The effect of relative cerebral hyperperfusion during cardiac surgery with cardiopulmonary bypass to delayed neurocognitive recovery.

OBJECTIVE: Delayed neurocognitive recovery (dNCR) remains a common complication after surgery and the incidence of it is determined 30-80% after cardiac surgery with cardiac bypass (CPB) in eldery patients. Many researchers have identified that neuropsychological complications emerge from insufficient cerebral perfusion. Relative cerebral hyperperfusion also disrupts cerebral autoregulation and might play a significant role in dNCR development. The aim of this study is to determine hyperperfusion in the middle cerebral artery during CPB influence to dNCR development and brain biomarker glial fibrillary acidic protein (GFAP) impact in diagnosing dNCR. DESIGNS AND METHODS: This prospective - case control study included patients undergoing elective coronary artery bypass grafting or/and valve surgery with CPB. For cognitive evaluation 101 patients completed Addenbrooke's cognitive examination - ACE-III. To determine mild cognitive dysfunction, cut - off 88 was chosen. Mean BFV was monitored with transcranial Doppler ultrasonography (TCD) and performed before surgery, after induction of anaesthesia, during CPB and after surgery. Preoperative BFV was converted to 100% and used as a baseline. The percentage change of cerebral blood flow velocity during CPB was calculated from baseline. Patients with decreased blood flow velocity were included for further investigation. To measure glial fibrillary acidic protein, blood samples were collected after anaesthesia induction, 24 and 48 h after the surgery. According to the ACE-III test results, patients with relative hyperperfusion were divided into two groups: with Delayed neurocognitive recovery and without dNCR (non-dNCR group). RESULTS: 101 patients were examined, 67 (69.1%) men and 29 (29.9%) women, age 67.9 (SD 9.2) Increased percentage of BFV was determined for 40 (39.60%) patients. There were no differences in sex, haematocrit, paCO2, aortic cross-clamping or CPB time between the two groups. Percentage change of BFV was 105.60% in the non-dNCR group and 132.29% in the dNCR group, p = .033. Patients who developed dNCR in the early post-surgical period were significantly older, p < .001 and had a lower baseline of BFV, p = .004. GFAP concentration significantly increased in the dNCR group 48 hours after surgery, compared to the non-dNCR group, p = .01. CONCLUSIONS: Relative hyperperfusion during CPB may cause dNCR. Elderly patients are sensitive to blood flow velocity acceleration during CPB. GFAP concentration increased 48 h after surgery in dNCR group but did not have any connection with risk factors.

Safety of Dexmedetomidine as an Alternative Pediatric Magnetic Resonance Imaging (MRI) Sedative: A Retrospective Single-Center Study.

BACKGROUND Dexmedetomidine provides anxiolysis, sedation, dose-dependent hypnosis, and mild analgesia with minimal respiratory function effects. The aim of this study was to assess the efficacy and safety of dexmedetomidine for pediatric patients during MRI. MATERIAL AND METHODS We retrospectively analyzed 87 cases of pediatric sedations for MRI. Dexmedetomidine and a single dose of midazolam were used in all the cases, according to the in-house pediatric sedation protocol for MRI. The patients were divided in to 2 groups: group 1, who reached adequate sedation up to 10 min of induction and group 2, who achieved proper sedation after 10 min. RESULTS The median age was 3 years (0-17). The median duration of procedure was 75 min (40-150). The induction of standardized sedation was performed without additional sedatives and proper depth of sedation was reached in the majority of cases (94.3%). Five patients (5.7%) received additional sedative after 10 min of induction. The median time of adequate sedation was 8 min (3-13) after induction, and 51% of patients achieved RASS-4 in 8 min. There was no significant difference between groups 1 and 2. Ten patients (11.5%) experienced bradycardia, regardless of the usage of additional drugs, dexmedetomidine boluses, duration of the procedure, or induction time. CONCLUSIONS High-dose dexmedetomidine with a single dose of midazolam might be an effective combination at the induction stage for pediatric sedation for MRI, with very few adverse events. Over 50% of enrolled patients achieved an adequate level of sedation before 10 min. We conclude that induction of dexmedetomidine infusion can be shortened up to 8 min.

Values of circulating molecular biomarkers (microRNAs) for the evaluation of renal failure during urgent abdominal sepsis anaesthesia.

BACKGROUND: Micro-ribonucleic acids (miRNAs) are small non-coding molecules important for gene regulation and management of physiological processes (1). Alterations in the expression of miRNAs are potential novel biomarkers for many diseases (2). MATERIALS AND METHODS: Random patients who underwent emergency surgery for abdominal sepsis were enrolled into the study (N = 27). Patients were divided into three groups according to the renal function and into two groups depending on the presence or the absence of lethal outcomes during the hospitalization period. Relative expression levels of circulating serum miR-30d-5p, miR-23a-3p, miR-146a-5p were assessed with real-time quantitative polymerase chain reaction using the 2-ΔΔCt method and compared between the groups. RESULTS: Expression levels of all three miRNAs did not differ significantly between patients with acute renal failure (ARF) (n = 8), chronic renal failure (CRF) (n = 8), and with a normal renal function (NRF) (n = 11). Estimated glomerular filtration rates (eGFR) were significantly lower (p = 0.016), the values of urea (p = 0.007) and red blood cell distribution width (RDW) (p = 0.001) were significantly higher in septic patients who died, but no significant correlation between RDW values and expression of miRNAs was found. CONCLUSIONS: The expression levels of serum miR-30d-5p, miR-23a-3p, miR-146-5p did not significantly differ between three groups of patients who developed ARF, had CRF, or retained NRF. No significant association between the RDW value and expression of miRNAs was noted.

Value of Serum miR-23a, miR-30d, and miR-146a Biomarkers in ST-Elevation Myocardial Infarction.

BACKGROUND The aim of this study was to analyze the relative expression level of miR-30d-5p, miR-23a-3p, and miR-146a-5p, and to comprehensively assess the diagnostic and predictive possibilities of these miRNAs. Their expression changes have not yet been sufficiently investigated during acute myocardial infarction. Therefore, it is important to comprehensively assess the diagnostic and predictive possibilities of these micro-ribonucleic acids (miRNAs). MATERIAL AND METHODS Random patients with ST­elevated myocardial infarction (STEMI) were enrolled into the study group. The control group was comprised of patients with no inflammation or ischemic heart disease who were hospitalized for minor elective surgery. The relative expression level for each miRNA was determined by reverse transcription quantitative polymerase chain reaction (RT-qPCR)-analysis. RESULTS There were 88 participants enrolled into the study: 62 patients were diagnosed with STEMI and there were 26 healthy controls. Expressions of miR-30d-5p, miR-146a-5p, and miR-23a-3p were respectively 1.581-fold, 4.048-fold, and 4.857-fold lower in patients with STEMI compared to the control group patients (all P values were <0.001). Downregulation of miR-23a-3p was significantly negatively correlated with risk scores of GRACE (Global Registry of Acute Coronary Events) and APACHE II (Acute Physiology and Chronic Health Evaluation II). MiR-23a-3p was a fair predictor for STEMI: area under the curve (AUC)=0.806. Cox regression analysis revealed that expression levels of analyzed miRNAs were not significantly associated with negative endpoints at 1 month after the onset of STEMI. CONCLUSIONS All investigated miRNAs were differentially expressed when comparing patients with STEMI and control group individuals. The evaluation of miR-23a-3p expression levels in serum could be useful to assess the severity of STEMI and as a potential diagnostic biomarker of this condition. In addition, miR-23a-3p may provide limited short-term prognostic value for STEMI patients.

Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock.

UNLABELLED: Acute myocardial infarction complicated by cardiogenic shock is one of the main reasons of death in severely ill patients. One of the main indications for intra-aortic balloon counterpulsation is acute myocardial infarction complicated by cardiogenic shock. Aortic counterpulsation is associated with the risk of several important complications: bleeding, thrombosis, thrombocytopenia, limb ischemia, and aortic wall damage. The analysis of complications is necessary to better understand the course of myocardial infarction using aortic counterpulsation and to reduce the risk of complications. The aim of the study was to analyze the course of acute myocardial infarction complicated by cardiogenic shock in patients managed by intra-aortic balloon counterpulsation as well as to determine intra-aortic balloon counterpulsation-related complications. MATERIAL AND METHODS: The course of acute myocardial infarction complicated by cardiogenic shock in patients with aortic counterpulsation was analyzed. Patients were recruited from the Cardiology Intensive Care Unit, Department of Cardiology, Lithuanian University of Health Sciences, during the period of 2004-2010. The study comprised 73 patients: 30 women (41.1%) and 43 men (58.9%). RESULTS: Atrial fibrillation and asystolia were the most common cardiac complications during counterpulsation. Atrioventricular block was the predominant disorder of cardiac conduction system; acute renal failure was the most common noncardiac complication. Complications such as major bleeding, infection, aortic wall damage, or amputations were not documented in our study. Successful percutaneous coronary intervention was associated with fewer complications and reduced mortality rate. CONCLUSIONS: Aortic counterpulsation may be successfully employed providing significant hemodynamic support with rare major complications in a high-risk patient population. A unique finding of this study is a high rate of successful applications of aortic counterpulsation.