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A Few Clinical and Anesthetical
Considerations on Cardiac Surgery
Santos Gracia, José; Olivera Martínez,
Morlans Hernández, Karel;
Ojeda Mollinedo, Odalys; Cairo Romero, Féliz
Instituto de Cardiología y Cirugía
Cardiovascular (ICCCV) y
Centro de Investigaciones Médico-Quirúrgicas (CIMEQ), La Habana, CUBA
Introduction: Malignant arrhythmias, low cardiac output syndrome and abnormal post-operative bleeding are dreadful complications in contemporary cardiac surgery. The anesthesiologist, by his active vigilance, plays a paramount role in the peri-operative conductions of these patients.
Objectives: We propose a suitable approach for cardiac surgery with cardiopulmonary bypass (CPBP) and ischaemic arrest (IA) due to aortic cross clamp (ACC) that includes: 1. Energy preservation in the ischaemic myocardial cells using magnesium sulphate pre-ACC; 2. Blood cardioplegia with "warm" reperfusion pre declamping and 3. Preventive Epsilon Amino Caproic Acid (EACA).
Methods: Prospective, observational, not randomized with stratified sample groups study in two cardiac centers. 70 consecutive patients (January-December 2000) divided into CIMEQ group 32 patients and ICCCV with 38 patients. After induction a continuous infusion of magnesium sulfate at 60 ml per hour, 4 grams/ 16 moles in normal saline solution and an initial dose of 8 grams of EACA was given (plus EACA 4 gr. post-CPBP) A "base" cardioplegic solution was prepared with, Mannitol, KCl, Magnesium Sulphate, Dextrose 5%, Procainamide and homologous blood. Every 20 minutes cardioplegia was repeated and a "warm wash-out cardioplegia" nearly declamping was given.
Results: ACC was longer in CIMEQ (58,2 vs. 47,5 p< 0,02) but CPBP time was not significant. Ventricular fibrillation (VF) did not occur in CIMEQ vs. 8/38 (21%) ICCV p< 0,007. CIMEQ used more nitroglycerine p<0,0004. Postoperative "non-surgical" bleeding was not significative. The comparison EACA ($6,96) vs Aprotinine ($778,00) was very profitable.
Conclusion: CIMEQ group
in spite of longer ACC had similar CPBP times and sinus rhythm in all studied
patients. These benefits might be due to the magnesium blood cardioplegia (less
ionic intracellular calcium overload). Associate to EACA successfully reduced
the economic and morbidity costs in CIMEQ group.
2nd Virtual Congress of Cardiology
Dr. Florencio Garófalo
Dr. Raúl Bretal
Dr. Armando Pacher
Technical Committee - CETIFAC
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