[Early activation of patients after myocardial revascularization as a means for optimization of cardiosurgical treatment].

Analyzing the commonest characteristics of early activation (EA) programs could objectively confirm the expediency of their wide introduction, by studying the commonest characteristics of EA as a means for improving anesthetic and resuscitative provision of surgery with extracorporeal circulation for coronary heart disease and postoperative rehabilitation.

[Choice of agents for early activation-oriented general anesthesia in patients operated on for ischemic heart disease].

The purpose of the study was to analyze the choice of agents for general anesthesia in the implementation of an early activation in patients operated on for coronary heart disease (CHD). Anesthetic maintenance protocols were analyzed in 1008 patients who were operated on under extracorporeal circulation (EC) in 1995, 1999, 2001, 2004, and 2006. After aortocoronary bypass grafting, the trachea was extubated in 45% of cases. 1999 was marked by a significant diference in the use of agents for general anesthesia in patients activated in the operating suite and in those who had prolonged artificial ventilation. In 2006, there were differences in the frequency of use of anesthetics in activated and inactivated patients. In 2006, the most popular anesthetics were propofol (82% of cases), midazolam (72%), isoflurane (37%), and sevoflurane (53%). The doses of fentanyl were reduced from 10.3 +/- 0.3 microg/kg/h in 1995 to 3.4 +/- 0.2 microkg/kg/h in 2006 (p < 0.05). During activation in the operating room, the frequency of naloxone use was reduced from 85.2% in 1999 to 21.1% in 2006 (p < 0.05). The authors paid particular attention to the pharmacodynamics of anesthetics used for the early activation of patients operated on under EC for CHD. It is concluded that early activation of patients operated on under EC for CHD is possible after general anesthesia based on diferent agents. Early activation substantially changes the concept of general anesthesia during myocardial revascularization operations.

[Early activation of patients after myocardial revascularization under prolonged extracorporeal circulation].

The purpose of the study was to analyze the experience with fast-track activation of patients after myocardial revascularization with cardiopulmonary bypass (CPB) longer than 150 min and to study the efficiency of these procedures. The study included 64 ischemic patients (56 males and 8 females) aged 58.7+/-1 years, surged with CPB. In all cases, surgery and CPB were uncomplicated. The time of CPB was 151-298 (187+/-4) min; that of aortic cross-clamping was 67-181 (121+/-4) min. Hemodynamics, pulmonary gas exchange, and laboratory parameters were virtually normal before activation. Tracheal extubation was performed in the operating room 27-117 (61+/-3) min following the end procedure. The length of intensive care unit (ICU) stay was less than 24 hours in 82.8% of patients. The remaining patients stayed at an ICU 2-15 (2+/-1) days, which was associated with cardiac, pulmonary, renal complications, etc. The doses of dopamine and/or dobutamine and norepinephrine, and the index PO2a/FiO2 were shown to be predictors of ICU stay. It is concluded that fast-track activation is appropriate for patients undergoing prolonged CPB. The patients enrolled in the fast-track programme after prolonged CPB are to meet the following requirements: minimum inotropic and vasopressor support and PO2a/FiO2 greater than 350 mm Hg.

[Risk factors of prolonged intensive care after early activation of cardiosurgical patients].

The purpose of the study was to reveal the predictors of more than 24-hour intensive care unit stay for patients activated early (up to 5 hours) after surgery under extracorporeal circulation and to explore the possibilities of predicting the prolongation of postoperative intensive care in the clinical situation under examination. The protocols of anesthetic maintenance, early activation, and postoperative intensive care were analyzed in 83 patients (50 males and 33 females) aged 31 to 82 years, who had been operated on under extracorporeal circulation for various cardiosurgical diseases. The multiple regression analysis showed that the significant predictors of more prolonged intensive care after early activation were the level of arterial lactatemia (p = 0.0021), the dosages of adrenaline and/or noradrenaline (p = 0.0048), age (p = 0.0051), and female sex (p = 0.0142). It was shown that the multiple regression analysis could approximately predict the duration of intensive care after early activation. The predicted and actual durations of intensive care in patients with an intensive care unit stay length of more than 24 hours coincided in 52% of cases. In patients with an intensive care unit stay length of less than 24 hours, the estimated and actual durations of intensive care were in agreement in 92% of cases. It is concluded that it is expedient to take into account the results of the performed analysis in choosing the optimum postoperative management policy in cardiosurgical patients who are to undergo early activation.