فهرست مطالب louise jafari

Failing heart has been described as the main mechanism of an unsuccessful separation the mechanical ventilator after cardiac surgery. Brain natriuretic peptide (BNP) is a specific marker for cardiac dysfunction. We aimed to evaluate the relationships between BNP levels and the duration of mechanical ventilation and the length of stay at the intensive care unit (ICU) after pediatric cardiac surgery. In this observational study, 52 infants aged between 2 and 50 months who underwent cardiac surgery were enrolled. Anesthesia and cardiopulmonary bypass methods were similar, and the weaning protocol in the ICU was the same in all the patients. The levels of pro-BNP and plasma lactate were recorded before surgery; at the time of ICU admission; and 24, 48, and 72 hours afterward. At the end of the study, the relationships between the levels of BNP and plasma lactate and the duration of mechanical ventilation and the length of stay at the ICU were assessed. Of the 52 patients, 35 (67.3%) were male. The mean age and weight were 17.14±12.50 months and 9.01±2.98 kg, respectively. The mean duration of cardiopulmonary bypass was 191.25±34.15 minutes, and the mean aortic cross-clamp time was 75.48±31.88 minutes. The mean duration of mechanical ventilation was 21.78±18.78 minutes, and the mean length of stay at the ICU was 133.67±97.68 hours. The results showed that there was no significant relationship between the pro-BNP level and the duration of mechanical ventilation (P>0.05). The levels of pro-BNP at the time of ICU admission and 24 and 48 hours after surgery had a direct relationship with the duration of ICU stay (P<0.05). In the present study, higher serum pro-BNP levels at the time of ICU admission and 24 and 48 hours after admission were related to a prolonged ICU stay. However, the serum BNP level was not correlated with the duration of mechanical ventilation after pediatric cardiac surgery. (Iranian Heart Journal 2018; 19(4): 40-46)

The use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery. This clinical trial was performed on 100 adult patients who underwent elective noncomplex cardiac surgery using cardiopulmonary bypass. Additional to the routine monitoring, the patients’ depth of anesthesia and neuromuscular blocked were assessed by bispectral index and nerve stimulator, respectively. In the on-table extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15 µg/kg/h) and inhalational anesthetics were used for early waking. In the control group (n = 50), the same anesthesia-inducing drugs were used but the dose of sufentanil during the operation was 0.7 - 0.8 µg/kg/h. After the operation, cardiorespiratory parameters and ICU stay were documented. Demographic and clinical variables were comparable in both study groups. In the OTE group, we failed to extubate two patients in the OR (success rate of 96%). There were no significant differences between the two groups in terms of systolic and diastolic blood pressure at the time of entering the ICU (P > 0.05). Heart rate was lower in the OTE than in the control group at ICU admission (89.4 ± 13.1 vs. 97.6 ± 12.0 bpm; P = 0.008). The ICU stay time was lower in the OTE group (34 (21.5 - 44) vs. 48 (44 - 60) h; P = 0.001). Combined inhalational-intravenous anesthesia along with using multiple anesthesia monitoring systems allows reducing the dose of total anesthetics and maintaining adequate anesthesia depth during noncomplex cardiac surgery with cardiopulmonary bypass. Thus, extubation of the trachea in the OR is feasible in these patients