Neuroaxial anesthesia methods combined with general anesthesia for beating heart surgery

301 Pages·2012·2.46 MB·English

BritishJournalofAnaesthesia102(S2):ii266–ii343(2012)
doi:10.1093/bja/aer485
OTHER
(Thenamesof the authorspresenting each paperare showninbold type)
Paper No: 1.00 Results: The total doses of sistemic fentanyl were
smaller in the multimodal groups (2793 micrograms
+2915.94 vs 1300 +2 392.79 vs 998 +229.10; p,0.001)
The time of extubation (7.83 hours +25.24 vs 4.57 +
Neuroaxial anesthesia methods combined 2 2.87 vs 1.72+2 1.07; p, 0.001) and the intensive care
with general anesthesia for beating heart un it stay (CG¼2.83+22.42 days, GMOI¼1.92+21.23,
surgery GMET¼1.41+20.75, p¼0.005) were smaller too, in both
multimodal groups, wihtout differents beetwen then, but
Aguero Martinez, Maria Oslaida,
this methods didn’t influence in the hospital stay. A neuro-
Rosa Jimenez Paneque, Idoris Cordero Escobar, logical complication associated to neuraxial blockade was
Raul Cruz Bouza and Antonio Cabrera Pratts notobserved.
Conclusions: The multimodal anesthetic methods are more
HermanosAmeijeirasHospital.Havana.Cuba
effectives, with theya superior perioperative patients evolu-
tion were obtained. Key words: Coronary surgery without
Introduction: In Cuba more than 50% of the coronary
extracorporeal circulation, intrathecal opioids, high epidural
surgery is carried out with the beating heart modality.
blockade, spinal anesthesia, epidural anesthesia, multimod-
Endotracheal general anesthesia has been the technique
alityanesthesia.
used in our service. Neuraxial Anesthesia combined
with the general anesthesia method, in this last
decade, has prevailed in a certain number of the cardio-
vascular centers of the world, due to their undeniable References
advantages. 1 LenaP,BalaracN,LenaD,DelaChapelleA,ArnulfJJ,MihoubiA,
Objectives:To evaluate the effects of the general anesthe- BonnetF.Fast-trackanesthesiawithremifentanilandspinalanal-
sia combined with high thoracic epidural blockade or intra- gesiaforcardiacsurgery:Theeffectonpaincontrolandqualityof
thecal administration of morphine/ fentanyl on the recovery. J of cardiothorac and vasc anesthesia 2008; 22(4):
536–42.
intraoperative analgesia, time of extubation, intensive
2 Yapici D, Ozer ZO, Atici S, Bilgin E, Doruk N, Cinel I, et al. Post-
care unit and hospital stay. To identify the frequency of
operative effect of low-dose intratecal morphine in
appearance of adverse effects related with the spinal ad-
coronary artery bypass surgery. J Card Surg 2008; 23:
ministration of opioides and the frequency of appearance
140–45.
of complications related with regional anesthetic’s
3 Tenenbein PK, Derouwere R, Maguire D, Duke PC, Muirhead B,
method. Enns J, et al. Thoracic epidural analgesia improves pulmonary
Methods: A controlled randomized trial was conducted in function in patients undergoing cardiac surgery. Can J Anesth
patients with diagnosis of coronary heart disease, pro- 2008;55(6):344–50.
grammed for off pump coronary artery bypass graft 4 CaputoM, AlwairH,RogerCA,GintyM,MonkC,TomkinsS,et al.
surgery.This patients were assigned to one of the following Myocardial, Inflamtory,andStressResponsesinoff-pumpcoron-
three groups: Control group (n¼30): Endotracheal general aryartery bypass surgery with thoracicepidural Anesthesia. Ann
ThoracSurg2009;87:1119–26.
anesthetic method. Multimodal group (n¼29) with thoracic
5 Moraes L, Canavi V, Canavi S, Sa Malbouissan LM, Carvalo CJ.
epidural anesthesia: bupivaca¨ana 0,5% (50mg) 10ml/single
Intrathecal morphine plus general anesthesia in cardiacsurgery:
dose and 5mg of morphine. Multimodal group with intra-
Effect on pulmonary funtion, post operative analgesia and
thecal administration of opioides (n¼29): fentanil 1,5 mcg/ plasma morphine concentration. Clinics (Sao Paulo) 2009; 64(4):
kgand morphine8mcg/kg. 279–85.
&
TheAuthor[2012].PublishedbyOxfordUniversityPressonbehalfoftheBritishJournalofAnaesthesia.Allrightsreserved.
ForPermissions,pleaseemail:[email protected]
BJA
AbstractspresentedatWFSA
Paper No: 57.00 Paper No: 63.00
Perioperative Anaesthesiological
Candedemia in intensive care unit
Management Obesity Patients Undergoing
Prof. Chandralekha1, I. Xess1 and Fahmi Hasan2
Bariatric Surgery
1Dept.ofAnesthesiologyand2DepttofMicrobiology
Alisher Agzamov, Abdul Raheem, Al Qattan and
Mohammad Behzad
Introduction: There is a need to understand the epidemi-
DepartmentofAnaesthesiology&ICU,AlSabah&ZainHospitals, ologyandriskfactorsassociatedwithcandidemiaincritically
KuwaitCity,Kuwait illpatients.Theriseinincidenceofnon¨Calbicanscandidemia
and emergence of antifungal resistance have made such a
Introduction: In the long run, surgical treatment proves to study necessary. Candidemia in Intensive Care Units (ICUs)
the most effective measure for the treatment of both settingare of specialconcern dueto highmortality rate.
morbid adipositas and concomitant morbidity. Patients Objective: The aim of this study was to evaluate epidemi-
undergoing bariatric surgical procedures are a challenge to ology of Candidemia, associated risk factors and outcome
the anaesthesiologist: Obesity-associated morbidity, the ofthediseaseandantifungalresistanceamongICUpatients.
poten-tially difficult airway and intravenous accesses as Methods: The study was carried out at an Indian tertiary-
well as the demand for effective pain and anti-emetic care teaching hospital, New Delhi, India from a period of
therapy. Interrestingly, only sparse and conflicting data three years. January 2005 to December 2008. Prospective
exist about the perioperative anaesthesiological manage- analysis of 85 cases of Candida blood stream infection
ment ofthese patients. (BSI) donefrom January 2005 to December2008. Out of85
Objectives: This study retrospectively reviewed the previous patients, 38 patients were getting repetitive BSI infection
perioperative anaesthesiological management and and 47 patients got Candida infection only once during
appraised critically the situation in the follow-ing analysis. their hospital stay. Follow up study was done till discharge
A potential for improvement should be identified and or death of the patients and data were analyzed. Isolates
included into a new SOP via the PDCA cycle of the quality were characterized and antifungal susceptibility test was
management system. doneagainstfluconazoleandamphotericin B.
Methods: Retrospectively, peri-operative charts of all Results: Non- C. albicans species accounted for majority of
patients undergoing gastric banding or gastric bypass pro- episodes of candidemia as reported by our previous study.
cedures within the last five years at our obesity Patients in ventilators and foleys catheter along with old
treatment centre were analysed. Anesthesiological treat- age were significantly associated with persistence of infec-
ment be-fore, during and after the bariatric surgery as tion(P¡U¨ 0.05).Overallmortalitywas(65.8%)56of85incan-
well as the pain therapy were documented. Ad-herence didemiapatients.Thetimeandthechoiceofantifungalsfor
to the standard operating procedures, processing -times the treatment of candidemia were significantly associated
and qualification of the anaesthesiologist were further spe- with the clearance of the infection (P¼0.01) but not with
cific benchmarks. mortality (P¼0.23). 30% of the isolates showed decreased
Results: Overall, 224 patient charts were available for this susceptibility to fluconazole.
survey (n¼103 gastric banding and n¼121 gastric bypass). Conclusion: There is a shift in the epidemiology of candide-
Mostofthepatients(64%)hadanaesthesiologicallyrelevant mia and the timely institution of antifungals and combin-
co-morbidites. Significant differences between the bypass ation therapy suggest the better outcome of the patients.
andthebandinggroupswerefoundforthemedianprocess- Presence of azole resistances is a matter of concern in our
ing times. The need for postoperative opiods differs signifi- isolates.
cantly as well (90 vs. 120mg Pethidine). No severe
anaesthesiological complications occurred. The overall rate
of PONV was impressive with 32%. Based on a pre-existing
References
SOP, even a large number of different anaesthesiologists of
various qualification levels was able to conduct anaethesia 1 BeheraB,SinghRI,XessI,MathurP,HasanF,MishraMC,Candida
rugosa: a possible emerging cause of candidemia in trauma
inaveryhomogeneousway.
patientsInfections2010;38:387–393
Conclusions: Bariatricpatients are a high risk patient group.
2 SinghRI,XessI,MathurP,BeheraB,GuptaB,MishraMC,Epidemi-
Present-day anaesthesiological practice as well as the pro-
ologyofcandidemiaincriticallyilltraumapatients:experiencesof
foundimplementationofaSOPcouldpermitsafeanaesthe-
alevelItraumacentreinNorthIndia.JMedMicrobiol2011;60:
sia and a minimised risk for complications. Due to the high 342–348
PONV rate, a routine perioperative PONV prophylaxis should 3 BartonRC,Candidarugosa:anewfungalpathogenemerging,but
beimplemented. fromwhere?JMedMicrobiol2011;Editorial265
ii267
BJA
AbstractspresentedatWFSA
Paper No: 68.00 3 Nisson,RawalN,UnossonM,Acomparisonofintra-operativeor
postoperative exposure to music–a controlled trial of the
effects on postoperative pain. Anaesthesia. 2003 Jul;
Effect of Indian Classical Music (Raga 58(7):699–703.
4 YaleUniversitySchoolofmedicine2003Effectsofmusictherapy.
Therapy)on Fentanyl, Vecuronium, Propofol
5 Sairam TV, (2004a) Medicinal Music. Chennai: Nada Centre for
requirement and cortisol levels in
MusicTherapy
Cardiopulmonary Bypass 6 SairamTV,(2004b)RagaTherapy.Chennai:NadaCentreforMusic
Therapy
Sandeep Kumar Kar1, Chaitali Sen2 and
7 SairamTV,(2004c)WhatisMusic?Chennai:NadaCentreforMusic
Anupam Goswami3 Therapy
1InstituteofPostGraduateMedicalEducation&Research 8 Lewis.AnesthAnalg2004;98:533–6
KOLKATAINDIA2I.P.G.M&RKolkataINDIAand3I.P.G.M.E&R 9 Yapici N, Tarhan IA, Kehlibar T, Coruh T, Arslan Y, Yilmaz M,
YapiciF,OzlerA,AykacZ,BloodCortisolLevelsOnCardiopulmon-
ary Bypass After Methylene Blue Administration . The Internet
Introduction: Indian classical music has immense healing
JournalofThoracicandCardiovascularSurgery.2008;2.
potential and considerable stress reducing capabilities
10 Miller7theditionNeuromuscularmonitoringchapter47
which has been harnessed since the Mughal era. Music is
regarded as the medicine with no side effects. Cardiopul-
monary bypass is associated with immense stress response Paper No: 69.00
andhighlevelsofintraoperativecortisol levelswhichis det-
rimentaltothepatientandinvolveslargedosesofFentanyl,
propofol and vecuronium requirement to maintain hemo- Why so much fear to anesthesia?
dynamic stability intraoperatively. We evaluated the effect
Horacio Bonchini
of Indian classical music therapy on cortisol levels and the
above drugs requirement during cardio pulmonarybypass. HospitalEscuelaEvaPero´n,GranaderoBaigorria,Dpto.Rosario,
ARGENTINA
Materials&Methods:AfterobtainingclearancefromInstitu-
tionalEthicalCommitteeandwritteninformedconsentfrom
Introduction:Thereareonlyafewoccasionsinthecourseof
patients, 34 patients were assigned to either Group I Music
a person’s life, in which one faces the biggest existential
group (n¼17) and Blank CD Group II (n¼17). The patients
problem of humanity, fear of death. This seems to happen
awareness level and depth of anesthesia was monitored by
when one has the need to undergo an anesthetic-surgical
BIS(Bispectralindex),Fentanylandpropofolinfusiontitrated
procedure; it is then when the bare possibility of harm and
toaBISscoreof50andneuromuscularmonitoringwasdone
death appears. And it compulsorily reminds us the finite
by Post tetanic count (PTC) in the Aductor Pollicis muscle.
natureof human life.
Vecuronium was repeated whenever a PTC count of 7 was
Objective:Toverifyifitistruetheobservationthatfearofan-
achieved, in both the groups. Music therapy or blank CD
esthesia is generalized among our patients; and to define
was played by earphone, in the patient’s ear in both the
which would be the possible causes that more frequently
groups, from 30 mins before induction to till the patient
provoke this fear. Finally, it will be evaluated if they are
wasshifted to theICU.
related to the innate fear of death. Material and methods:
Result: We found significant decrease in the cortisol levels
A survey was designed to be answered anonymously, with
both after Sternotomy and after aortic crosscalmp release.
eightquestion.Twowereopenanswers:thedefinitionofAn-
In the Music group (Group I) which was 30% less than the
esthesiaandtowhathe/sheassociatedthewordAnesthesia.
BlankCDgroup(GroupII).Fentanyl,propofolandvecuronium
The other questions were multiple choices. 456 Patients
requirementintheMusicgroupwerereducedby30%and25
between 18 to 70 years old, were surveyed; xx were facing
%and 25% respectively, which were statistically significant
scheduled surgeryand XXwere not.
(P,0.05)
Results:48%answeredtheywouldbeafraidofanesthesiaif
Conclusion:IntraoperativeIndianclassicalmusictherapyef-
they had to be operated. 48.9% were worried the same by
fectively reduced the intraoperative stress (as revealed by
the anesthetical act as by the surgical one. 75% of the
reduced levels of cortisol) and reduced the requirement of
patients recognized they had never been interested in
drugs(Fentanyl,PropofolandVecuronium)duringCardiopul-
getting information about how anesthesia is done. 68.8%
monaryBypass.
knew the anesthesiologist is a physician. Only 5% could
define correctly the word anesthesia. Those peopleyounger
References than 30 years old were more afraid of anesthesia; being
their biggest fear to feel pain or not to be asleep enough.
1 Bagchi,Kalyan.(Ed)(2003)Music,MindandMentalHealth.New
Thesamehappenedtothoseoneswhohadneverhadanan-
Delhi.
esthetic experience. While those over 30, who had already
2 TonyWigram,IngeNygaardPedersenandLarsOleBonde.Jessica
KingleyPublishersPhiladelphia2002:A comprehensiveguideto been anesthetized, felt less fear. They were afraid of dying
musictherapy,Theory,clinicalpracticeResearch&Training. inthe operating room.
ii268
BJA
AbstractspresentedatWFSA
Discussion:Sincemostofthesurgicalpatientswereover30, Conclusions: Right ventricle cannot be still considered “the
and agreeing with the other studies on this matter, it could Cinderella” anymore in carddiac surgery. The presence of
be inferred that the biggest fear of our patients is to die dysfunctioning RV, the likelihood of cardiac deathincreases,
during anesthesia. Anyway, the group that expressed fear especially if TAPSE isequal orlower than15mm. Nowadays,
tosufferpainbecauseofinsufficientanesthesia,wassurpris- we know that in mos of cases, there is an interdipendence
ingly bigger than expected. What called our attention was between the two ventricles, so improving LV function could
thelittleinterest,ofthispopulation,toknowmoreaboutan- be sufficient to improve also RV function. In all the other
esthesia andtheanesthesiologist’s role. cases,wespeculatethatverylikely,amorestrictintraopera-
Conclusion:Althoughthefearofdeaththatourpatientsface tivemoritoringassociatedwithpulmonaryvasodilatorscould
whentheyaregoingtobeanesthetizedmaynotbealtered, improve theoutcome,but thisquestion hasto beverify.
weconsiderwemustreducetheunfoundedfearofnotbeing
sufficiently asleep or feeling pain, by getting closer to the
patient to dissipate the myth of insufficient anesthesia. Paper No: 112.00
Thatwaywewillhave added comfortto ourpatients.
Keywords: Anesthesia;fear; pain; death PAI-1 and t-PA/PAI-1 complex potential
fibrinolytic markers for postoperative
bleeding in cardiopulmonary bypass
Paper No: 82.00
patients
The impact of right ventricle upon early Agnese Ozolina, Eva Strike, Inta Jaunalksne and
cardiac mortality of patients with ischemic Indulis Vanags
mitral regurgitation undergoing mitral
RigaStradinsUniversity,DepartmentofPaulsStradinsClinical
valve surgery UniversityHospital,ClinicalPaulsStradinsClinicalUniversity
Hospital,DepartmentPaulsStradinsClinicalUniversityHospital,
CarloDiLorenzo1,PaoloPelaia1,SalvatoreIuorio1,
DepartmentofAnaesthesiologyandCardiacsurgery,Latvia
Flavia Petrini2 and Antonio Maria Calafiore3
1ClinicadiAnestesiaeRianimazione,Azienda Introduction: Excessive bleeding (EB) remains a serious
ospedaliero-UniversitariaAncona,Italy2Dipartimentodi problem following cardiac surgery. Bleeding after cardiac
AnestesiaeRianimazione,Universita` and3DepartmentofCardiac surgery is multifactorial in aetiology but fibrinolysis plays a
Surgery,PrinceSultan determinantrole.
Objectives:Wehypothesizedthatlowerpreoperativelevelof
Background: The aim of this retrospective study is to evalu- Plasminogen activator inhibitor type-1 (PAI-1) and lower
ate if right ventriculardilatation ordysfunction might affect ratio of tissue – plasminogen activator/PAI-1 complex
earlycardiacmortalityofpatientswithischemicmitralregur- (t-PA/PAI-1) after surgery maybe associatedwith enhanced
gitation (IMR) undergoing mitral valve surgery(MVS). fibrinolyticactivityandincreased bleeding.
Methods: From March 2006 to May 2008, 103 patients with Method: A total of 88 adult cardiac surgical patients (mean
IMR, electivelyoperated on bya single surgeon (AMC), were age66+10years,48%men)whodidnotreceiveantifibrino-
enrolledinthestudy.Patientswithseveretricuspidregurgita- lytic prophylaxis were enrolled in a prospective study. Vari-
tionwereexcludedfromthestudyduetomisleadingassess- ables were collected preoperatively (T0); at admission in
ment of tricuspid annular plane systolic excursion (TAPSE); intensive care unite (T1), at 6 and 24 hours (T6, T24) after
the last item was used to evaluateRV function. Diastolic RV surgery. To allow comparison between patients, two groups
diameter was also evaluated. The primary end-point was were made according to 24-hour postoperative bleeding
early cardiac mortality. All the analyses were validated in volume: group I.500ml/24h, group II ? 500ml/24h. Correl-
1000 bootstrap samples. This retrospective study was ationofbloodamountwithroutinecoagulationtestsandfi-
approved by Institutional Review Board of University of brinolysis parameters (PAI-1, t-PA/PAI-1 complex, D-dimer)
Chieti and thiswaived thepatients’ consent. wereanalysedusingSPSS17.0aslinearregression(Pearson’s
Results: Ten patients (9.7%) died by 30 days from the oper- correlation coefficient). Comparisons between groups were
ation dueto cardiac cause. Rightventriculardiameter(RVD) done with two-sample t-test for continuous data, with chi-
wasinverselycorrelatedtoTAPSE(r¼-0.349).Thus,logisticre- square test for categorical data. The statistical significance
gressionwasperformedincludingeitherRVDorTAPSEsepar- wasdefinedaspvalue,0.05.
ately. Lower TAPSE was a risk factor for increased early Results: Nine patients were excluded from the studydue to
cardiacmortality(OR¼0.76,95%CL¼0.56-0.96)regardlessof surgical bleeding. 45% of patients (n¼38) had blood
tricuspid surgery. To determine cut-off value of TAPSE, ROC loss.500ml/24 hours and were registered as I group. Post-
curve analysis was performed: TAPSE (AUC¼0.75) with a operative bleeding volume significantly correlated with the
cutoff of 15mm (sensitivity¼80%, specificity¼78.5%, preoperative level of PAI-1 (r¼- 0.3, p¼0.009), with haemo-
OR¼14.5) globin and platelet count at T6 after surgery (r¼20.42,
ii269
BJA
AbstractspresentedatWFSA
p,0.001; r¼- 0.3, p¼0.02). Level of preoperative PAI-1 and postoperative 24-hour blood loss were analyzed using SPSS
t-PA/PAI-1 complex after surgery significantly differed 18(Student T-test,X2, Fischer’stest,Pearson coefficient).
between I group (n¼38) and II group (n¼41): PAI-1 Results: Patients with the 5G/5G genotype had significantly
19+8.3 vs. 29+13, p,0.001; t-PA/PAI-1 3+1.4 vs. lower preoperative PAI-1 levels (17+10.8 vs. 24+9.6,
4.2+2.4,p¼0.012.PatientsinIgroupshowedasignificantly p¼0.04), higher D-dimer levels at 6h (371+227 vs. 232+
higher level of D-dimers after surgery: at T1 - 318 vs. 228, 184, p¼0.03)and at 24h (326+207 vs.209+160, p¼0.05)
p¼0.05; at T6 – 333 vs. 234, p¼0.03; at T24 – 300 vs. 197, and greater postoperative blood volume (641+210 vs.
p¼0.007. 432+167, p¼0.001) compared with 4G/4G genotype. Pre-
Discussion:EBaftercardiacsurgeryisassociatedwithdiffer- operative PAI-1 level also statistically significantly differed
entfibrinolyticactivity.Therearepatientswithalowerinhibi- between5G/5G and 4G/5G genotypes (17+10.8 vs. 27+13,
tory potential for fibrinolysis who could benefit most from p¼0.004). There were no significant differences in blood
antifibrinolytic prophylaxis. loss between 5G/5G and 4G/5G genotypes. Complex of t-PA/
Conclusion: A lower preoperative level of PAI-1 and lower PAI-1 did not statistically differed between 3 genotypes.
level of t-PA/PAI-1 complex just after surgery may lead to The highest level of t-PA/PAI-1 complex had patients with
higher levels of D-dimer later on and could be used as fi- the 4G/5G genotype (4G/5G – 3.9+2.1; 5G/5G – 3.6+2.4,
brinolytic system markers of enhanced fibrinolysis and 4G/4G – 3.1+1.8).Correlationwasfoundin4G/5Ggenotype
increased bleeding tendency. between PAI-1 level and blood loss (r¼2 0.4, p¼0.01) and
t-PA/PAI-1complexandbloodloss(r¼20.32,p¼0.04).Asso-
ciation between PAI-1 and t-PA/PAI-1 complex (r¼0.5,
Paper No: 133.00 p¼0.02) was observed in4G/4G genotype.
Conclusions: PAI-1 promoter - 675 (4G/5G) polymorphism
Influence of PAI-1 promoter polymorphism affectsPAI-1concentration,D-dimerlevelandbloodlossin-
to fibrinolytic activity of patients after dicatingthatpatientswith5G/5Ggenotypehasenhancedfi-
on-pump cardiac surgery brinolyticactivity.
Agnese Ozolina1, Eva Strike1, Inta Jaunalksne1,
Liene Nikitina-Zake2 and Indulis Vanags2 Paper No: 138.00
1PaulsStradinsClinicalUniversityHospital,Departmentof
AnaesthesiologyandCardiacsurgery,Latvia2LatvianBiomedical
ResearchandStudyCentreand3RigaStradinsUniversity,
The effect of aminophylline versus
Departmentof
milrinone on ischemia-reperfusion
Introduction:Lowplasminogenactivatorinhibitor-1(PAI-1) myocardial injury during open heart
and tissue – plasminogen activator/PAI-1 (t-PA/PAI-1)
surgery
complex are associated with increased bleeding after
on-pump cardiac surgery. PAI-1 levels are influenced by Hamdy Youssef
genetic factors. The PAI-1 gene promoter contains -
675(4G/5G) polymorphism. Introduction: Cardioplegic arrest during cardiopulmonary
Objectives: Investigate effect of the PAI-1 promoter - bypass (CPB) is essential for the majorityof cardiac surgical
675(4G/5G) polymorphism on PAI-1, t-PA/PAI-1 concentra- procedures;Cardioplegiaprotectsthemyocardiumbyprovid-
tions andon bleedingvolumeaftercardiac surgery. ing continuous or intermittent oxygen while simultaneously
Methods:Ninetypatientswhodidnotreceiveantifibrinolytic reducingcardiomyocyteoxygendemand, butitdoes notin-
prophylaxis were included in the prospective study. Study herently increase the ischemic–reperfusion injury tolerance
was approved by the institutional Committee of Ethics. We of the cardiomyocytes. Aminophylline and milrinone by
obtained informed written consent from all patients for their phosphodiesterase inhibitorand anti-inflammatoryac-
their inclusion in the study. Seven patients were excluded tivity may decrease this type of injury. Aim of the work:
duetosurgicalbleeding.Eighty-threepatientswereclassified This study has been designed to compare between the pro-
according to PAI-1 genotype: 4G/4G (n¼21), 4G/5G (n¼42), tective effect of aminophylline and milrinone during open
5G/5G (n¼20). Data of fibrinolysis were recorded: PAI-1 heart surgery forvalve replacement with CPB.
level preoperatively, D – dimer at 0h, 6h and 24 hours Patients and Methods: Afterapproval from the local ethical
after surgery, t-PA/PAI-1 complex 24 hours postoperatively. committee, Assiut university hospital,sixty adult patients
The groups were compared concerning factors which might undergoing elective single valve replacement were rando-
influence the postoperative bleeding: age, gender, body mized to receive aminophylline 5mg/kg (n¼20), milrinone
mass index, surgical parameters, hemoglobin, platelets and 50mg/kg (n¼20), or normal saline as control group
fibrinogen. Postoperative bleeding volume was registered as (n¼20) through intravenous infusion 10 minutes before
milliliters 24 hours after surgery. Association between the aortic cross-clamping. The cardiac troponin I, inotrope
genetic polymorphism, fibrinolysis parameters and score, duration of mechanical ventilation, and length of
ii270
BJA
AbstractspresentedatWFSA
ICU stay and other hemodynamic variables were measured evaluation (OD 10.41, p ,.003) and punctuality (OD 7.18, p
and recorded. ,.0001). Patients were not able to remember the name of
Results:Therewerenodifferencesbetweenthethreegroups anesthesiologist in more that 25% of surveys (this item did
withregardtoclinicalvariables.CardiactroponinIraisedsig- notinfluence theanalysis).
nificantly after declamping in the three groups, however it Conclusion:Theevaluationofpatientperceptionofanesthe-
was significantly lower in aminophylline and milrinone siology care is possible in the pre-anesthesic consultation
group compared to control group immediately after CBP procedure. The degree of satisfaction is linked more to the
and after 8 hours with no significant differences between anesthesiologist’sabilitytocommunicatethattoothervari-
aminophylline and milrinone group. inotrope score duration ables,andinducesthemtostrengtheningintheattitudesof
of mechanical ventilation and length of ICU stay showed empathyand training intheclinicalinterview.
no significantdifferences between thethree groups.
Conclusion: administration of aminophylline or milrinone References
reduces the subclinical myocardial injury with no difference
1 Hadjistavropoulos HD, Dobson J, Boisvert JA. Information provi-
betweenbothagentsandwithnoeffectonthehemodynam-
sion, patient involvement and emotional support: prospective
ic parameters or short term clinical outcome in patients
areas for improving anesthetic care. Can J Anaesth 2001; 48:
undergoing singlevalve replacement with CPB. 864–870.
2 HeideggerT,HusemanY,NueblingM,MorfD,SieberT,HuthA,etal.
Patientsatisfationwithanaesthesiacare:developementofapsy-
Paper No: 141.00 chometricquestionaireandbenchmarkingamongsixhospitalsin
SwitzerlandandAustria.BrJAnaesth2002;89:863–872.
3 DexterF,CandiottiKA.MulticenterAssessmentoftheIowaSatis-
Patients value in a pre-anesthesia faction with Anesthesia Scale, an Instrument that Measures
Patient Satisfaction with Monitored Anesthesia Care. Anesth
consultation: is possible to evaluate de
Analg.2011Apr25.
quality patient perception in anestesiology
care?
Paper No: 195.00
Maria Jose Mayorga-Buiza and
Mercedes Echevarria-Moreno
Situation diagnosis of postoperative pain
Introduction: An indicator of health service quality is the Cristian Humberto Bosio
degreeofpatientsatisfactionwithcare.Thepatientsatisfac-
tion with the anesthesiologist is difficult to measure in the Pain is an “unpleasant sensory and emotional experience,
ORforobviousreasons.However,preoperativeconsultations related to actual or potential tissue damage, or described
couldbeaperfectsituationforqualityofcareevaluationand in terms of such damage”. 1 Postoperative pain is a type of
patient perception. acute pain iatrogenic through the surgery with him being
Objective: To analyze which variables most influence the excluded biological function. Today the consequences of
degree of satisfaction of our patients after preoperative poor postoperative management are known. 2,3,4 Satisfac-
consultation. tion is currently used as an indicator of excellence in the
MaterialandMethods:Weconductedananonymoussurvey quality of care and improvement programs are intended to
in randomized patients scheduled for pre-anesthesia evalu- standardize quality pain care.5,6 The overall objective of
ation. The survey included 4 questions on a categorical thisstudywastoevaluatepostoperativepainpatientsadmit-
scale,(nosatisfied,somewhatsatisfied,regularsatisfied,sat- ted to surgical wards and thus provide data to assist in the
isfied and verysatisfied): Timeliness ofcare, Compression of strategic policy planning for treatment and sizing the need
information received, Respect and Degree of Satisfaction, for furthereffortsto improve the qualityof care. In January
and about the knowledge of anesthesiologist name who 2011, a descriptive cross sectional study was done with
evaluated them. Surveys were conducted from January patients scheduled for elective surgery who agreed to
2007 /December 2008. The statistical analysis was a binary collect data in a survey during the preoperative and post-
logisticregressionmodel,whichselectedthebestsetofpre- operative period. Also collected information on painkillers
dictorsofsatisfaction. (p?0.05). treatments prescribed. Were processed data obtained from
Results:1263surveyswereconducted.98.7%ofrespondents the descriptive analysis of variables in examination. The
considered their degree of satisfaction satisfied /very satis- study observed that 79% of respondents during the pre-
fied. The 96.95 felt sufficiently informed /well enough. operative (n¼44), thinksthatthe pain in the firstdays after
83.3% felt that punctuality in the schedule was good or surgery, is unbearable. 78% of respondents in the post-
verygoodbutonly71.8%knewthenameoftheanesthesiol- operative period (n¼55) expressed pain in the first 24
ogist who attended them. Regression analysis found: the hours following surgery, 54% of these, reported some
highest degree of satisfaction were related to information degreeofinadequateanalgesiaatthetimeoftheinterview.
received (OD 12.788, p ,.0001), perception of received We also found a significant relationship between greater
ii271
BJA
AbstractspresentedatWFSA
levelsofpainandgreaterpatientdemandforextraanalgesic Introduction: The multimodal analgesia involves the use of
dosesaccordingtoFisher’sexacttest(p¼,0.05).Thisstudy different analgesics is recommended in current practice to
showedahighprevalenceofincorrecttreatmenttomeetthe providesuperiorpainreliefandtoreduceopioidconsumption
needsofanalgesiainpostoperativepain.Diclofenacwasthe and its side effects. Gabapentin in different dosages has
drugmostusedin91%ofcasesandtherewasa80%over- been found effective to reduce opioid consumption and de-
doseofit.Onlyonecaseofopioidanalgesicsprescriptionas creasing postoperative pain. We designed this study to find
partoftreatmentwasreported.93%ofcaseswereclassified minimumoptimaldoseofgabapentintobeusedwithpeth-
as inadequate analgesic treatment because of: (i) lack of idinein ourpopulation.
extra analgesic dose prescription in the presence of pain Objective: To determine the minimum effective dose of
(93%);(ii)overdosagewithNSAIDs(78%);(iii)inadequatean- gabapentin for postoperative pain and reduced opioid con-
algesia(62%); (iv)dangerous associations between drugs of sumption in patients undergoing total abdominal
thesamegroup(25%).Thelevelofpatientsatisfactionwith hysterectomy.
analgesic therapy implemented by health personnel was Methodology: After informed consent eightyseven patients
very high as evidenced in previous studies.7 It is recom- were included in this double blinded randomized control
mended that a committee of acute pain to make analgesia study. Patients were assigned randomly to one of the three
protocols. Also the creation of a unit for pain to control the groupsto receive capsule gabapentin orally 300mg, 600mg
patients,monitortheanalgesicmethodsandteachingactiv- and900mgrespectively,onehourbeforesurgery.Postopera-
ities forallthe staff involved. tively pethidine consumption, pain score and side effects of
gabapentin were monitored for 24 hours. Rescue analgesia
References wasgiven andmonitored.
Results: The groups did not differ demographically for age,
1 FinkelDM,SchlegelHR.Dolorpostoperatorio,conceptosba´sicosy
weight and height. Mean pethidine consumption in all
fundamentosparauntratamientoadecuado.Availableat:http://
threegroupswas331mg/24hourswithnostatisticaldiffer-
www.sld.cu/galerias/pdf/sitios/anestesiologia/dolor_postop.pdf.
VisitedinOctober2010. ence among the groups. The results support the use of
2 BolibarI,CatalaE,CadenaR:Eldolorenelhospital:delosesta´n- 300mg single oral dose of gabapentin in reducing pethidine
daresdeprevalenciaalosdecalidad.Rev.Esp.Anestesiol.Reanim. consumption for postoperative analgesia Rescue analgesia
(2005);52:131–140.Availableat:http://www.sedar.es/restringido/ and number of goods and demands on PCIA data were
2005/3/131.pdf.VisitedinOctober2010. also well matched with no statistical significance. The
3 FinkelDM,SchlegelHR.Op.Cit. groups also did not differ for side effects of gabapentin like
4 Valent´ın-Lopez B, Garcia-Caballero j, Mun˜oz-Ramo´n JM, nausea, vomiting, somnolence and dizziness, howeverextu-
Aparicio-Grande P, Diez-Sebastia´n J, Criado-jimenez Atencio´n del
bation wasdelayed in 900mggroup.
dolor postoperatorio en un hospital de tercer nivel: situacio´n
Conclusion: A single oral dose of gabapentin 300mg given
inicial previa a la implantacio´n de un programa de calidad. Esp.
preoperatively is as effective as higher dose of
Anestesiol. Reanim. (2006); 53 :408–418. Available at: http://
www.sedar.es/restringido/2006/n7_2006/3.pdf. Visited in October 600-900mgforpostoperativeanalgesiawithreducedpethid-
2010. ineconsumption.
5 Zas-Ros BLa satisfaccio´n como indicador de excelencia de la
calidaddelosserviciosdesalud;Rev.Electro´nicaPsicologiaCien-
tifica. Available at:http://www.psicologiacientifica.com/bv/
psicologia-80-1-la-satisfaccion-como-indicador-de-excelencia-en- References
la-calidad-d.html.VisitedinOctober2010.
1 VandeVusseAC,Stomp-vandenBergSG,KesselsAH,WeberWE.
6 GallegoJl,Rodriguez-de-la-TorreMR,GallegoVasques-GuerreroJC, Randomised controlled trial of gabapentin in Complex Regional
Gallego Gil M; :Estimacio´n de la prevalencia e intensidad del PainSyndrometype.BMCNeurol.2004;4:13.
dolor postoperatorio y su relacio´n con la satisfaccio´n de los
2 SeibRK, PaulJE. Preoperativegabapentinforpostoperativeanal-
pacientes. Rev. Esp. Soc Esp. Dolor. (2004); Vol 11 n.4. Available
gesia:Ameta-analysis.CanJAnesth.2006;53:461–9.
at: http://scielo.isciii.es/scielo.php?pid¼S1134-80462004000400
3 KYHo,GanTJ,HabibAS.Gabapentinandpostoperativepain – A
003&script¼sci_arttext.VisitedinOctober2010.
systematic review of randomized controlled trials. Pain. 2006;
7 Valent´ın-Lopez B, Garcia-Caballero j, Mun˜oz-Ramo´n JM,
126:91–101.
Aparicio-GrandeP,Diez-Sebastia´nJ;Criado-jimenez,OpCit.
4 DierkingG,DuedahlTH,RasmussenML,etal.Effectsofgabapentin
onpostoperativemorphineconsumptionandpainafterabdominal
hysterectomy:Arandomized,double-blindtrial.ActaAnaesthesiol
Paper No: 199.00
Scand.2004;48:322–7.
5 RorariusMF,MennanderS,SuominenP.Gabapentinforthepreven-
Effect of single dose gabapentin on tionofpostoperativepainaftervaginalhysterectomy.Pain2004;
110:175.
postoperative pain and opioid consumption
6 DierkingG,DuedahlTH,RasmussenML,FomsgaardJS,MøinicheS,
following total abdominal hysterectomy:
RømsingJ,etal.Effectsofgabapentinonpostoperativemorphine
A Dose Finding Study consumption and pain after abdominal hysterectomy: a rando-
mized, double-blind trial. Acta Anaesthesiol Scand. 2004Mar;
Anand Kumar 48(3):322
ii272
BJA
AbstractspresentedatWFSA
7 PengPW,WijeysunderaDN,LiCC.Useofgabapentinforperiopera- Objectives: The purpose of this study was to see whether
tive pain control – a meta-analysis. Pain Res Manag. 2007 completionofsimulatortrainingwithasatisfactoryandspe-
Summer;12(2):85–92. cific endpoint could improve doctors ability to make a fiber
optic intubation significantly faster and more confident
thaninexperienceddoctors.
Paper No: 214.00
Methods: This study was a randomized clinical study. Ten
doctors were included equally split between the control
groupandthesimulatorgroup.Fivedoctorsreceivedtraining
The Use Of Sugammadex In Orthopedic
intheEducationalLabatTheUniversityHospital“Rigshospi-
Surgeries For The Correction Of Idiopathic
talet” in Copenhagen, Denmark. Within a week they had to
Scoliosis With Evoked Potentials perform a real fiber optic intubation on an anaesthetized
Monitorization patient in the operating room. The endpoint was time
spendduring theprocedure.
Jorge Barrios Alarcon, Wagner Kouno,
Results:Theffivedoctorsinthesimulatorgrouppracticedin
Ricardo Ferreira, Oswaldo Cavalari and
average54minutes+8minutesandcompletedbetween22
Luis Sergio Marques and33virtualfiberopticalintubations.Thentheyhadtopass
a test with specific endpoints: time used (less than 60
Sugammadex is a newpharmacologic agent utilized for the seconds), numberofcollisions (maximum 10) endeffective-
rapid reversal of non-depolarizing muscle relaxants. The ness (greater than 80%). Doctors in the control group were
purpose of this study was to demonstrate the possibility of significantly slower to FOI compared to doctors who joined
the use of sugammadex for reversal of rocuronium-induced the simulator group. Using Mann-Whitney test finding a
muscle relaxation before the start of intraoperative neuro- p-value ,0.05.Themediandifferenceis266and95%confi-
physiologic monitoring (IONM) during idiopathic scoliosis denceinterval[232to 542].
with somatosensoryevoked potentials(SSEP). Conclusion: The use of the virtual airway simulator should
Methods: 20 adult patients, with a mean age of 34+10 become a compulsory part of educating the first year resi-
years, ASA I or II were involved in the study. They all had dents in the management of difficult airways. The doctors
the diagnosis of scoliosis and were scheduled for surgeryto can gain significant better experience in the use of a fiber
correct their scoliosis with the use of SSEP. Immediately opticscopebeforemeetingapatientintheoperatingroom.
before the start of the surgical instrumentation and the
startoftheIONM,sugammadexwasadministeredaccording
References
tothetrainoffour(TOF)andanalyzedwiththeIONMat0,1
and 2minutes. 1 RoweR,CohenRA.AnEvaluationofaVirtualRealityAirwaySimu-
Results:After2minutesoftheadministrationofsugamma- lator.AnesthAnalg2002;95:62–6.
dex,allpatients had aTOF.0.9. 2 Rosenstock C et al. Qualitative analysis of unanticipated difficult
Conclusion:Theutilizationofarocuroniumspecificantagon- airwaymanagement.ActaAnaesthesiolScand2006;50:290–7
istwasefficientinpromotingthenormalizationofthemotor 3 MayroseJetal.UtilizationofVirtualrealityforendotrachealintub-
ationtraining.Resuscitation2003;59:133–8
conduction-responsetothestimulioftheIONMinapredict-
4 GoldmannK,SteinfeldtT.Acquisitionofbasicfiberopticintubation
abletime.
skillswithavirtualrealityairwaysimulator.J.ofClinicalAnaesthe-
sia2006;18:173–8.
5 Blum MG, Powers TW, Sundaresan S. Bronchoscopy Simulator Ef-
Paper No: 234.00
fectivelyPreparesJuniorResidentstoCompetentlyPerformBasic
ClinicalBronchoscopy.AnnThoracSurg2004;78:287–91
6 CrawfordSW,ColtHG.VirtualRealityandWrittenAssessmentsof
Inexperienced doctors get remarkable PotentialValuetoDetermineKnowledgeandSkillinFlexibleBron-
skills in fiberoptic intubation after specific choscopy.Respiration2004;71:269–275
7 LetterfromCamillaLindholmRasmussenCand.Jur.
training in a virtual airway simulator
Pernille Vaabengaard and
Michael Seltz Kristensen Paper No: 240.00
Rigshositalet,Blegdamsvej,Afd2073,Copenhagen,Slagelse
Sygehus,Anaestesiafdelingen,4200Slagelse,Denmark Local anesthesia for awake craniotomy
Angel Mario Ruiz, Sandra Ximena and
Introduction: It is very essential for anaesthesiologist to be
incontrolwhendealingwithadifficultairway.Thereforestu- Jaramillo Jairo Moyano
dents need to be trained in this discipline. The sooner the HospitalUniversitarioFundacionSantaFedeBogotaHospital
better. A somewhat newer method is the use of virtual UniversitarioFundacionSantaFedeBogotaHospitalUniversitario
airwaysimulators. FundacionSantaFedeBogota
ii273
BJA
AbstractspresentedatWFSA
Theintracranialtumorresectiononeloquentmotorareasare consumption, postoperative pain scores
at high risk of developing neurological deficit intrasurgery. and satisfaction in patients undergoing
Manyanesthetictechniquesareusedtoperformthissurgical
gynecologic oncologic surgery under
procedurewithsedationorintermittentanesthesiaActually,
general anesthesia
notdescribedmultimodaltechniquescombiningregionalan-
esthesia, sedationand systemicanalgesia inthese patients. Inci Kara, Seza Apiliogullari, Bahar Oc,
Weuseatechniqueawake,consistentwiththeimplementa- Jale Bengi Celik and Ates Duman
tion of a complete blockade of scalp plus sedation and
SelcukUniversity,SelcukluMedicalFaculty,Departmentof
analgesia.
AnesthesiologyandIntensiveCare
Objective: To assess the quality of anesthesia, reliability
neurologicalmonitoring andcontrolof anxiolysis
Introduction: Gynecologic cancers represent a major health
Methodology:Thestudyincluded6patientsdiagnosedwith
problem among women(1). Gynecologic oncologic surgery
tentorial tumor in neighborhood to eloquent areas with
includes a wide variety of surgical procedures. (2). Post-
radiological signs of intracranial hypertension. Patients
operative pain is a majorconcern in these patients because
without pulmonary or cardiac pathology with Midazolam
it affects multiple systems and induces physiological, im-
wastitratedwithdosesof0.2to04mg/kgIVdoseandremi-
munological,and psychological changes(3)
fentanil 0.03to 0.05 ug /kg/ minplus andscalpblockwith
Objectives:Weaimedtocompareintrathecalmorphineplus
lidocaine 2% WOE and bupivacaine 0, WOE 5% at level of
patient-controlled analgesia with patient-controlled anal-
greater and lesser occipital, supraorbital and inferior troch-
gesia alone on morphine consumption, pain relief and
learandmandibularnerves.Antiemeticprophylaxis.Weeval-
patients satisfaction after gynecologic oncologic surgery
uated nausea, vomiting and respiratory depression,
(GOS)undergeneralanesthesia
cooperative patient, occurrence of neurological deficit, and
Metods: In this double-blinded, randomized, controlled
postoperativepain.
study, 60 women undergoing GOSwere allocated to receive
Results: All patients were partners (in our scale level of co-
either intrathecal morphine 0.3mg (Group 1) or placebo
operation was good) and were able to perform adequately
group(Group2).Fortheplacebogroup,theskinwaspunctu-
neurological assessment. The average operative time was
redwiththedentalneedle,butitwasnotadvancedbeyond
between 1–5 hours, the most common tumors were
the subcutaneous tissue. Monitoring and anesthesia were
gliomas located in eloquent 50% air and 50% in motor
standardized.Anesthesiawasinducedwith2mg.kg-1ofpro-
areas. Neurological changes were monitored during surgery
pofol and 2mg.kg-1 of fentanyl. and 0.6mg.kg-1. of rocuro-
in48%ofpatients.Adverseeventsattributabletoanesthesia
nium. After tracheal intubation, anesthesia was maintained
weremoderatehypercapniain16%withoutotherassociated
with a mixture of air (0.5L/min) and oxygen (0.5L/min)
complications. One patient (16%) showed a complication
plus 1 MAC of desflurane On arrival to the postanesthesia
transoperative, presented a focal motor seizures, which
care unit (PACU), each patient received a PCA pump pro-
yielded spontaneously. 84% of patients does’t require sys-
grammed to deliver an initial morphine bolus of
temicanalgesics in thefirst6hours postoperative
0.05mg.kg-1 at 7min intervals if pain was more than 60
Discussion:Theimplementationofthistechniqueaswellas
ontheVAS.OndischargefromthePACUthepumpwasrepro-
being innovative in neurosurgical patients turns out to be a
grammed for a morphine bolus of 1.5mg and a 7min
safe technique to avoid the continual changes in patient’s
lockout interval and no background infusion. The primary
anesthetic depth and therefore hemodynamic changes to a
outcome measure was pain relief and patient satisfaction
patient with intracranial hypertension should not besubject
which evaluated by using 100mm VAS (0-100). Secondary
toalterationincerebralautoregulationandthelossofcom-
outcomes were morphine consumption, and side effects in-
pliance, so we recommend the use of this technique in a
cluding nausea, vomiting, pruritus, sedation, fatigue and re-
properpatientselectioninrelationtoanxietyandpreexisting
spiratory depression. Outcome measures were recorded by
comorbidities for resection of tumors that allow continuous
the same trained nursing staff. at 30min., 1, 3, 6, 12, 24
neurologic payment in intra-and postoperative . We saw
and48hpostoperatively.Inapilotstudy20patientsenrolled
thesamemannerasthepatientshadadequatepaincontrol
to GOS under GA consumed an average of 57+ 21mg of
Conclusion:Blockadeofthescalpinassociationwithmidazo-
morphine in the first 48h with PCA pump. To achieve a
lamandremifentaniliseffectiveandsafeforadministration
one-third reduction of opioid consumption with an a´ error
in awake craniotomy for tumor resection in, allowing
of 0.005 and a power of 90%, we needed 26 patients in
optimum collaboration and neurologicalassessment.
each group.
Results: Fifty six women (28 intrathecal and 28 plasebo)
completed the study. No differences were noted with
Paper No: 273.00
respecttoage,weight,height,timeofsurgeryandoperation
typebetweenthegroups.Significantdifferencewasdemon-
The effects of intrathecal morphine on strated in morphine consumption(19.25+13mg and
54.23+22mg in group 1 and group 2 respectively) and
patient-controlled analgesia morphine
ii274
BJA
AbstractspresentedatWFSA
fatique scores. Satisfaction scores and side effects were both hearts Improve ejection times Reduce costs Control
similar in both groups. Conclusion In conclusion, 0.3mg through hemodynamics and transoesophageal
intrathecal morphine in gynecologic oncologic surgery echocardiogram
couldimprovepostoperativeanalgesiaandreducemorphine Results:Ofeleventransplantstherewere2deaths – onedue
consumptionwithout anyserious sideeffects. tohepatopathybecauseofalcoholismandoneduetoacute
vascular rejection.
References Discussion:Theheterotopiccardiactransplanthassomedif-
ficulties such as incorrect synchrony if donor’s heart rate is
1 JemalA,SiegelR,XuJ,WardE.Cancerstatistics.CACancerJClin
2010;60:277–300 higher than recipient’s one; supraventricular arrhythmias of
2 Chen LM, Weinberg VK, Chen C, Powell B, Chen LL, Chan JK, recipient’sordonor’sheart.Whenchoosingonepacemaker,
Burkhardt DH. Perioperative outcomes comparing patient con- thedonor’sheart,whosesinusnodewaselectrocoagulated,
trolledepiduralversusintravenousanalgesiaingynecologiconcol- allowsthenativehearttoachievesynchronyattheventricu-
ogysurgeryGynecologicOncology115(2009)357–361 lar level, generating a physiological synchronysince the au-
3 Kehlet H, Holte K. Effect of postoperative analgesia on surgical tonomous nervous system is preserved and acts on the
outcome.BrJAnaesth2001;87:62–72
cardiac rhythmof therecipient’s heart.
Conclusion: In the world there are more than 100 people
with two hearts. Our experience, the only one in Latin
Paper No: 275.00
America, shows that heterotopic cardiac Tx is a valid
therapy when there is more than 10% donor/recipient mis-
Heterotopic cardiac transplant
match orsevere pulmonary vascular resistance.
Nelson Ruiz and Claudio Burgos
Paper No: 288.00
Introduction: Heterotopic cardiac transplant is avalid alter-
native:(i)whentherecipientisaffectedbypulmonaryhyper-
tension secondary to his left chronic cardiomyopathy and
Perioperative blood glucose level in non
thereisimminentriskofacuterightventriculardysfunction;
(ii) in patients with heart disease with healing possibilities diabetic patients undergoing on pump
and no long lasting mechanic assist devices available; and versus off pump coronary artery bypass
(iii) whenthe donor hasamismatch higherthan20%. grafting
Objetives: Describe the surgical procedure and the experi-
Hamid Kamalipour, Hedayatollah Akhlagh,
enceof thisdepartment.
Material and Method: We studied eleven patients whose Gholamreza Dabiri and Karmella Kamali
prevalent pathologies were idiopathic dilated cardiomyop-
athy, hypertensive cardiomyopathy. Sinus rhythm was pre- Background: Hyperglycemia during cardiac surgery is asso-
dominant in most cases. The average waiting time was of ciated with poor outcomes, more complications and
271 days. Eight transplants were elective, one urgent and increased mortality not only in diabetic patients but also in
twoemergencies. Thetechnique: patients who are not previously diagnosed with diabetes.
DonorRecipient:PulmonaryArteryRightAtriumLeftAtrium The purpose of this study is to compare perioperative blood
Left Atrium Aorta Artery Aorta Artery (end-to-side) Closed glucose level in off-pump CABG versus on pump CABG in
VenaeCavae non diabetic patients undergoing coronary artery bypass
grafting.
† Donor LVejectstowardsAo, inits diastole.
Methods:Onehundredfiftyconsecutivepatientsaged40to
† RecipientLVejects duringdonor’s diastole.
65yearsold,ASAclassIIorIII,ejectionfraction40%ormore
—if this is not the case, there will be blood stasis with wereenrolled.Onehundredenrolleeswentthroughonpump
arrhythmias, displacement of interventricular septum, cardiac surgery whereas fifty enrollees were operated
thromboembolic phenomenon, cardiac arrest. In order to without cardiopulmonary bypass. Blood glucose level was
achieve the above, both hearts were synchronized with 2 recorded six times; before induction of anesthesia, afteran-
dual-chamberpacemakers (DDDR). esthesia induction, before grafting, after grafting, 30
Pacemaker-1: ABEE connected to recipient’s RA VBEE con- minutes after protamine administration and1stpost opera-
nected to donor’sRA tive hour. Statistical analysis was performed with SPSS soft-
Pacemaker-2: ABEE connected to recipient’s RV VBEE con- ware version 15(Chicago,IL, USA)
nected to donor’sLV Results: Both groups showed ascending trend in periopera-
Anotheroptionisusingonepacemaker(DDD).Pacemaker-1: tive blood glucose level but there was no significant differ-
ABEEconnectedtorecipient’sRVVBEEconnectedtodonor’s ence between them except for post grafting blood
LV glucose(p¼0.02). There was an increasing pattern of hyper-
—with this we are able to: Simplify synchronization and AV glycemiafromintraoperativeperiod(about13%)topostop-
interval programming Userecipient’s sinus node to manage erative period (up to 90%) in both on pump and off pump
ii275