Mechanisms of oxidative stress and myocardial protection during open‑heart surgery.

Cold heart protection via cardioplegia administration, limits the amount of oxygen demand. Systemic normothermia with warm cardioplegia was introduced due to the abundance of detrimental effects of hypothermia. A temperature of 32–33°C in combination with tepid blood cardioplegia of the same temperature appears to be protective enough for both; heart and brain. Reduction of nitric oxide (NO) concentration is in part responsible for myocardial injury after the cardioplegic cardiac arrest. Restoration of NO balance with exogenous NO supplementation has been shown useful to prevent inflammation and apoptosis. In this article, we discuss the “deleterious” effects of the oxidative stress of the extracorporeal circulation and the up‑to‑date theories of “ideal’’ myocardial protection.

Sudden cardiac arrest after declamping of aorta during a bypass surgery for dissecting infra-renal aortic aneurysm: A case report / 대한마취과학회지

Significant hemodynamic change is rarely shown in the case of bypass surgery for infra-renal aortic aneurysm.However, a man underwent aortoiliac bypass surgery for dissecting infra-renal aortic aneurysm experienced sudden cardiac arrest and hypoxemia just after declamping of aorta and subsequent renal impairment.We supposed that transient myocardial dysfunction after declamping and release of inflammatory materials after reperfusion caused cardiac arrest and renal impairment.Therefore, careful anesthetic management is needed not only during the clamping of aorta but also at the time of declamping even in the infra-renal aortic bypass surgery.