ABSTRACT
Primary graft dysfunction after heart transplantation (HTx) has a very high mortality rate, especially if the left ventricle (PGD-LV) is involved. Early diagnosis is important to select the appropriate therapy to improve prognosis. The value of high-sensitivity troponin T (HS-TNT) measurement obtained at patient arrival at the intensive care unit was analyzed in 71 HTx patients. Mild or moderate PGD-LV was defined by hemodynamic compromise with one of the following criteria: left ventricular ejection fraction <40%, hemodynamic compromise with right atrial pressure >15 mm Hg, pulmonary capillary wedge pressure >20 mm Hg, cardiac index <2.0 L/min/m2, hypotension (mean arterial pressure <70 mm Hg), and need for high-dose inotropes (inotrope score >10) or newly placed intra-aortic balloon pump. The mean recipient age was 54 ± 12 years (73% men), and donor age was 47 ± 11 years. Ischemic time was 200 ± 51 minutes, and coronary bypass time was 122 ± 31 minutes. Nine (13%) HTx patients were diagnosed with PGD-LV post-HTx, 8 with biventricular dysfunction. Four patients died, 2 with PGD-LV (22%) and 2 without PGD (4%). Mean HS-TNT before HTx was 158 ± 565 ng/L, and post-HT was 1621 ± 1269 ng/L. The area under the curve (receiver-operator characteristic) of HS-TNT to detect patients at risk of PGD-LV was 0.860 (P < .003). A cutoff value of HS-TNT >2000 ng/L had a sensitivity of 75% and specificity of 87% to identify patients at risk of PGD-LV. Multivariate analysis identified HS-TNT >2000 ng/L (P < .02) and coronary bypass-time (P < .01) as independent predictors of PGD-LV. HS-TNT >2000 ng/L at intensive care admission after HT and prolonged coronary bypass time were the most powerful predictors of PGD-LV. HS-TNT may be helpful for early detection of HTx patients at risk of PGD-LV.
Subject(s)
Heart Transplantation/adverse effects , Primary Graft Dysfunction/diagnosis , Troponin T/metabolism , Ventricular Dysfunction, Left/diagnosis , Biomarkers/metabolism , Coronary Artery Bypass/adverse effects , Early Diagnosis , Female , Heart Ventricles , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Prognosis , ROC Curve , Sensitivity and Specificity , Stroke Volume/physiology , Ventricular Dysfunction, Left/etiologyABSTRACT
Interventional neuroradiology procedures have become increasingly complex, requiring planning and coordination. Key roles are played by the anesthesiologist and the radiologist, as well as by technicians and nurses. This review aims to analyze the anesthesiologist's part in managing these procedures, from the start of the intervention through the immediate postoperative period. First concerns are to assure patient safety during transfer, maintain the airway, keep the patient immobile and hemodynamically stable, and manage anticoagulant and antiplatelet treatments. Rapid awakening must also be assured so that the patient's neurologic status can be assessed in situ. The anesthesiologist should treat any neurologic complications that develop and that might lead to emergency situations during the procedures.
Subject(s)
Anesthesia, General/methods , Radiography, Interventional , Anesthesia Recovery Period , Anesthesiology , Anticoagulants/therapeutic use , Brain Diseases/surgery , Cerebrovascular Disorders/surgery , Cerebrovascular Disorders/therapy , Embolization, Therapeutic , Humans , Interdisciplinary Communication , Intraoperative Complications/prevention & control , Monitoring, Intraoperative , Neurosurgical Procedures , Physician's Role , Postoperative Care , Postoperative Complications/prevention & control , Preanesthetic Medication , Preoperative CareABSTRACT
Los procedimientos que se realizan en neurorradiologíaintervencionista son cada vez más complejos por loque deben estar bien planificados y coordinados. Elanestesiólogo junto con el radiólogo, técnicos y enfermerasjuega un papel fundamental. Con esta revisión sepretende analizar el papel del anestesiólogo en estos procedimientosdesde el inicio hasta su manejo en el postoperatorioinmediato. En primer lugar debe garantizar laseguridad en el transporte, mantener la vía aérea, conseguirla inmovilidad del paciente, controlar la estabilidadhemodinámica, manejar la anticoagulación y la antiagregacióny asegurar un despertar rápido para valorarneurológicamente al paciente in situ. Así mismo, deberátratar las posibles complicaciones cerebrales durante losprocedimientos que pueden llegar a ser emergencias (AU)
Interventional neuroradiology procedures havebecome increasingly complex, requiring planning andcoordination. Key roles are played by the anesthesiologistand the radiologist, as well as by technicians and nurses.This review aims to analyze the anesthesiologists part inmanaging these procedures, from the start of theintervention through the immediate postoperativeperiod. First concerns are to assure patient safety duringtransfer, maintain the airway, keep the patient immobileand hemodynamically stable, and manage anticoagulantand antiplatelet treatments. Rapid awakening must alsobe assured so that the patients neurologic status can beassessed in situ. The anesthesiologist should treat anyneurologic complications that develop and that mightlead to emergency situations during the procedures (AU)
