ABSTRACT
BACKGROUND: The aim of our study was to evaluate the efficacy of myocardial protection during coronary artery bypass grafting (CABG) in cold blood intermittent (CBIC) and warm continuous blood cardioplegia (WCBC). To assess myocardial necrosis, Troponin T, a structural protein belonging to the troponin complex, was measured. Troponin T is released in the blood stream 4 hours after myocardial damage, and it does not cross-react with the isomeric form of the skeletal muscle. METHODS: Our study involved 20 consecutive patients, scheduled for isolated CABG. They were divided into two groups: the first group (10 patients; 8 m, 2 f) underwent surgery with the use of CBIC, the second group (10 patients; 9 m, 1 f) with WCBC. The serum levels of cardiac Troponin T (cTn-T) were all <0.2 microg/l before operation. RESULTS: In the CBIC the mean cTn-T peaked on the 1st day after CABG, in the WCBC group the first peak occurred in the 2nd hour after arrival in the intensive care unit, and the second peak occurred on the 4th day postoperatively. The mean serum cTn-T was lower in the WCBC vs CBIC group from the 1st to the 5th day postoperatively, with a statistical difference on the 1st day (p<0.05). In the CBIC group either the cTn-T peak values (r=0.77; p<0.02) or area under the concentration curve of cTn-T release (r=0.85; p<0.004), were directly correlated with the aortic cross-clamping time. This was not demonstrated in the WCBC. CPK and CK-MB peaked in both groups 6 hours after arrival in the intensive care unit and on the 1st day postoperatively, with higher values at 6 hours in the WCBC group (p<0.05). The CK-MB/CPK ratio was significantly lower in the WCBC group at the six hours (p<0.05). CONCLUSIONS: The results of this preliminary study suggest that fewer necrosis markers are released during CABG in the WCBC group; in the CBIC group the release of cTn-T whether measured by peak serum level or by area under the curve, shows a statistically significant correlation with cross-clamping time. Warm blood cardioplegia is safe and supplies adequate myocardial protection during CABG; the more prolonged cross-clamping is, the more myocardial protection is afforded by WCBC.
Subject(s)
Cardioplegic Solutions/administration & dosage , Coronary Artery Bypass , Heart Arrest, Induced/methods , Myocardial Ischemia/surgery , Myocardial Reperfusion Injury/prevention & control , Troponin T/metabolism , Aged , Biomarkers/blood , Cold Temperature , Creatine Kinase/blood , Enzyme-Linked Immunosorbent Assay , Female , Follow-Up Studies , Hot Temperature , Humans , Isoenzymes , Male , Middle Aged , Myocardial Ischemia/blood , Myocardial Reperfusion Injury/blood , Myocardium/metabolism , Treatment OutcomeABSTRACT
A retrospective study of our anaesthesiologic activity during the decade 1982-1991 concerning 314 severely burned patients (53.4% of all the hospitalizations) submitted to escharrectomy with cutaneous grafts showed a greatest incidence in 1990 (19.5% of all the interventions) mostly for 12 to 60 year-old patients. In 51% of all cases, patients had burns over less than 30% of the body surface. 76% got a combined general anaesthesia mainly by isoflurane (68%) and 24%, especially 0 to 12 year-old patients (63.1%), a monopharmacological anaesthesia by ketamine.
Subject(s)
Anesthesia, General/methods , Burns/therapy , Adolescent , Adult , Child , Humans , Isoflurane , Ketamine , Middle Aged , Pressure Ulcer/surgery , Retrospective Studies , Skin TransplantationABSTRACT
Impairment of the state of consciousness is an important contributing factor in the onset of respiratory tract infections; in this study the data were collected prospectively to investigate the incidence and clinical implications of pneumonia in a population of head injured patients. The study was conducted on all patients treated at our centre throughout 1990. The incidence of pneumonia in the head injured was 10.8% versus 7.3% in the rest of the patients. Mortality in the group with pneumonia was not significantly different from the group without pneumonia. The average time of onset was on the fifth day from admission. The lung injury score (LIS) on the sixth day, the time on artificial ventilation and the length of stay in intensive care were significantly greater in those with pneumonia (1.18, 14.6 days and 21.9 days versus 0.8, 4.2 days and 12.9 days respectively). Staphylococcus was the single most frequently isolated germ. Our study concludes that pneumonia represents a relatively frequent and early complication in patients with head injury, and it is associated with prolonged artificial ventilation and longer staying in ICU.
