Anesthetic management of patients with active infective endocarditis undergoing cardiac valve surgery under cardiopulmonary bypass / 中华麻醉学杂志

ABSTRACT

Objective To summarize experience and characteristics of the perioperative anesthetic management of patients with active infective endocarditis (AIE) undergoing cardiac valve surgery under cardiopulmonary bypass (CPB).Methods A total of 117 patients of both sexes,aged 18-70 yr,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,undergoing cardiac valve surgery under CPB from January 2014 to June 2015 in Peking Union Medical College Hospital,were enrolled in the study and divided into AIE group (n =57) and non-AIE group (n =60).Anesthesia was induced by Ⅳ injection of midazolam 1-2 mg,etomidate 0.15-0.30 mg/kg,sufentanil 0.3-0.5 μg/kg and rocuronium 0.6-1.0 mg/kg.After orotracheal intubation,the patients underwent high-frequency volume-controlled ventilation with low tidal volume,and positive end-expiratory pressure was increased appropriately.Esophageal echocardiography was used for evaluation.Anesthesia was maintained by inhalation of 1.0％-1.5％ sevoflurane,intermittent Ⅳ boluses of sufentanil 0.2-0.3 μg/kg and Ⅳ infusion of piperium bromide 2 mg/h,and the bispectral index value was maintained between 40-60 during surgeDy.Sensitive antibiotics were given during surgery according to the results of preoperative blood culture in AIE group.The following data were collectedbaseline patient characteristics,preoperative blood routine,erythrocyte sedimentation rate,concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide,operation time,CPB time,intraoperative consumption of vasoactive drugs,fluid intake and output,use of antibiotics,length of postoperative intensive care unit stay,extubation time,new invasive operation (intra-aortic balloon counterpulsation was performed),time for use of vasoactive drugs,postoperative 24 h drainage,length of hosptial stay,serious complications (postoperative bleeding,pericardial tamponade,severe arrhythmia,heart failure,acute lung injury,renal failure and other organ function failure,etc.) and development of death.Results Compared with non-AIE group,age,body mass index and preoperative Hb,Hct,systolic blood pressure and diastolic blood pressure were significantly decreased,the rate of preoperative hypertension,neutrophil count,erythrocyte sedimentation rate,concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide,body temperature and heart rate were increased,the intraoperative volume of allogeneic blood transfused and consumption of norepinephrine,phenylephrine and ephedrine after CPB were increased,the time for postoperative use of vasoactive drugs,extubation time and length of postoperative intensive care unit stay were shortened,and the length of hospital stay was prolonged in AIE group (P＜0.05).Conclusion For the patients with AIE undergoing cardiac valve surgery under CPB,comprehensive evaluation should be performed and heart failure be corrected actively before surgery;esophageal echocardiography should be used for evaluation,the application of vasoactive drugs could be increased appropriately and anesthetists should pay attention to respiratory management during surgery;cardiotonic and anti-shock therapy should be maintained,arrhythmia prevented and anti-infective therapy strengthened after surgery.