mammary arteries. The probabilities of being free of myocardial infarction (92 and 82% respectively) and angina (94 and 86% respectively) were lower in the later group. CONCLUSIONS: Patients who received two mammary arteries had a higher probability of a long term disease free survival than patients who received one mammary artery.
Assuntos
Artéria Torácica Interna/cirurgia , Revascularização Miocárdica/métodos , Intervalo Livre de Doença , Feminino , Seguimentos , Cardiopatias/epidemiologia , Cardiopatias/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Abdominal aortic aneurysms (AAA) usually undergo progressive dilatation and eventually may rupture, complication that carries a high mortality rate. If certain clinical conditions, like operative risk and aortic diameter are met, all patients should be considered for surgical repair. Analysis of our results with the surgical treatment of asymptomatic AAA prompted this study. Out of 479 consecutive patients operated because of AAA between 1976 and 1995, 378 (79%) were electively treated. Two decades: 1976-85 (101 patients) and 1986-95 (277 patients) were compared as far as associated medical conditions, surgical procedures, complications and mortality rate. There was no difference in age, sex, risk factors and aortic diameter. During the second decade we favoured the use of aortic tube grafts (53% vs 25%, p < 0.01) and epidural anesthesia (94% vs 35%, p < 0.01). During the last decade only 53.3% of the patients received blood transfusion, compared to 95.3% during the first period (p < 0.001). Operative mortality decreased from 5.94% to 0.72% (p < 0.05). Postoperative hospital stay diminished from 11.2 +/- 8.2 to 9.6 +/- 6.3 days (p < 0.05). These results compare favourably with those reported from other academic centers and support our therapeutic approach. Our contemporary surgical results serve as a reference for future clinical evaluation of endovascular procedures currently under investigation.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Cirúrgicos Eletivos/mortalidade , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/epidemiologia , Feminino , Humanos , Masculino , Fatores de TempoRESUMO
The aim of the study was to compare three anaesthetic agents in patients with ejection fraction below 0.40 subjected to coronary revascularization surgery. Twenty five elective coronary surgical patients with ejection fraction below 0.40 were prospectively studied. Premedication was pethidine 1 mg/kg and induction was fentanyl 0.03 mg/kg and pancuronium 0.1 mg/kg. The patients were randomized to one of three maintenance techniques (fentanyl, isoflurane or halothane). Radial arterial pressure, heart rate, right atrial pressure, pulmonary arterial and occluded pressures, and thermodilution cardiac output were measured, and cardiac index and resistance calculated, at the following times: before induction; 5 min after intubation; 2 min after sternotomy; immediately after discontinuation of bypass; 15 min afterwards; immediately after sternal closure; during suture of the skin; 5 min after arrival in the postoperative care unit; and 60 min postoperatively. Mean arterial pressure decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction. Cardiac index decreased significantly in the isoflurane group and nonsignificantly in the halothane group after induction and after sternotomy. Neither pressure nor flow decreased in patients receiving fentanyl. Following weaning from cardiopulmonary bypass, systemic vascular resistance decreased significantly in all groups. Cardiac index, however, did not increase above control values and arterial pressure consequently decreased; there was no significant difference between groups.
Assuntos
Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Ponte de Artéria Coronária , Fentanila/administração & dosagem , Halotano/administração & dosagem , Isoflurano/administração & dosagem , Volume Sistólico/efeitos dos fármacos , Adjuvantes Anestésicos/administração & dosagem , Idoso , Função do Átrio Direito/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Ponte Cardiopulmonar , Procedimentos Cirúrgicos Eletivos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Intubação Intratraqueal , Masculino , Meperidina/administração & dosagem , Pessoa de Meia-Idade , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Pancurônio/administração & dosagem , Medicação Pré-Anestésica , Estudos Prospectivos , Pressão Propulsora Pulmonar/efeitos dos fármacos , Esterno/cirurgia , Resistência Vascular/efeitos dos fármacosRESUMO
Pulmonary thromboendarterectomy under circulatory arrest and deep hypothermia is presently a curative treatment for pulmonary hypertension secondary to chronic pulmonary artery thromboembolic occlusion, but is still not frequently performed around the world. We report here the first successful pulmonary thromboendarterectomy under circulatory arrest performed in Chile. The patient was a 37 year old white man, high school teacher, with a 5 months history of effort dyspnea and cough. Pulmonary hypertension secondary to chronic pulmonary thromboembolism was confirmed by angiography and echocardiography. The patient was operated on April 27, 1995. After the operation the patient had an immediate and maintained normalization of his pulmonary hemodynamics. He presented periods of delirium that postponed mechanical ventilation disconnection until the 7th postoperative day, after which he had an uneventful neurological recovery. Before hospital discharge a control angiography showed complete patency of the pulmonary artery system with no evidence of residual thrombi. Presently he is enjoying a normal life and back to his teaching activities.
Assuntos
Endarterectomia/métodos , Parada Cardíaca Induzida , Hipotermia Induzida , Embolia Pulmonar/cirurgia , Adulto , Circulação Assistida , Doença Crônica , Humanos , Hipertensão Pulmonar/cirurgia , Masculino , Período Pós-Operatório , Embolia Pulmonar/diagnósticoRESUMO
Revascularization significantly improves early and late prognosis in acute myocardial infarction and has prompted substantial changes in therapeutic stategies. We report 140 patients aged 60.3 years old (123 male) operated within 15 days of sustaining an acute myocardial infarction, between January 1984 and December 1989. Coronary angiogram showed single vessel disease in 8 (6%), double vessel disease in 32 (23%), triple vessel disease in 85 (61%) and left main vessel disease in 13 (9%). Indications for surgery were postinfarction angina in 92 patients (66%), multiple severe coronary stenoses in 18 (13%), infarction of less than six hours from onset in 16 (11%), acute angioplasty failure in 7 (5%) and cardiogenic shock in 7 (5%). Thirty one patients were operated during the initial 24 h of infarction (16 with less than 6 h), 14 between the second and third day and 95 between the fourth and fifteenth day. Overall mortality was 4.3% (6/140). Among patients with failed angioplasty and cardiogenic shock, mortality was 23% (7/140), among patients with postinfarction angina this figure was 2.1% (2/92). No patient operated within 6 hours of infarction onset or due to severe coronary stenosis, died. Ninety seven percent of patients were followed during mean of 49 months. Three patients had a new acute myocardial infarction, two had sudden death and two died of unrelated causes. One required angioplasty and none was reoperated. Five years actuarial survival was 95% and the actuarial probability of being free of acute myocardial infarction, angioplasty or reoperation at five years was 99 and 100% respectively. It is concluded that early surgical revascularization in cute myocardial infarction is safe and has excellent long term results.
Assuntos
Infarto do Miocárdio/cirurgia , Revascularização Miocárdica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
Crosses were made between Fanny (highly susceptible to blast) and 11 cultivars differing in blast resistance. Using the pedigree method (PM) segregating generations were evaluated and selected for blast resistance. Via anther culture (AC), doubled-haploids were obtained from F1 plants and from F2 blast-susceptible plants. Pedigree and anther culture-derived lines were planted together and evaluated for blast resistance under rainfed conditions at the Santa Rosa Experiment Station, Villavicencio, Colombia. The principal objective was to compare PM and AC in terms of their efficiency in producing rice lines resistant to blast. Results of a stratified analysis showed an association between method and blast resistance. Results of the logit-model analysis showed that AC produced a significantly (P=0.0001) higher proportion of lines with initial blast resistance (leaf- and neck-blast reaction ≤4) than did PM across all cross types. Stable blast resistance was assessed based on field performance over 3 years. AC was superior to PM in generating stable resistance for only some cross types. Consequently, with a few exceptions, AC can be used as effectively as PM to develop rice cultivars resistant to blast, with savings in time and labor. Additionally, blast-resistant lines were obtained either by the pedigree method or by anther culture from crosses between blast-susceptible cultivars (Fanny/CICA4 and Fanny/Colombial). This excludes somaclonal variation as a possible mechanism responsible for this resistance and suggests that a recombination of minor genes could have occurred and was fixed through either method. However, the stability of the resistance was greater in pedigree-derived lines. The implications of these findings for rice blast-resistance breeding are discussed.
RESUMO
Between May 1993 and August 1994, 15 patients (10 men) with type A aortic dissection (9 acute) had a replacement of the ascending aorta and/or aortic arch with circulatory arrest with profound hypothermia and retrograde cerebral perfusion. Mean circulatory arrest time was 47.5 min (range 23 to 68 min). Three patients (20%) died in relation to postoperative bleeding. No patient had a new neurologic damage related to surgery. Ten patients were awake and oriented before 24 hours of the operation and another one before 48 hours; 4 patients required more than 48 hours to be completely awake and oriented. Two patients were operated on with a recent stroke. One of them recovered without sequelae before hospital discharge and the other one had a major regression of his brain damage. Two other patients had emergency surgery because of cardiac tamponade and cardiogenic shock. Both of them had a satisfactory recovery. Six patients presented azotemia but only 2 of them needed dialysis. There was no case of Q wave infarction nor congestive heart failure in the perioperative period. Follow-up was 100% completed (12 patients) with a mean of 9.8 months (range 5 to 18 months). One patient died on the 10th postoperative month because of a late infectious process. Eight patients are in functional class I and 3 in II. Ten of them are back to their usual activities'. Although retrograde cerebral perfusion is a new surgical technique, it seems to be a very valuable complement for brain protection in ascending aorta and/or aortic arch surgery with circulatory arrest with profound hypothermia.
Assuntos
Aorta/cirurgia , Circulação Cerebrovascular , Parada Cardíaca Induzida , Perfusão/métodos , Idoso , Aorta Torácica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de TempoRESUMO
The objective of this work was to compare urinary dopamine, noradrenaline, adrenaline, sodium and potassium excretion in a group of normotensive Piaroa Amazonic ethnia who do not use salt in their regular food intake, against a group of urban normotensive citizens known to have a high salt intake in their regular meals. Twenty adult normotensive Piaroa subjects living in the Amazonas forest, 11 men and 9 women, 23-72 years old, and 33 normotensive urban citizens, 25-70 years old, 17 men and 17 women, were included in the study. After a 10 min. rest, an average of three supine systolic (SBP) and diastolic (DBP) blood pressure recordings was obtained. Piaroas subjects SBP and DBP were 111.3 +/- 2.9 mmHg and 62.7 +/- 1.9 mmHg respectively; urban subjects SBP and DBP were 111.8 +/- 2.2 mmHg and 70.3 +/- 1.6 mmHg respectively. Supine heart rate was lower in Piaroas (58.0 +/- 1.8 beats/min) than in urban subjects (76.5 +/- 1.9 beats/min), p < 0.05. Sodium urinary excretion was much lower in Piaroas (12.6 +/- 5.2 mmol/24 h) when compared to urban subjects (210.7 +/- 24.5 mmol/24 h), p < 0.01. No difference was found in daily urinary potassium excretion between Piaroas and urban subjects (50.4 +/- 7.2 mmol/24 h vs 45.1 +/- 7.4 mmol/24 h). Urinary dopamine excretion was lower in Piaroas (314.7 +/- 40.1 micrograms/24 h) in comparison to urban subjects (800.4 +/- 59.2 micrograms/24 h), p < 0.05. Daily urinary noradrenaline and adrenaline excretion were 67.9% and 85.4% respectively lower in Piaroas than in urban subjects. In conclusion, lower amounts of sodium daily intake are associated to lower kidney dopamine production in Piaroas as compared to urban subjects. Apparently indigenous tribes might require less kidney dopamine synthesis to excrete the very small amounts of salt they consume in their regular food intake. The opposite was found in urban subjects; more kidney dopamine synthesis would be required for larger amounts of urinary sodium excretion. In this population, essential hypertension has been associated to a failure of the natriuretic mechanism triggered by dopamine onkidney tubules.