Results Generated From:
EMBASE <1980 to 2010 Week 27>
EMBASE (updates since 2010-07-02)
<1>
[Use Link to view the full text]
Accession Number
2010345555
Authors
Veldman A.
Institution
(Veldman) Monash Newborn, Monash Medical Centre, Monash University, 246
Clayton Rd, Clayton 3168, VA, Australia.
(Veldman) Ritchie Centre for Baby Health Research, Monash Institute of
Medical Research, Monash University, Clayton, VA, Australia.
Title
Complications of hydroxyethyl starch in paediatric patients.
Source
European Journal of Anaesthesiology. 27(1)(pp 86-87), 2010. Date of
Publication: January 2010.
Publisher
Lippincott Williams and Wilkins
<2>
[Use Link to view the full text]
Accession Number
2010345546
Authors
Cui W. Li Y. Li S. Wang R. Li J.
Institution
(Cui, Li, Li) Department of Anesthesia, China.
(Wang) National Center for Clinical Pharmacology, Capital Medical
University affiliated Beijing Friendship Hospital, China.
(Li) Department of Neurobiology Beijing Institute for Neuroscience,
Capital Medical University, Beijing, China.
(Li) Department of Neurobiology and Beijing Institute for Neuroscience,
Capital Medical University, #10 You An Men Wai Xi Tou Tiao, Beijing
100069, China.
Title
Systemic administration of lidocaine reduces morphine requirements and
postoperative pain of patients undergoing thoracic surgery after
propofol-remifentanilbased anaesthesia.
Source
European Journal of Anaesthesiology. 27(1)(pp 41-46), 2010. Date of
Publication: January 2010.
Publisher
Lippincott Williams and Wilkins
Abstract
Background and objective Remifentanil is being increasingly used as an
analgesic in fast-track surgery, but severe postoperative pain may happen
occasionally. In this study, we evaluated the effects of systemic
administration of lidocaine on postoperative pain and morphine
requirements after propofol-remifentanil-based anaesthesia. Methods Forty
patients undergoing thoracic surgery were randomly assigned to lidocaine
(33.0mugkg-1 min-1) and physiological saline control groups in propofol-
remifentanil-based anaesthesia. The setting of the plasma concentration (C
p) of the target-controlled infusion of propofol was adjusted according to
the bispectral index of the electroencephalogram and blood pressure. The
Cp and effect-site concentration (Ce) of propofol were calculated by
target-controlled infusion pump during the intraoperative period. Pain
scoring includes a four-point verbal rating scale, Riker's
sedation-agitation scale and a visual analogue scale; the morphine
requirement in the postanaesthesia care unit and the morphine consumption
via a patient-controlled analgesia device on the ward were recorded during
the postoperative period.Results Morphine requirements within 30, 30-60
and 0-120 min in the postanaesthesia care unit of the lidocaine group
decreased significantly (P<0.05, nU20 per group)compared with that of the
control group. The four-point verbal rating scale at 30 min in the
postanaesthesia care unit, visual analogue scale at 6 h on coughing and
patient-controlled analgesia morphine consumption during 2-6 h
postoperative time were also significantly (P<0.05, nU20 per group)
reduced in the lidocaine group. In addition, the intraoperative propofol
Ce in the lidocaine group during the periods of intubation, organ
resection, closing of chest cavity and extubation was significantlylower
(P<0.05, nU20 per group) than that in the control group under the same
hypnotic depth. Conclusion Systemic administration of lidocaine could
reduce morphine requirements, postoperative pain and intraoperative
propofol Ce of patients undergoing thoracic surgery after
propofol-remifentanil- based anaesthesia. copyright 2010 European Society
of Anaesthesiology.
<3>
Accession Number
2010350858
Authors
Kowalczyk M. Banach M. Lip G.Y.H. Kozlowski D. Mikhailidis D.P. Rysz J.
Institution
(Kowalczyk, Rysz) Department of Nephrology, Hypertension and Family
Medicine, Medical University of Lodz, Lodz, Poland.
(Banach) Department of Hypertension, Medical University of Lodz, Lodz,
Poland.
(Lip) University of Birmingham, Centre for Cardiovascular Sciences, City
Hospital, Birmingham, United Kingdom.
(Kozlowski) Department of Cardiology and Electrotherapy, Medical
University of Gdansk, Gdansk, Poland.
(Mikhailidis) Department of Clinical Biochemistry, Medical School,
University College London, London, United Kingdom.
Title
Levosimendan - A calcium sensitising agent with potential anti-arrhythmic
properties.
Source
International Journal of Clinical Practice. 64(8)(pp 1148-1154), 2010.
Date of Publication: July 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Levosimendan is a 'Ca2+sensitiser', which exerts its inotropic effect by
increasing the affinity of troponin C for Ca2+, directly stabilising the
Ca2+-induced conformation of troponin C. It leads to a positive inotropic
effect without impairing diastolic relaxation and causing cytosolic Ca2+
ion overload, which might result in cardiac myocyte dysfunction,
arrhythmias and cell death. Levosimendan may also have significant
anti-inflammatory properties. Data from various studies suggest that
levosimendan might have anti-arrhythmic effects, although the outcome of
clinical trials on the effect of this agent in (for example) atrial
fibrillation (AF) remains controversial. Currently, on the basis of
available data, it is especially worth emphasising the potential role of
this drug in the termination of AF after cardiac surgery, which
significantly influences early- and long-term morbidity and mortality.
This review considers the putative anti-arrhythmic properties of
levosimendan and discusses the potential clinical application of such a
drug. copyright 2010 Blackwell Publishing Ltd.
<4>
Accession Number
2010350843
Authors
Farooqi F.M. Talsania S. Hamid S. Rinaldi C.A.
Institution
(Farooqi, Talsania, Hamid, Rinaldi) St Thomas' Hospital, Guy's and St
Thomas' Hospitals, NHS Foundation Trust, London, United Kingdom.
Title
Extraction of cardiac rhythm devices: Indications, techniques and outcomes
for the removal of pacemaker and defibrillator leads.
Source
International Journal of Clinical Practice. 64(8)(pp 1140-1147), 2010.
Date of Publication: July 2010.
Publisher
Blackwell Publishing Ltd
Abstract
Cardiac rhythm management devices (pacemakers) are being increasingly
implanted worldwide not only for symptomatic bradycardia, but also for the
management of arrhythmia and heart failure. Their use in more elderly
patients with significant comorbidities is rising steeply and consequently
long-term complications are increasingly arising. Such an increase in
device therapy is being paralleled by an increase in the requirement for
system extraction. Safe lead extraction is central to the management of
much of the complications related to pacemakers. The most common
indication for lead extraction is system infection Adhesions in
chronically implanted leads can become major obstacles to safe lead
extraction and life-threatening bleeding and cardiac perforations may
occur. Over the last 20 years, specific tools and techniques for
transvenous lead extraction have been developed to assist in freeing the
lead body from the adhesions. This article provides a comprehensive review
of the indications, tools, techniques and outcomes for transvenous lead
extraction. The success rate largely depends on the time from implant. Up
to 12 months from implant, it is rare that traction alone will not
suffice. For longer lead implant duration, no single technique is
sufficient to address all extractions, but laser provides the best chance
of extracting the entire lead. Operator experience is vital in determining
success as familiarity of a wide array of techniques will increase the
likelihood of uncomplicated extraction. Long implantation time, lack of
operator experience, ICD lead type and female gender are risk factors for
life-threatening complications. Lead extraction should therefore, ideally
be performed in high volume centres with experienced staff and on-site
support from a cardiothoracic surgical team able to deal with bleeding
complications from cardiovascular perforation. copyright 2010 Blackwell
Publishing Ltd.
<5>
Accession Number
2010336579
Authors
Carrier M. Perrault L.P. Fortier A. Bouchard D. Pellerin M.
Institution
(Carrier, Perrault, Bouchard, Pellerin) Department of Cardiac Surgery,
Montreal Heart Institute, Universite de Montreal, Montreal, QC, Canada.
(Fortier) Montreal Heart Institute Coordinating Center, Montreal, QC,
Canada.
Title
L-arginine supplemented nondiluted blood cardioplegia: A clinical trial.
Source
Journal of Cardiovascular Surgery. 51(2)(pp 283-287), 2010. Date of
Publication: April 2010.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. L-arginine was shown to improve protection of the myocardium during
coronary artery bypass graft (CABG) surgery. The objective of the present
study was to determine the concentration of L-arginine to obtain the most
effective protection of the myocardium during CABG surgery. Methods.
Seventy-five patients undergoing CABG surgery were randomized in 3 groups.
The first group (N.=25) was administered a placebo injection in the blood
cardioplegic solution, the second group (N.=25) received an injection of 4
mmol/L of L-arginine and a third group (N.=25) an injection of 6 mmol/L of
L-arginine in the blood cardioplegic solution. Blood samples from the
ascending aorta and the coronary sinus catheter were collected before,
immediately after and at 20 minutes after aortic cross-clamping. Total
plasmatic nitrite and nitrate ratio and lactate release from the
myocardium in the collected blood samples were measured. Results.
Seventy-five patients averaging 62+/-7 years of age and undergoing 3.1+/-1
coronary bypass grafts during 41+/-17 minutes of aortic cross clamping
time were recruited. Values of total plasmatic nitrite and nitrate ratio
remains non-significant before and after aortic clamping and also between
groups (P=0.9812 and 0.3573 respectively). Myocardial lactate release was
statistically different before and after cross clamping (P=0.0002) and
also between the 3 groups (P=0.0311). Conclusion. Nondiluted blood
cardioplegic solution supplemented with 4 mmol/L of L-arginine was
associated with a significant decrease of myocardial lactate release after
aortic cross-clamping and reperfusion during CABG surgery.
<6>
Accession Number
2010336575
Authors
Wang J. Wu J.J. Ren X.Y. Chen C.L. Qiao J. Abudureheman M. Zheng H.
Institution
(Wang, Wu, Ren, Chen, Zheng) Department of Anesthesiology, Xinjiang
Medical University, No. 1, Li yu Shan Street, Urumqi, Xinjiang, China.
(Qiao, Abudureheman) Department of Cardiac Surgery, Xinjiang Medical
University, Urumqi, China.
Title
Application of low-volume zero-balanced ultrafiltration and its effect on
blood propofol concentration: A randomized controlled trial.
Source
Journal of Cardiovascular Surgery. 51(2)(pp 257-263), 2010. Date of
Publication: April 2010.
Publisher
Edizioni Minerva Medica S.p.A.
Abstract
Aim. The aim of this study was to evaluate the effectiveness of low-volume
zero-balanced ultrafiltration during cardiopulmonary bypass in heart valve
replacement surgery. Methods. This was a randomized, double-blind,
controlled study carried out in the operating room. Forty patients of ASA
grade II-III, elected to undergo heart valve replacement surgery, were
enrolled. All patients were randomly assigned to either a low-volume (35
mL/kg) zero-balanced ultrafiltration group (N.=20) or to a control group
(N.=20). Blood propofol concentrations and entropy index were measured
using cardiopulmonary bypass. Concentrations of plasma tumor necrosis
factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10),
and cardiac troponin I were measured before and after the end of
cardiopulmonary bypass and corrected according to hematocrit. Results.
Blood levels of cardiac troponin I, TNF-alpha, IL-6, and IL-10 after
surgery were all significantly lower in the ultrafiltration group than in
the control group (P<0.05) after the end of bypass. Blood propofol
concentrations decreased significantly in both groups during
cardiopulmonary bypass and remained significantly lower in the
ultrafiltration group than the control group. However, there was no
significant difference between the two groups in the entropy index
(P=0.5583). Conclusion. Low-volume zero-balanced ultrafiltration performed
during cardiopulmonary bypass surgery significantly decreased post-bypass
levels of the cytokines, TNF-alpha, IL-6, IL-10, and postoperative cardiac
troponin I. Blood propofol concentration was also decreased; however, the
depth of anesthesia was not affected significantly.
<7>
Accession Number
2010289898
Authors
Kim S. Kim H.K. Kang D.-Y. Jeong J.M. Choi Y.H.
Institution
(Kim) Department of Nuclear Medicine, College of Medicine, Korea
University Guro Hospital, South Korea.
(Kim, Kang, Choi) Department of Thoracic and Cardiovascular Surgery,
College of Medicine, Korea University Guro Hospital, South Korea.
(Jeong) Department of Nuclear Medicine, College of Medicine, Seoul
National University, Seoul, South Korea.
Title
Intra-operative sentinel lymph node identification using a novel
receptor-binding agent (technetium-99m neomannosyl human serum albumin,
99mTc-MSA) in stage I non-small cell lung cancer.
Source
European Journal of Cardio-thoracic Surgery. 37(6)(pp 1450-1456), 2010.
Date of Publication: June 2010.
Publisher
Elsevier
Abstract
Objective: In the previous report, to simplify the synthesis and labelling
procedures and to improve the biological properties, we developed a novel
mannose receptor-binding agent, technetium-99m human serum albumin
(99mTc-MSA), for sentinel lymph node detection. This study is the first
clinical trial designed to test the reliability and feasibility of
sentinel node detection using this new radioactive agent in patients with
stage I non-small cell lung cancer. Methods: Forty-two patients (30 men,
12 women; mean age 63.3 +/- 8.9 years) that were candidates for lobectomy
with mediastinal lymph node dissection for stage I non-small cell lung
cancer were enrolled. A total dose of 1 mCi of 99mTc-MSA in 0.2 ml was
administered in one shot at the peritumoural region approximately 3 h
before surgery. The radioactivity in the lymph nodes was counted before
(in vivo) and after (ex vivo) dissection with a hand-held gamma probe. A
sentinel lymph node was defined as any node for which the radioactivity
count was 5 times that of the resected lung tissue with the lowest count
for the ex vivo counts. All harvested lymph nodes were cut into 2-mm
slices and ultimately diagnosed by using formalin-fixed and
paraffin-embedded sections with haematoxylin and eosin staining. Results:
99mTc-MSA was taken up by the lymph nodes and its detection did not change
until 21 h after the injection. The number of dissected lymph nodes per
patient was 22.1 +/- 11.6 (range 4-57). Among 42 patients, the sentinel
lymph nodes could be identified in 40 patients (95.2%). The number of
sentinel lymph nodes identified was 2.3 +/- 1.1 stations (range 1-5) per
patient. Ten out of 40 patients (25.0%) had metastases in 11 sentinel
lymph nodes. Three of these 11 sentinel lymph nodes (27.3%) had skip
metastases. No false-negative sentinel lymph nodes were detected in any of
the 10 patients with N1 or N2 disease (0%). The relationship between in
vivo and ex vivo results for mediastinal sentinel lymph nodes showed
concurrence in 29 out of 40 patients (72.5%). Conclusions: Intra-operative
sentinel lymph node identification using 99mTc-MSA appears to be feasible
and reliable in stage I non-small cell lung cancer. copyright 2010
European Association for Cardio-Thoracic Surgery.
<8>
Accession Number
2010289874
Authors
Ngaage D.L. Bland J.M.
Institution
(Ngaage) Cardiothoracic Centre, Castle Hill Hospital, Kingston-Upon-Hull,
East Yorkshire, United Kingdom.
(Bland) Department of Health Sciences, University of York, United Kingdom.
Title
Lessons from aprotinin: is the routine use and inconsistent dosing of
tranexamic acid prudent? Meta-analysis of randomised and large matched
observational studies.
Source
European Journal of Cardio-thoracic Surgery. 37(6)(pp 1375-1383), 2010.
Date of Publication: June 2010.
Publisher
Elsevier
Abstract
In view of the safety concerns that led to the withdrawal of aprotinin,
should antifibrinolytics be used indiscriminately in cardiac surgery? This
meta-analysis examines the efficacy and safety profile of tranexamic acid,
and in comparison to aprotinin. We identified randomised trials and large
observational studies investigating the use tranexamic acid from January
1995 to January 2009 using Pubmed/Cochrane search engine and included them
in a two-tier meta-analysis. There were 25 randomised trials and four
matched studies with a total of 5411 and 5977 patients, respectively,
reporting tranexamic acid use in varying dosages. Tranexamic acid is
administered intravenously either as single dose, infusion or both,
sometimes added to pump prime or applied topically. Total intravenous dose
of tranexamic acid varies from 1 g to 20 g, administered over a period of
20 min to 12 h. Compared with placebo, tranexamic acid is associated with
a lower mean difference in blood loss (random effect -298 ml, 95%
confidence [CI] -367 to -229, p < 0.001) and decease in rates of
re-operation for bleeding by 48%, transfusion of packed red cell by 47%
and use of haemostatic blood products by 67%. A non-significant tendency
for postoperative neurological events but a decrease in operative
mortality was observed in patients treated with tranexamic acid compared
with non-treatment group. Compared to aprotinin, tranexamic acid has less
effective blood-conserving effect and mortality risk. Given the potential
to increase neurological complications, the current trend towards
indiscriminate use of tranexamic acid for all cardiac patients needs to be
re-evaluated. Further studies are needed to clarify the neurological risk,
appropriate indications and dosing of tranexamic acid. copyright 2010
European Association for Cardio-Thoracic Surgery.
<9>
Accession Number
2010352165
Authors
Armitage J.M. Bowman L. Clarke R.J. Wallendszus K. Bulbulia R. Rahimi K.
Haynes R. Parish S. Sleight P. Peto R. Collins R.
Institution
(Armitage, Bowman, Clarke, Wallendszus, Bulbulia, Rahimi, Haynes, Parish)
SEARCH Study, Clinical Trial Service Unit, University of Oxford, Old Road
Campus, Roosevelt Drive, Oxford OX3 7LF, United Kingdom.
(Sleight) Department of Cardiovascular Medicine, University of Oxford,
United Kingdom.
(Peto, Collins) Clinical Trial Service Unit, University of Oxford, United
Kingdom.
Title
Effects of homocysteine-lowering with folic acid plus vitamin B 12 vs
placebo on mortality and major morbidity in myocardial infarction
survivors: A randomized trial.
Source
JAMA - Journal of the American Medical Association. 303(24)(pp
2486-2494), 2010. Date of Publication: June 23-30 2010.
Publisher
American Medical Association
Abstract
Context: Blood homocysteine levels are positively associated with
cardiovascular disease, but it is uncertain whether the association is
causal. Objective: To assess the effects of reducing homocysteine levels
with folic acid and vitamin B12 on vascular and nonvascular outcomes.
Design, Setting, and Patients: Double-blind randomized controlled trial of
12 064 survivors of myocardial infarction in secondary care hospitals in
the United Kingdom between 1998 and 2008. Interventions: 2 mg folic acid
plus 1 mg vitamin B12 daily vs matching placebo. Main Outcome Measures:
First major vascular event, defined as major coronary event (coronary
death, myocardial infarction, or coronary revascularization), fatal or
nonfatal stroke, or noncoronary revascularization. Results: Allocation to
the study vitamins reduced homocysteine by a mean of 3.8 mumol/L (28%).
During 6.7 years of follow-up, major vascular events occurred in 1537 of
6033 participants (25.5%) allocated folic acid plus vitamin B12 vs 1493 of
6031 participants (24.8%) allocated placebo (risk ratio [RR], 1.04; 95%
confidence interval [CI], 0.97-1.12; P=.28). There were no apparent
effects on major coronary events (vitamins, 1229 [20.4%], vs placebo, 1185
[19.6%]; RR, 1.05; 95% CI, 0.97-1.13), stroke (vitamins, 269 [4.5%], vs
placebo, 265 [4.4%]; RR, 1.02; 95% CI, 0.86-1.21), or noncoronary
revascularizations (vitamins, 178 [3.0%], vs placebo, 152 [2.5%]; RR,
1.18; 95% CI, 0.95-1.46). Nor were there significant differences in the
numbers of deaths attributed to vascular causes (vitamins, 578 [9.6%], vs
placebo, 559 [9.3%]) or nonvascular causes (vitamins, 405 [6.7%], vs
placebo, 392 [6.5%]) or in the incidence of any cancer (vitamins, 678
[11.2%], vs placebo, 639 [10.6%]). Conclusion: Substantial long-term
reductions in blood homocysteine levels with folic acid and vitamin B12
supplementation did not have beneficial effects on vascular outcomes but
were also not associated with adverse effects on cancer incidence. Trial
Registration: isrctn.org Identifier: ISRCTN74348595 copyright2010 American
Medical Association. All rights reserved.
<10>
Accession Number
2010323724
Title
Association of estimated glomerular filtration rate and albuminuria with
all-cause and cardiovascular mortality in general population cohorts: a
collaborative meta-analysis.
Source
The Lancet. 375(9731)(pp 2073-2081), 2010. Date of Publication:
20100612/18.
Publisher
Elsevier Limited
Abstract
Background: Substantial controversy surrounds the use of estimated
glomerular filtration rate (eGFR) and albuminuria to define chronic kidney
disease and assign its stages. We undertook a meta-analysis to assess the
independent and combined associations of eGFR and albuminuria with
mortality. Methods: In this collaborative meta-analysis of general
population cohorts, we pooled standardised data for all-cause and
cardiovascular mortality from studies containing at least 1000
participants and baseline information about eGFR and urine albumin
concentrations. Cox proportional hazards models were used to estimate
hazard ratios (HRs) for all-cause and cardiovascular mortality associated
with eGFR and albuminuria, adjusted for potential confounders. Findings:
The analysis included 105 872 participants (730 577 person-years) from 14
studies with urine albumin-to-creatinine ratio (ACR) measurements and 1
128 310 participants (4 732 110 person-years) from seven studies with
urine protein dipstick measurements. In studies with ACR measurements,
risk of mortality was unrelated to eGFR between 75 mL/min/1.73 m2 and 105
mL/min/1.73 m2 and increased at lower eGFRs. Compared with eGFR 95
mL/min/1.73 m2, adjusted HRs for all-cause mortality were 1.18 (95% CI
1.05-1.32) for eGFR 60 mL/min/1.73 m2, 1.57 (1.39-1.78) for 45 mL/min/1.73
m2, and 3.14 (2.39-4.13) for 15 mL/min/1.73 m2. ACR was associated with
risk of mortality linearly on the log-log scale without threshold effects.
Compared with ACR 0.6 mg/mmol, adjusted HRs for all-cause mortality were
1.20 (1.15-1.26) for ACR 1.1 mg/mmol, 1.63 (1.50-1.77) for 3.4 mg/mmol,
and 2.22 (1.97-2.51) for 33.9 mg/mmol. eGFR and ACR were multiplicatively
associated with risk of mortality without evidence of interaction. Similar
findings were recorded for cardiovascular mortality and in studies with
dipstick measurements. Interpretation: eGFR less than 60 mL/min/1.73 m2
and ACR 1.1 mg/mmol (10 mg/g) or more are independent predictors of
mortality risk in the general population. This study provides quantitative
data for use of both kidney measures for risk assessment and definition
and staging of chronic kidney disease. Funding: Kidney Disease: Improving
Global Outcomes (KDIGO), US National Kidney Foundation, and Dutch Kidney
Foundation. copyright 2010 Elsevier Ltd. All rights reserved.
<11>
Accession Number
2010338776
Authors
Vlasselaers D. Mesotten D. Langouche L. Vanhorebeek I. van den Heuvel I.
Milants I. Wouters P. Meyns B. Bjerre M. Hansen T.K. Van den Berghe G.
Institution
(Vlasselaers, Mesotten, Langouche, Vanhorebeek, van den Heuvel, Milants,
Wouters, Van den Berghe) Department of Intensive Care Medicine, Katholieke
Universiteit Leuven, Belgium.
(Meyns) Department of Cardiac Surgery, Katholieke Universiteit Leuven,
Belgium.
(Wouters) Department of Anesthesiology, Universiteit Gent, Belgium.
(Bjerre, Hansen) Immunoendocrine Research Unit, Aarhus University
Hospital, Denmark.
Title
Tight Glycemic Control Protects the Myocardium and Reduces Inflammation in
Neonatal Heart Surgery.
Source
Annals of Thoracic Surgery. 90(1)(pp 22-29), 2010. Date of Publication:
July 2010.
Publisher
Elsevier USA
Abstract
Background: Neonatal cardiac surgery evokes hyperglycemia and a systemic
inflammatory response. Hyperglycemia is associated with intensified
inflammation and adverse outcome in critically ill children and in
pediatric cardiac surgery. Recently we demonstrated that tight glycemic
control (TGC) reduced morbidity and mortality of critically ill children.
Experimental data suggest that insulin protects the myocardium in the
setting of ischemia-reperfusion injury, but this benefit could be blunted
by coinciding hyperglycemia. We hypothesized that insulin-titrated TGC,
initiated prior to myocardial ischemia and reperfusion, protects the
myocardium and attenuates the inflammatory response after neonatal cardiac
surgery. Methods: This is a prospective randomized study at a university
hospital. Fourteen neonates were randomized to intraoperative and
postoperative conventional insulin therapy or TGC. Study endpoints were
effects on myocardial damage and function; inflammation, endothelial
activation, and clinical outcome parameters. Results: Tight glycemic
control significantly reduced circulating levels of cardiac troponin-I (p
= 0.009), heart fatty acid-binding protein (p = 0.01), B-type natriuretic
peptide (p = 0.002), and the need for vasoactive support (p = 0.008). The
TGC suppressed the rise of the proinflammatory cytokines interleukin-6 (p
= 0.02) and interleukin-8 (p = 0.05), and reduced the postoperative
increase in C-reactive protein (p = 0.04). Myocardial concentrations of
Akt, endothelial nitric-oxide synthase, and their phosphorylated forms
were not different between groups. Conclusions: In neonates undergoing
cardiac surgery, intraoperative and postoperative TGC protects the
myocardium and reduces the inflammatory response. This appears not to be
mediated by an early, direct insulin signaling effect, but may rather be
due to independent effects of preventing hyperglycemia during reperfusion.
copyright 2010 The Society of Thoracic Surgeons.
No comments:
Post a Comment