RESUMO
Introduction: Mixed venous oxygen saturation [SvO2], is an invasive monitoring technique that reflects the balance between systemic oxygen transport and tissue oxygen consumption. Whereas tissue oxygen saturation [StO2] is a noninvasive technique that allows early detection of tissue hypoperfusion. The purpose of this study is to evaluate StO2 in patients undergoing elective coronary surgery: single cardiopulmonary bypass [CPB], and to find a correlation between StO2 and SvO2
Material and Methods: All patients scheduled for elective coronary surgery from May to July 2013, were included in the study. The anesthetic management and hemodynamic monitoring were the same. The following parameters: BP, HR, CI, SaO2, SvO2, StO2 at the eminence thenar, Hb and deltaPCO2 were monitored at the following times: T1: before anesthesia induction, T2: after induction, T3: 30 min after the beginning of CPB, T4: after the weaning from CBP, T5: H 12, at D1, D2 and at the occurrence of an adverse outcome such as anemia, hypotension, arrhythmia, hypoxia, fever with or without chills
Results: Forty-five patients were included in this prospective study. Forty patients had 63 events: low cardiac output, isolated hypotension, hypoxia, anemia, AFib and atrial flutter. There was no statistically significant difference in StO2 from pre-induction till up to 2 days postoperatively, except after the weaning from CPB and 12 hours postoperatively. No correlation was noted between SvO2 and StO2 during the events that occurred both during and after the operation
Conclusion: Microcirculation at the eminence thenar may be altered after CPB. This fact is reflected by the decrease in StO2 that was noted immediately after CPB and that returned to normal 12 hours postoperatively. However, StO2 is not correlated with SvO2 upon the occurrence of an event during or after elective cardiac surgery. Further studies are needed to show the benefit of this noninvasive monitoring in cardiac surgery
RESUMO
The aim of this study is to compare the efficacy of HES 130/0.4, a new hydroxyethyl starch, to lactated Ringer's solution [LR] in the prevention of hypotension after spinal anesthesia for cesarean section [CS]. One hundred and twenty nonlaboring ASA I and II women having non urgent CS were enrolled in this prospective and randomized study. Subjects were randomly assigned to receive prior to anesthesia either 1 liter of LR [Gr I: n = 59] or 500 ml of HES 130/0.4 [Gr II: n = 61] Blood pressure was measured until discharge from the post anesthesia care unit. Hypotension was treated with IV boluses of 3 mg of ephedrine. The nausea scale was recorded. Arterial and venous umbilical blood gazes were obtained. Data were compared using Mann-Whitney U-test and Student's t-test [p < 0.05 was significant]. Thirty-nine patients in Gr II while 48 pts in Gr I experienced hypotension [p = .033]. The total dose of ephedrine was statistically smaller in Gr II compared with Gr I [p = .001]. Nausea after induction of spinal anesthesia occurred with similar frequency in both groups. Neonatal outcome was excellent and similar in both groups. HES 130/0.4 is more effective than LR to prevent hypotension following spinal anesthesia for CS; its routine use in this purpose should be considered