Assuntos
Ponte Cardiopulmonar/efeitos adversos , Achados Incidentais , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/diagnóstico , Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Crioglobulinas/metabolismo , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-IdadeRESUMO
BACKGROUND: High-sensitivity C-reactive protein predicts cardiovascular events in a wide range of clinical contexts. However, the role of high-sensitivity C-reactive protein as a predictive marker for perioperative acute myocardial infarction during noncardiac surgery is not yet clear. The present study investigated high-sensitivity C-reactive protein levels as predictors of acute myocardial infarction risk in patients undergoing high-risk noncardiac surgery. METHODS: This concurrent cohort study included patients aged ≥ 50 years referred for high-risk noncardiac surgery according to American Heart Association/ACC 2002 criteria. Patients with infections were excluded. Electrocardiograms were performed, and biomarkers (Troponin I or T) and/or total creatine phosphokinase and the MB fraction (CPK-T/MB) were evaluated on the first and fourth days after surgery. Patients were followed until discharge. Baseline high-sensitivity C-reactive protein levels were compared between patients with and without acute myocardial infarction. RESULTS: A total of 101 patients undergoing noncardiac surgery, including 33 vascular procedures (17 aortic and 16 peripheral artery revascularizations), were studied. Sixty of the patients were men, and their mean age was 66 years. Baseline levels of high-sensitivity C-reactive protein were higher in the group with perioperative acute myocardial infarction than in the group with non-acute myocardial infarction patients (mean 48.02 vs. 4.50, p = 0.005). All five acute myocardial infarction cases occurred in vascular surgery patients with high CRP levels. CONCLUSIONS: Patients undergoing high-risk noncardiac surgery, especially vascular surgery, and presenting elevated baseline high-sensitivity C-reactive protein levels are at increased risk for perioperative acute myocardial infarction.
Assuntos
Proteína C-Reativa/análise , Infarto do Miocárdio/diagnóstico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Troponina I/sangue , Troponina T/sangue , Idoso , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/diagnóstico , Masculino , Monitorização Intraoperatória , Infarto do Miocárdio/sangue , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: High-sensitivity C-reactive protein predicts cardiovascular events in a wide range of clinical contexts. However, the role of high-sensitivity C-reactive protein as a predictive marker for perioperative acute myocardial infarction during noncardiac surgery is not yet clear. The present study investigated high-sensitivity C-reactive protein levels as predictors of acute myocardial infarction risk in patients undergoing high-risk noncardiac surgery. METHODS: This concurrent cohort study included patients aged >50 years referred for high-risk noncardiac surgery according to American Heart Association/ACC 2002 criteria. Patients with infections were excluded. Electrocardiograms were performed, and biomarkers (Troponin I or T) and/or total creatine phosphokinase and the MB fraction (CPK-T/MB) were evaluated on the first and fourth days after surgery. Patients were followed until discharge. Baseline high-sensitivity C-reactive protein levels were compared between patients with and without acute myocardial infarction. RESULTS: A total of 101 patients undergoing noncardiac surgery, including 33 vascular procedures (17 aortic and 16 peripheral artery revascularizations), were studied. Sixty of the patients were men, and their mean age was 66 years. Baseline levels of high-sensitivity C-reactive protein were higher in the group with perioperative acute myocardial infarction than in the group with non-acute myocardial infarction patients (mean 48.02 vs. 4.50, p = 0.005). All five acute myocardial infarction cases occurred in vascular surgery patients with high CRP levels. CONCLUSIONS: Patients undergoing high-risk noncardiac surgery, especially vascular surgery, and presenting elevated baseline high-sensitivity C-reactive protein levels are at increased risk for perioperative acute myocardial infarction.
Assuntos
Idoso , Feminino , Humanos , Masculino , Proteína C-Reativa/análise , Infarto do Miocárdio/diagnóstico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Troponina I/sangue , Troponina T/sangue , Biomarcadores/sangue , Estudos de Coortes , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/diagnóstico , Monitorização Intraoperatória , Infarto do Miocárdio/sangue , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
PURPOSE: The aim this study was to evaluate the clinical outcome of patients needing intra-operative blood transfusion by tissue perfusion markers. METHODS: A prospective single center cohort study. Adult patients needing blood transfusion during the intra-operative period were recruited. RESULTS: This study included 61 patients. At the time of blood transfusion the hemoglobin level was 8.4+/-1.8 g/dL. Scv02 has been the best tissue perfusion marker to determine mortality, compared with hematemetric values and other tissue perfusion markers, with a cut-off point at ROC curve equal to 80% (AUC=0.75; sensitivity=80%; specificity=65.2%). Patients who received blood transfusion and had Scv02
Assuntos
Transfusão de Sangue , Cuidados Intraoperatórios/métodos , Complicações Pós-Operatórias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diurese , Feminino , Hematócrito , Mortalidade Hospitalar , Humanos , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/terapia , Estimativa de Kaplan-Meier , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pressão Parcial , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Fatores de RiscoRESUMO
The hyperglycemia usually observed in patients undergoing heart surgery with extracorporeal circulation (EC) represents a difficult therapeutic problem. We studied the effects of several regimens of insulin therapy on serum glucose (SG) in 24 noninsulin dependent diabetic patients (NIDDs). The patients were randomly divided in five groups; group A received on IV bolus of 10.0-50.0 U/h according to glycosuria; groups B, C, D and E were given a continuous iv insulin infusion of 2.5, 5.0, 7.5 and 10.0 U/h respectively. In 10 non-diabetic patients (NDP) SG levels were also measured, but insulin was not given. A mean of 5.0 l/m2 of body surface of fluids containing 300 g of glucose were administered to all patients during surgery. At the operations SG levels rose progressively soon after the anesthesia was started, reached the highest values during the period of EC, and decreased slowly in blood samples taken after the EC phase and by 24h. This patterns was shown by all groups studied statistically significant lower SG levels, however, were observed in patients of group C, whose values were similar to those seen in the NDP group. Groups D and E had slightly higher SG levels than those of group C. An additional NIDDM patient with advanced chronic renal failure (CRF), had a tendency to hypoglycemia even during the EC period in response to relatively low doses of insulin (2.5 U/h), given by a continuous iv infusion and, although the insulin administration was stopped, his SG levels remained well below the mean values of the other patients for the rest of the operation.(ABSTRACT TRUNCATED AT 250 WORDS)