probes are faster to insert, easier to use and safer. ...... Laboratories, Indianapolis, IN, USA; â Brown University, Providence, RI, USA; â¡Mahidol University, Bangkok, Thailand ...... city, Tokyo, 193 Japan ... amount of DOA used, IL-6, IL-1ra, NOx, PAI-1, thrombo- ...... CPR and open chest massage (i.e. 0.7% of our total adult.
http://ccforum.com/supplements/4/S1
P1
Work up to rule out perioperative myocardial infarction: is it overused? SK Appavu, TR Haley, A Khorasani and SR Patel
Departments of Surgery and Anesthesiology, Cook County Hospital and the Department of Surgery, University of Illinois College of Medicine, Chicago, Illinois, USA
The awareness of the diagnostic difficulty and the documented high mortality risk of perioperative myocardial infarction (PMI) has led to the wide use of work up to rule out PMI after major noncardiac operations. This has caused stable postoperative patients to be kept in monitored hospital beds for extended periods of time and to be subjected to additional tests. We hypothesized that the mortality of PMI is high and, therefore, the wide use of postoperative work up to identify these patients is justifiable. We performed the following study to prove our hypothesis. All patients in the recovery room after major noncardiac operations who underwent work up to rule out PMI were identified and followed. The PMI work up included care in an electronically monitored unit, physical assessment, continuous ECG monitoring, and three 12lead electrocardiograms and cardiac enzymes obtained at six to eight hour intervals. Data collection included patient demographics; preoperative cardiac risk factors; incidence of intraoperative hypotension, hemorrhage and ECG changes; type of anesthesia and operative procedures and their durations; postoperative ECG and cardiac enzyme results; the incidence of PMI and patient outcome.
P2
Two hundred patients were studied; 85 males and 115 females. Their mean age was 62.9 years. Preexisting conditions included hypertension in 162 patients, peripheral arterial disease in 102, diabetes mellitus in 97, angina in 30, previous myocardial infarction in 41, and smoking in 107. Of 200 patients, 164 had an abnormal preoperative ECG. Vascular operations were performed in 104 patients, nonvascular abdominal operations in 48, and other operations in the remaining 48. Intraoperatively, hypotension occurred in 29 patients, blood loss of >500 ml in 25 and ECG changes in 10. There were no deaths. PMI occurred in 5/200 (2.5%) patients. Four had undergone vascular operations and one had had an abdominal operation. The mean age of the patients with PMI was 64.2 years. The duration of operation and blood loss were similar to those of patients without PMI. None of these patients developed cardiac failure or cardiogenic shock and none of them died. Conclusion: The incidence of PMI among patients undergoing noncardiac surgery is low and its mortality is negligible. Physicians should become more selective in the use of monitored beds and in the ordering of a work up to rule out PMI.
Relationship between cardiac troponin I (cTnI) release during cardiac operations and myocardial cell death JF Vazquez-Jimenez*, Ma Qing†, B Klosterhalfen‡, O Liakopoulos*, G von Bernuth†, BJ Messmer* and M-C Seghaye†
Department. of Cardiac Surgery*, Pediatric Cardiology†, Pathology‡, Aachen University of Technology, Pauwelsstrasse. 30, D-52057, Aachen, Germany
Aims: To study the relationship between myocardial release of cTnI and myocardial cell death as assessed by the amount of apoptosis and necrosis after cardiac surgery. Methods: Eighteen young pigs were operated on with standardized cardiopulmonary bypass (CPB). Release of cTnI in the cardiac lymph (CL), coronary sinus (CS), and arterial blood (A) was related to postoperative myocardial cell death by both necrosis and apoptosis. Apoptotic cells were detected by a TUNEL detection kit. Necrotic cells were counted by light microscopy. Results: In all animals, cTnI was significantly released and reached peak values observed simultaneously in A (cTnI,
20.1±2.6 ng/ml) (mean ±SEM), CS (19.5±3.2 ng/ml) and CL (5202±2500 ng/ml). Percentage of total myocardial cell death was 3.1±0.5%, including 1.2±0.35% necrosis and 1.9±0.5% apoptosis. cTnI release during and after CPB did not correlate with the degree of myocardial apoptosis or necrosis. Conclusion: Cardiac operations with CPB are related to myocardial cell damage including myocardial cell death due to both necrosis and apoptosis. As the loss of cTnI is not related to the amount of cell death, our results suggest that increased cardiac myocyte membrane permeability more than cell death is responsible for intraoperative and postoperative cTnI release.
Critical Care
P3
Vol 4 Suppl 1
20th International Symposium on Intensive Care and Emergency Medicine
Evaluation of thoracic fluid contents in patients with acute myocardial infarction H Okawa, A Suzuki, I Sakai, H Tsubo, H Ishihara and A Matsuki
University of Hirosaki School of Medicine, Department of Anesthesiology, 5 Zaifucho, Hirosaki, 036-8562 Japan
It is common to evaluate patients with acute myocardial infarction (AMI) according to the Forrester classification. A high PCWP value is a good predictor of pulmonary congestion although there is no documented correlation between PCWP and the degree of pulmonary congestion in patients with normal PCWP. In this study, we sought to investigate the correlation between (1) PCWP and thoracic fluid contents (TFC) as an indicator of pulmonary congestion, (2) PCWP and cardiac index (CI) and (3) CI and TFC in patients with AMI with PCWP values
