Tag Archives: Cardiac Surgery

Is Remote Ischemic Postconditioning Cardioprotective in Children Undergoing Cardiac Surgery?

Children who undergo cardiac surgery may suffer predictable systemic inflammatory responses, myocardial depression, and pulmonary endothelial dysfunction, all related to ischemia-reperfusion (IR) injury and cardiopulmonary bypass (CPB). One therapeutic strategy to prevent these injuries involves remote ischemic preconditioning (RIC), whereby a remote organ (usually a limb) is made repeatedly ischemic and then reperfused over a short period before the more significant IR insult (like cardiac surgery). This practice has been shown to modify the expression of key proteins in cytokine synthesis and leukocyte trafficking. Cheung et al demonstrated that RIC, applied prior to the initiation of CPB, provided some myocardial protection in children who underwent cardiac surgery.

In the August issue of Pediatric Anesthesia Zhong et al applied the same principles, though the timing of ischemia was different. The authors recruited 69 subjects (35 in the control group and 34 in the ischemic group) between the ages of 3 and 12 years who underwent repair of their congenital heart diseases. Remote ischemia was achieved by inflating a blood pressure cuff located on a lower limb to a pressure of 200 mm Hg for 5 minutes, followed by deflation for 5 minutes; this was repeated for a total of 3 cycles. These maneuvers were performed after the aorta was unclamped. The primary endpoint the maneuver’s effect on cardiac troponin I levels over 24 hours. Secondary endpoints included clinical outcomes, adverse cardiac events and changes in other metabolic markers such as neuron-specific enolase. Read more…

Does Sodium Bicarbonate Prevent Kidney Injury After Cardiac Surgery?

Up to 50% of all patients requiring cardiopulmonary bypass during cardiac surgery develop acute renal failure, with less than 5% requiring renal replacement therapy. Consequently, post-cardiac surgery acute kidney injury (AKI) is associated with increased morbidity and mortality. In the July Critical Care Medicine, McGuinness and colleagues designed a multicenter Phase IIb trial to test the hypothesis that a perioperative infusion of sodium bicarbonate might attenuate AKI in cardiac surgery patients. Read more…