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Biomedical subjects

G Fita

Publications and source records attributed to G Fita.

At least 19 recordsLinked to original sources
PubMed2001

Plasma magnesium in patients submitted to cardiac surgery and its influence on perioperative morbidity.

BACKGROUND: To determine the changes in magnesaemia in cardiac surgical patients submitted to cardiopulmonary bypass (CPB) and their influence on perioperative morbidity. METHODS SETTING: the cardiovascular surgery department of a university hospital. PATIENTS: 60 patients of both sexes, mean age 60+/-12 yrs, operated on consecutively for myocardial revascularization or valve replacement. INTERVENTIONS: plasma Mg2+ levels were measured preoperatively, during CPB, postCPB and throughout the first 24 hrs after operation. Preoperative plasma Mg2+ levels of these patients were compared with those of 15 non-cardiac surgical patients and 11 healthy volunteers. RESULTS: Mean values of Mg2+ similar in the three populations although in the group of cardiac patients the number of hypomagnesaemic patients was significantly higher (16 patients=26.6%). In these 16 patients, preoperative hypomagnesaemia had a statistically significant relationship with the preoperative treatment with beta-blockers and previous history of arrhythmias (p<0.05). A progressive statistically significant decrease of Mg2+ was observed throughout the surgery that remained low at 24 hours postoperatively (p<0.05). Normomagnesemic patients needed significantly more shocks and electrical energy to obtain heart defibrillation after CPB. The incidence of both postoperative arrhythmias and postoperative low cardiac index (<2.5 L.m2) was statistically significantly more frequent in hypomagnesaemic patients (p<0.05). CONCLUSIONS: Preoperative hypomagnesaemia was more frequent in this small sample of cardiac surgical patients than in non-cardiac surgical patients and was related to preoperative treatment with b-blockers. Hypomagne-saemia caused by CPB persisted 24 hrs after operation and was associated with higher incidence of both postoperative arrhythmias and low cardiac index.

Adrenergic beta-Antagonists↗
PubMed1999

Platelet function during cardiac surgery and cardiopulmonary bypass with low-dose aprotinin.

OBJECTIVE: To determine whether two low-dose regimens of aprotinin influence platelet function. DESIGN: Prospective, randomized, single-blinded trial. SETTING: University teaching hospital performing 600 cardiac operations per year. PARTICIPANTS: Fifty-nine patients scheduled for cardiac surgery undergoing cardiopulmonary bypass (CPB) of expected duration of 60 minutes or more. INTERVENTIONS: Patients were randomized into three groups. Group C (control) included 21 patients who did not receive aprotinin. In group A2, 17 patients received 14,286 kallikrein inhibitor units (KIU)/kg (2 mg/kg) of aprotinin before surgery, followed by a continuous infusion of 7,143 KIU/kg/h (1 mg/kg/h) until the end of surgery. In group A4, 19 patients received 28,572 KIU/kg (4 mg/kg) of aprotinin before surgery, followed by the same infusion. MEASUREMENTS AND MAIN RESULTS: Postoperative bleeding and transfusion requirements were significantly less in group A4. Changes in platelet number and function were similar in the three groups. Platelet aggregation was assessed in four periods: before CPB (T1), post-CPB (T2), and 2 hours (T3) and 4 hours (T4) after CPB. Platelet aggregation induced by adenosine diphosphate, 1 and 2 micromol/L; ristocetin, 1 mg/mL; and arachadonic acid (AA), 1.4 mmol/L, decreased at T2 (p < 0.001) in all groups, and for the ristocetin and AA groups, remained at less than baseline values at T3 and T4. In five patients from each group, platelet receptors for glycoprotein IIb-IIIa (GPIIb-IIIa) and expression of platelet activation markers, guanosine monophosphate 140 (GMP-140) and lysosomal protein, were measured by flow cytometry before and after CPB. Modifications in the expression of GPIIb-IIIa were always modest and without statistical significance. Platelet activation markers, GMP-140 or lysosomal protein, nearly doubled from baseline to post-CPB only in the A4 group, whereas they remained stable in both other groups (statistically not significant). CONCLUSION: The two regimens of aprotinin, both considered low dosage, did not exert a protective effect on platelet function. Neither dose produced changes in platelet GPIIb-IIIa or platelet activation markers. However, bleeding and transfusion needs were decreased.

Adenosine Diphosphate↗
PubMed1999

[Esmolol in anesthesiology: pharmacology and indications].

Esmolol is a beta-adrenergic receptor antagonist with a relatively specific affinity for beta 1 adrenergic receptors. Its mechanism of action is therefore largely cardioselective and only high doses block beta 2 adrenergic receptors. The pharmacologic features of the drug give it rapid onset of beta-blocking action (distribution half-life = 2 minutes) and a short duration of action due to rapid clearance (clearance half-life = 9 minutes). The rapid metabolism of esmolol allows its beta-blocking activity to be lowered rapidly by changing the rate of infusion and obtaining rapid reversibility of effect in the minutes following interruption of the infusion. The esmolol dose is therefore manageable and individual adjustments can be made in function of a patient's clinical status. Such properties mean that esmolol is indicated for short-term treatment of hypertension and tachycardia during the perioperative period and in clinical situations that require easy unblocking of beta receptors. Hypertension and bradycardia are the most frequent complications associated with the administration of esmolol, such that blood pressure, heart rate and electrocardiographic data must be monitored.

Adrenergic beta-Antagonists↗
PubMed1999

[Changes in oxygen saturation in the jugular bulb during cardiac surgery].

OBJECTIVE: Heart surgery with cardiopulmonary bypass (CPB) leads to changes in supply and consumption of cerebral oxygen (DO2 and VO2C). Monitoring jugular bulb oxygen saturation (SjO2) detects changes in the DO2C/VO2C ratio that occur in patients undergoing heart surgery. The objective of this study was to determine the evolution of SjO2, of the arteriovenous difference of cerebral oxygen and of cerebral oxygen extraction, as well as the possible relation between those variables and changes in mean arterial pressure, hemoglobin counts and temperature in patients undergoing heart surgery with CPB. PATIENTS AND METHOD: A prospective study carried out in 31 patients who underwent coronary valve surgery. To monitor SjO2, each patient's internal jugular vein was cannulated with an oximetric catheter in a retrograde direction to monitor SjO2. RESULTS: Baseline SjO2 (68 +/- 7.4%), obtained after anesthetic induction, was similar to SjO2 before (65 +/- 6%) and after (67 +/- 8.2%) CPB. However, SjO2 upon starting CPB (60 +/- 8.6%) and during rewarming (63 +/- 3%) were significantly lower than at baseline. SjO2 was significantly higher during hypothermic bypass (78 +/- 5%) than at baseline. SjO2 ranged from a low of 60 +/- 8% as CPB was initiated to a high of 78 +/- 5% during hypothermic CPB. Mean arterial pressure was significantly lower at the start of bypass (44 +/- 6 mmHg) than anesthetic induction (83.5 +/- 13.1 mmHg) and the decrease correlated with a significant decrease in SjO2. Changes in mean arterial pressure were unrelated to significant changes in SjO2 at other moments, however. Nor was there a significant relation between changes in temperature or hemoglobin and the evolution of SjO2. At least one episode of SjO2 desaturation (= 50%) occurred in 29% of the patients, with the lowest values being recorded at the start of CPB and during rewarming. CONCLUSIONS: The greatest risk of cerebral oxygen imbalance between supply and demand occurs at the start of CPB and during rewarming, as shown by decreases in SjO2 levels below baseline at those times.

Blood Pressure↗
PubMed1995

Maintained unilateral analgesia.

We describe a case of a patient subjected to what proved to be an epidural puncture with catheter placement resulting in persistent unilateral analgesia. The epidurographic study by contrast medium injection through the catheter showed unilateral distribution of the contrast following the cranio-caudal axis in the anterior epidural space.

Adult↗
PubMed1993

[Transposition of the great arteries. Its anatomical correction. Our initial experience].

Arterial switch correction of transposition of the great arteries has been performed without mortality on 8 children, 7 neonates and one 6 years old child, at our institution. One infant and the 6 year old child has previous pulmonary artery banding and modified Blalock-Taussig shunts. The coronary cuffs were anastomosed to the neo-aorta using the "trap-door" technique described by Mee and in seven the Lecompte manoeuvre was used. Postoperative management included treatment for persistent pulmonary hypertension and left ventricular dysfunction. All patients were discharged in satisfactory condition, and continue to do so at a maximum follow-up of ten months. These results encourage us to elect the arterial switch procedure as the primary treatment of transposition of the great arteries.

Anastomosis, Surgical↗
PubMed1991

Adverse reactions to vancomycin prophylaxis in cardiac surgery.

Several adverse effects of vancomycin have been reported. The aim of this study was to assess the incidence of adverse responses to antibiotic prophylaxis with vancomycin in cardiac surgical patients. Prospectively, 116 consecutive patients (106 adults and 10 children) undergoing cardiac surgical procedures in this institution from January to June 1990 were studied. After the anesthetic induction, vancomycin, 1 g in adults and 10 mg/kg in children, was intravenously administered over 30 minutes. The infusion rate was slowed if any adverse effect was observed. As a control group, 10 similar patients were evaluated during the same period of 30 minutes after anesthetic induction but prior to vancomycin administration and surgical stimulation. Thirty-one patients (26.72%) developed an adverse effect, mainly hypotension (29 patients, 25%), which was considered severe in 15 patients (12.93%). Seven patients (6.03%) developed a maculopapular erythema that was associated with hypotension (Red-Man's syndrome) in 5 patients and with bronchospasm in 1 patient. The incidence of adverse reactions in children (20%) was similar to the overall incidence. Only 1 patient in the control group (10%) developed hypotension during the period studied. The incidence of adverse reactions was not related to age, body weight, vancomycin dose administered per kilogram body weight, type of surgical procedure, or associated disease. Mean duration of the infusion was similar in patients with and without adverse responses (34.60 +/- 12.41 minutes and 37.38 +/- 14.55 minutes, respectively). It is concluded that perioperative prophylaxis with vancomycin in cardiac surgery produces a high and unpredictable risk of significant hypotension.

Adult↗
PubMed1990

Amrinone in perioperative low cardiac output syndrome.

Amrinone has been shown to have a beneficial effect on left ventricular function in low output syndrome (LOS), but its use after open-heart surgery has not been extensively revised. We studied 10 patients with LOS post-cardiopulmonary bypass (CPB), who failed to respond to conventional treatment (vasoactive drugs plus intraaortic balloon pump) and were treated with amrinone, 0.75 mg.kg-1 followed by a continuous infusion of 5 to 10 micrograms.kg-1-min-1. One patient failed to respond to the treatment and subsequently died, but in the other nine patients blood pressure and cardiac index increased, left filling pressure decreased and they were successfully weaned from the CBP and survived. These results suggest that amrinone, either alone or combined with other inotropic drugs and mechanical support, is a valuable drug in the management of LOS after CPB.

Aged↗
PubMedDate not supplied

[Use of a new inotropic agent, enoximone, in heart surgery].

We report our experience with the use of enoximone in 5 patients with severely depressed preoperative myocardial function who underwent cardiac surgery. In patients 1 and 2, enoximone was administered as the inotropic of choice before cardiopulmonary bypass (CPB) and a substantial improvement of cardiac index was achieved; in these patients, enoximone administration after CPB permitted to overcome low cardiac output which persisted after high dose dobutamine in patient 1, and in patient 2 right ventricular contractility improved. In patient 3 the use of enoximone permitted the discontinuation of CPB, which had not been previously possible with the association of dopamine and dobutamine. In this patient, adrenaline perfusion improved the low cardiac output syndrome but resulted in poorly tolerated side effects. However, in patient 4 the administration of enoximone during pre-CPB did not improve in a reduction in filling pressures without an increase in the cardiac index because the patient was hypovolemic. In patient 5, the administration of enoximone permitted to interrupt the infusion of dobutamine and to reduce the dose of sodium nitroprusside, which had resulted in significant tachycardia, with increased myocardial contractility and a reduction of vascular peripheral and pulmonary resistances. We conclude that enoximone, single or in association with other inotropics, should be considered a drug of choice in patients undergoing cardiac surgery who develop a low cardiac output syndrome.

Adrenergic beta-Agonists↗
PubMedDate not supplied

[Tremor and epidural anesthesia].

To evaluate the influence of temperature of the injected anesthetic solution on the development of tremor during epidural anesthesia, 66 patients divided in three homogeneous groups were evaluated: group I (n = 22; bupivacaine 4 degrees C), group II (n = 24; bupivacaine 20 degrees C), and group III (n = 24; bupivacaine 37 degrees C). The incidence of tremor was 20% (4 patients) in group I, 9% (2 patients) in group II and 12.5% (3 patients) in group III. No significant differences were found between the groups. The overall incidence was 13.6%. The epidural injection of 5 ml of saline at 37 degrees C achieved the attenuation and/or disappearance of tremor in three (3/4) group I patients (4 degrees C) and in one (1/3) group III patient (37 degrees C), whereas it was ineffective in one patient from group I and one from group III. In the two patients from group II (20 degrees C) and in one from group III (37 degrees C), tremor was self-limited. We conclude that the incidence of tremor during epidural anesthesia is not correlated with the temperature of anesthetic solutions, and that the epidural injection of saline at 37 degrees C may give some therapeutic benefit.

Adolescent↗