RESUMO
PURPOSE: Pre and post-operative administration of sevoflurane in myocardial revascularization surgery provides enhanced cardioprotective effects exerted by pharmacologic pre- and post-conditioning, as compared to propofol. The identification of the enzymes involved in conditioning mechanisms is crucial to the understanding of the effects of sevoflurane in cardiac surgery patients. The impact of sevoflurane on another crucial target organ-the kidney-was also assessed. METHODS: Ninety patients undergoing off-pump myocardial revascularization surgery were allocated to receive either intra- and postoperative sevoflurane (SS), intraoperative sevoflurane and postoperative propofol (SP), or intra- and postoperative propofol (PP)). Troponin I and hemodynamic parameters were monitored during the first 48 postoperative hours; blood and urine samples were collected at baseline and at 24h to determine Akt, ERK1/2, PKG, iNO, bradykinin receptor, caspase 3, NT proBNP and urinary NGAL. RESULTS: The enzymes were overexpressed in the SS group, remained unchanged in the SP group, and decreased in the PP group. Renal function was best preserved in the SS group. CONCLUSIONS: The overexpression of enzymes induced by intraoperative anesthesia and postoperative sedation with sevoflurane reduces myocardial damage and improves renal function in patients undergoing off-pump myocardial revascularization surgery.
Assuntos
Cardiotônicos/administração & dosagem , Doença da Artéria Coronariana/cirurgia , Éteres Metílicos/administração & dosagem , Revascularização Miocárdica/métodos , Inibidores da Agregação Plaquetária/administração & dosagem , Propofol/administração & dosagem , Idoso , Anestésicos Intravenosos/administração & dosagem , Doença da Artéria Coronariana/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sevoflurano , Resultado do TratamentoRESUMO
The Acute Kidney Injury Network (AKIN) classification considers SCr values, urea and urine output in order to improve timely diagnose ARF and improve patient prognosis by early treatment. Preoperative levosimendan is a new way for cardiac and kidney protection, we try to evaluate this drug in fifteen patients comparing values of AKIN scale parameters pre and post cardiac surgery in patients with right ventricle dysfunction.
Assuntos
Hidrazonas/uso terapêutico , Rim/efeitos dos fármacos , Piridazinas/uso terapêutico , Disfunção Ventricular Direita/fisiopatologia , Injúria Renal Aguda , Idoso , Antiarrítmicos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Bloqueio Neuromuscular , Complicações Pós-Operatórias/prevenção & controle , Período Pré-Operatório , SimendanaRESUMO
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