ABSTRACT
Prolonged QT interval is a predictor of cardiovascular mortality. It indicates delayed repolarization of ventricular myocardium and is considered a precursor of malignant cardiac arrhythmias and sudden cardiac death. Increased cardiovascular risk (CVR) in the presence of prolonged QT interval, corrected by heart rate (QTc), is attributed to ventricular electrical instability. Patients with chronic renal disease (CRD) usually die from sudden cardiac death before reaching the final stage, final chronic kidney disease (CRD stage V). We investigated whether patients with CRD stage III-V have prolonged QT interval, what are the possible causes of this extension, and whether in this patient population trimetazidine application may affect the reduction in QT prolongation. Our study showed one quarter of predialysis patients, mostly asymptomatic, to have QT prolongation, thus being at a higher risk of CV events. Introducing trimetazidine along with standard therapy can reduce the incidence of sudden cardiac death, and calculation of the QTc index would be a useful and economical method of screening and monitoring high risk patients.
Subject(s)
Long QT Syndrome/drug therapy , Renal Insufficiency, Chronic/complications , Trimetazidine/therapeutic use , Vasodilator Agents/therapeutic use , Aged , Death, Sudden, Cardiac , Female , Humans , Long QT Syndrome/complications , MaleABSTRACT
ACL TOP is a fully automated coagulation analyzer, designed for simultaneous measurement of routine and special coagulation parameters. We evaluated analytical and technical performance characteristics of the coagulation system composed of the ACL TOP analyzer and HemosIL reagent group for the determination of routine clotting (PT, APTT, fibrinogen, FVII, and FVIII), chromogenic (protein C) and immunological assays (FXIII antigen). Within run and between run CVs ranged from 0.9% to 7.7% and from 2.0% to 14.8% respectively. The obtained CVs for imprecision of calibration curves were <5% of PT and <7% for fibrinogen. The method comparison study showed good correlation between results obtained on the ACL TOP and BCS/BCT analyzers, with correlation co-efficients ranging from 0.709 to 0.955, but with significantly different results for PT INR, APTT, fibrinogen and protein C, and wide dispersion of differences observed in difference plots for most assays. Despite good correlation and agreement for FVIII, problems in measuring FVIII<10% were encountered. The effective througput for the ACL TOP and BCS was 151 and 212 PT/APTT/fibrinogen tests per hour, respectively. Although the ACL TOP is designed to run multiple assays on a large number of samples, software limitations make the instrument suitable rather for mid-sized laboratories.
Subject(s)
Blood Coagulation Tests/instrumentation , Blood Coagulation Tests/methods , Calibration , Humans , Indicators and Reagents , Reproducibility of ResultsABSTRACT
BACKGROUND: Our study compared the haemodynamic changes after spinal anaesthesia with 2% lignocaine and 0.5% plain bupivacaine. METHODS: A controlled, randomized trial was performed on 30 patients scheduled for arthroscopic knee surgery. Two percent lignocaine and 0.5% plain bupicacaine was used for spinal anesthesia. We measured cardiac output, blood pressure and level of sensory blockade before and for 25 minutes after spinal anaesthesia. RESULTS: In patients developing sensory block below T6 there were no differences between the study drugs in heamodynamic measurements. In patients who developed a sensory block at or above T6 there was a greater drop in mean arterial pressure and cardiac output and a faster decrease in heart rate in patients receiving bupivacaine. CONCLUSION: In patients developing a sensory block at or above the T6 dermatome, the decrease in cardiac output and mean arterial pressure in the first 25 min. after spinal anaesthesia is smaller if 2% lignocaine rather than 0.5% bupivacaine is used for blockade.
Subject(s)
Anesthetics, Local/administration & dosage , Bupivacaine/administration & dosage , Hemodynamics/drug effects , Knee Joint/surgery , Lidocaine/administration & dosage , Nerve Block , Adult , Arthroscopy , Female , Humans , MaleABSTRACT
BACKGROUND: Our study compared the haemodynamic changes after spinal anesthesia with 2% lignocaine and 0.5% plain bupivacaine. METHODS: A controlled, randomized trial was performed on 30 patients scheduled for arthroscopic knee surgery. 2% lignocaine and 0.5% plain bupivacaine were used for spinal anaesthesia. We measured cardiac output (electrical bioimpedance cardiography), blood pressure and development of sensory blockade before and for 25 minutes after spinal anaesthesia. RESULTS: In patients developing a sensory block below T6 there were no differences between both anaesthetics in haemodynamic parameters. But in patients developing a sensory block at or above T6 there was a greater drop in mean arterial pressure and cardiac output and a faster decrease in heart rate for bupivacaine compared to patients receiving Lignocaine. CONCLUSION: In patients developing a sensory block at or above the T6 dermatome, the decrease in cardiac output and mean arterial pressure in the first 25 min after spinal anaesthesia is smaller when 2% lignocaine rather than 0.5% bupivacaine is used for blockade.
