Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 1 de 1
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Am J Kidney Dis ; 41(6): 1247-56, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12776278

RESUMO

BACKGROUND: Potassium-rich cardioplegia has advantages over other cardioplegic solutions in preserving the myocardium during cardiopulmonary bypass, but it is avoided in patients with renal failure because of hyperkalemia. METHODS: We first determined the ability of intraoperative hemodialysis (IHD) to remove potassium during cardiopulmonary bypass with potassium-rich cardioplegia in 9 patients by measuring potassium levels in all dialysate and urine. We then studied 24 patients with renal failure, grouped with the 9 previous patients, to assess safety, rebound hyperkalemia, and patient outcome with this technique. RESULTS: In the first phase, 9 patients were administered 128 +/- 11 mmol of potassium in potassium-rich cardioplegia, and IHD removed 157 +/- 23 mmol. Urinary potassium excretion was only 10 +/- 3 mmol. Potassium removal occurred at a rate of 1.25 mmol/min with 0-mEq/L (mmol/L) potassium dialysate and a rate of 0.75 mmol/min with 3.0-mEq/L (mmol/L) potassium dialysate. In all 33 patients, successful initiation of cardiac rhythm occurred after cardiopulmonary bypass, and 5 patients had cardiac arrhythmias possibly from hypokalemia. In the next 24 hours, 5 dialysis-dependent patients developed hyperkalemia (potassium > 5.2 mEq/L [mmol/L]) requiring hemodialysis. Postoperative hemodialysis was delayed 2 to 3 days in the other patients. The overall death rate was 24% at 30 days. CONCLUSION: IHD effectively and safely removes potassium administered during potassium-rich cardioplegia during cardiopulmonary bypass in patients with renal failure and prevents postoperative hyperkalemia in the majority of patients. Overall mortality in patients with acute and chronic renal failure undergoing cardiac surgery is high irrespective of control of potassium balance in these patients.


Assuntos
Soluções Cardioplégicas/farmacologia , Ponte Cardiopulmonar , Parada Cardíaca Induzida/métodos , Cuidados Intraoperatórios , Potássio/farmacologia , Diálise Renal , Idoso , Ponte Cardiopulmonar/instrumentação , Soluções Cristaloides , Desenho de Equipamento , Feminino , Cardiopatias/complicações , Cardiopatias/cirurgia , Humanos , Hiperpotassemia/induzido quimicamente , Hiperpotassemia/prevenção & controle , Complicações Intraoperatórias/induzido quimicamente , Complicações Intraoperatórias/prevenção & controle , Soluções Isotônicas , Masculino , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Substitutos do Plasma/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Potássio/administração & dosagem , Potássio/urina , Diálise Renal/instrumentação , Insuficiência Renal/sangue , Insuficiência Renal/complicações , Insuficiência Renal/terapia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...