[Enhanced recovery after surgery (ERAS®) in cardiac anesthesia]. / Enhanced Recovery After Surgery (ERAS®) in der Kardioanästhesie.

Enhanced Recovery After Cardiac Surgery (ERACS) is a multidisciplinary and multiprofessional treatment approach in cardiac surgery. Recently, a transfer and adaptation of enhanced recovery after surgery (ERAS) protocols from other disciplines, such as colorectal surgery, to cardiac surgery has been performed in different settings. First, prehabilitation programs have been established and investigated to improve patients' physical, psychological and nutritional status including treatment of preoperative anemia. Second, intraoperative therapeutic steps are described, such as infection reduction bundles, rigid sternal closure and guidance of perioperative anesthesia. For this, the use of short-acting agents, goal-directed fluid management and multimodal anesthesia are among the important measures. Third, early recovery and restoration of patient autonomy are achieved with early extubation and mobilization, efficient postoperative analgesia and diagnosis and treatment of delirium.The introduction of an ERACS protocol is a team effort requiring a protocol adapted to the institutional conditions and a willingness to perform a shift of culture in perioperative care. So far, the successful establishment of ERACS protocols in minimally invasive cardiac surgery has been reported and encourages the development of protocols of specific patient groups, such as pediatric cardiac surgery or left ventricular assist device implantation.

The development of isocitric lyase activity in germinating cotton seed.

In cotyledons of germinating cotton (Gossypium hirsutum L. var. Stoneville 213) seedlings, in the dark, isocitric lyase (EC 4.1.3.1) activity peaks after 2 days and thereafter slowly declines to a negligible value after 8 days. The maximum activity of this enzyme in cotyledons of 2-day-old seedlings was 16.2 mumoles of glyoxylate formed/15 min.10 cotyledon pairs. Actinomycin D at a concentration of 10 mug/ml, if added to the imbibing solution, completely prevents the development of isocitric lyase activity in these germinating seed. In cotyledons of germinating cotton seedlings, in the light, isocitric lyase activity peaks after 2 to 3 days and sharply declines to a negligible value after 4 days. The maximum activity of this enzyme in cotyledons of 2- to 3-day-old seedlings was 13.2 mumoles of glyoxylate formed/15 min.10 cotyledon pairs. Actinomycin D at a concentration of 10 mug/ml, if added to the imbibing solution, severely inhibits the development of enzyme activity.In germinating seed, in the light, the synthesis of chlorophyll and glyceraldehyde-3-P dehydrogenase is also limited by the addition of low concentrations of actinomycin D. The new synthesis of fructose-1, 6-diP aldolase, which is detectable after 1 to 2 days of germination, is inhibited by 10 mug/ml of actinomycin D. We, therefore, conclude that the synthetic events leading to the development of chlorophyll, some glyoxysomal and chloroplast enzymes in germinating cotton seedlings depend on newly transcribed mRNA.