scholarly journals Comparison of the Effects of Ketamine-Dexmedetomidine and Sevoflurane-Sufentanil Anesthesia on Cardiac Biomarkers After Cardiac Surgery: An Observational Study

2012 ◽  
pp. 63-72 ◽  
Author(s):  
H. ŘÍHA ◽  
T. KOTULÁK ◽  
A. BŘEZINA ◽  
L. HESS ◽  
P. KRAMÁŘ ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Observational Study ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Ischemia Reperfusion ◽  
Artery Bypass ◽  
Experimental Studies ◽  
Cardiac Troponin I ◽  
Cardiac Biomarkers ◽  
Cardioprotective Effects

Inhalational anesthetics have demonstrated cardioprotective effects against myocardial ischemia-reperfusion injury. Clinical studies in cardiac surgery have supported these findings, although not with the consistency demonstrated in experimental studies. Recent investigations have questioned the advantages of inhalational over intravenous anesthetics with respect to cardiac protection. Ketamine has been shown to be comparable with sufentanil, and has even demonstrated anti-inflammatory properties. Dexmedetomidine has been established as a sedative/anesthetic drug with analgesic properties, and has also demonstrated myocardial protective effects. In this retrospective observational study, the influence of ketamine-dexmedetomidine-based anesthesia (KET-DEX group; n=17) on the release of cardiac biomarkers was compared with that of sevoflurane-sufentanil-based anesthesia (SEVO group; n=21) in patients undergoing elective coronary artery bypass grafting. Compared with the SEVO group, the KET-DEX group exhibited significantly reduced cardiac troponin I (2.22±1.73 vs. 3.63±2.37 µg/l; P=0.02) and myocardial fraction of creatine kinase (CK-MB) levels (12.4±10.4 vs. 20.3±11.2 µg/l; P=0.01) on the morning of the first postoperative day. Furthermore, cardiac troponin I release, evaluated as the area under the curve, was significantly reduced in the KET-DEX group (32.1±20.1 vs. 50.6±23.2; P=0.01). These results demonstrate the cardioprotective effects of ketamine-dexmedetomidine anesthesia compared with those of sevoflurane-sufentanil anesthesia.

Propofol Is Cardioprotective in a Clinically Relevant Model of Normothermic Blood Cardioplegic Arrest and Cardiopulmonary Bypass

2005 ◽  
Vol 230 (6) ◽  
pp. 413-420 ◽  
Author(s):  
Kelvin H. H. Lim ◽  
Andrew P. Halestrap ◽  
Gianni D. Angelini ◽  
M.-Saadeh Suleiman
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Function ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Ischemia Reperfusion ◽  
Cardiac Troponin I ◽  
Cardioplegic Arrest ◽  
Relevant Model ◽  
Blood Cardioplegia

The general anesthetic propofol has been shown to be cardioprotective. However, its benefits when used in cardioplegia during cardiac surgery have not been demonstrated. In this study, we investigated the effects of propofol on metabolic stress, cardiac function, and injury in a clinically relevant model of normothermic cardioplegic arrest and cardiopulmonary bypass. Twenty anesthetized pigs, randomized to propofol treatment ( n = 8) and control ( n =12) groups, were surgically prepared for cardiopulmonary bypass (CPB) and cardioplegic arrest. Doses of warm blood cardioplegia were delivered at 15-min intervals during a 60-min aortic cross-clamped period. Propofol was continuously infused for the duration of CPB and was therefore present in blood cardioplegia. Myocardial biopsies were collected before, at the end of cardioplegic arrest, and 20 mins after the release of the aortic cross-clamp. Hemodynamic parameters were monitored and blood samples collected for cardiac troponin I measurements. Propofol infusion during CPB and before ischemia did not alter cardiac function or myocardial metabolism. Propofol treatment attenuated the changes in myocardial tissue levels of adenine nucleotides, lactate, and amino acids during ischemia and reduced cardiac troponin I release on reperfusion. Propofol treatment reduced measurable hemodynamic dysfunction after cardioplegic arrest when compared to untreated controls. In conclusion, propofol protects the heart from ischemia-reperfusion injury in a clinically relevant experimental model. Propofol may therefore be a useful adjunct to cardioplegic solutions as well as being an appropriate anesthetic for cardiac surgery.

scholarly journals Pre-cardiopulmonary bypass administration of dexmedetomidine decreases cardiac troponin I level following cardiac surgery with sevoflurane postconditioning

2019 ◽  
Vol 47 (8) ◽  
pp. 3623-3635
Author(s):  
Hong-mei Zhou ◽  
Xiao-yan Ling ◽  
Yun-jian Ni ◽  
Cheng Wu ◽  
Zhi-peng Zhu
Keyword(s):  
New York ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Damage ◽  
Heart Association ◽  
Cardiac Troponin I ◽  
Sevoflurane Postconditioning ◽  
Ctni Level

Objective This study was performed to determine the effect of dexmedetomidine (DEX) administration on myocardial damage in cardiac surgery with sevoflurane postconditioning. Methods We retrospectively examined all cardiac valve replacement surgeries from 1 April 2016 to 30 April 2017. Eligible patients were divided into two groups based on whether DEX was infused. DEX infusion was permitted only between intubation and the beginning of cardiopulmonary bypass (CPB). Sevoflurane was inhaled via the standard postconditioning procedure starting at aortic declamping. The cardiac troponin I (cTnI) level was measured at different time points. The postoperative outcomes and complications were also analyzed. Results One hundred patients were included in the study (DEX group, n = 53; non-DEX group, n = 47). Increased cTnI levels were significantly correlated with the New York Heart Association classification, CPB time, and DEX use. DEX use and the CPB time were potential independent factors contributing to changes in the cTnI level. The cTnI level at 6, 12, and 24 hours postoperatively was remarkably lower in the DEX than non-DEX group by 1.14, 7.83, and 5.86 ng/mL, respectively. Conclusions DEX decreased the cTnI level after CPB when sevoflurane postconditioning was used, especially at 6, 12, and 24 hours postoperatively.

scholarly journals Relationship Between Postoperative Cardiac Troponin I Levels and Outcome of Cardiac Surgery

Circulation ◽  
2006 ◽  
Vol 114 (14) ◽  
pp. 1468-1475 ◽  
Author(s):  
Bernard L. Croal ◽  
Graham S. Hillis ◽  
Patrick H. Gibson ◽  
Mohammed T. Fazal ◽  
Hussein El-Shafei ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I

scholarly journals eComment: Is early assessment of cardiac troponin I a valuable predictor of mortality after cardiac surgery?

2010 ◽  
Vol 10 (3) ◽  
pp. 416-417 ◽  
Author(s):  
Petros Tzimas ◽  
Nikolaos G. Baikoussis ◽  
Kallirroi Kalantzi ◽  
Georgios Papadopoulos
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Early Assessment ◽  
Valuable Predictor

scholarly journals Cardiac Troponin I Concentrations, but Not Electrocardiographic Results, Predict an Extended Hospital Stay after Coronary Artery Bypass Graft Surgery

2005 ◽  
Vol 51 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Robert F Salamonsen ◽  
Hans-Gerhard Schneider ◽  
Michael Bailey ◽  
Andrew J Taylor
Keyword(s):  
Coronary Artery ◽  
Hospital Stay ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cardiac Troponin I ◽  
Cardiac Damage ◽  
Simple Method ◽  
Cabg Surgery

Abstract Background: Cardiac damage in coronary artery graft (CABG) surgery is an important contributor to postoperative cardiac dysfunction and delayed hospital discharge. Currently, no simple method exists for its quantification. Methods: In a prospective study of 300 patients having routine CABG surgery, we compared cardiac troponin I (cTnI) concentrations at 6 and 24 h after surgery with electrocardiographic (ECG) results as predictors of an extended postoperative stay in the intensive care unit (ICU) and in the hospital. We stratified outcome variables by tertiles of cTnI concentration and studied the significance of differences between outcome variables across tertiles. Results: Multivariate analysis showed that 24-h cTnI is a significant predictor of increased postoperative ICU stay (P = 0.012) and postoperative hospital stay (P = 0.024). For 6-h cTnI, corresponding significance values were P = 0.29 and 0.9. ECG was of no value (P = 0.39 and 0.47). Differences in 24-h cTnI were highly significant, particularly for lowest vs highest tertiles, and allowed stratification of risk into “low” (<10 μg/L), “equivocal” (10–20 μg/L), and “high” (>20 μg/L). Conclusions: Use of a single 24-h cTnI value to quantify perioperative myocardial damage identifies patients who are at greater risk of extended ICU and hospital stays. This strategy could assist in allocation of patients to different management streams after CABG surgery.

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