DOI: https://doi.org/10.22141/2224-0586.6.85.2017.112769

The role and place of cardioprotection with modern infusion solutions in the perioperative period

Yu.O. Ploschenko, O.M. Klygunenko

Abstract


Cardiovascular diseases are major health and social problem in the world. Prevention of cardiac complications in extracardial surgical interventions is one of the most urgent problems of modern anesthesiology, surgery and cardiology. Abroad, detailed recommendations are published on optimal diagnostic and therapeutic management in these settings; similar recommendations were issued in Russia. Unfortunately, our country still has no such regulatory documents on the subject. Complications caused by myocardial ischemia most often develop in patients with coronary heart disease that cause long and traumatic surgery. Decompensation of concomitant coronary artery disease with a decrease in contractile function of the left ventricle is most common in elderly and senile age. The incidence of cardiac complications after general operations in the elderly is 9.1 %, mortality in such complications could reach 45.5 %. Cardiac complications significantly increase the length and cost of treatment, creates conditions for the development of multiple organ failure and violation of reparative processes in the zone of surgery. Thus, it is clear that prevention and timely adequate treatment of cardiac complications is an important tactical and strategic task. Unfortunately, possibilities to radically reduce the risk of cardiac complications due to changes in the type of anesthetic provision are sufficiently limited for a number of reasons. Therefore, it is quite obvious that anesthetists are interested in effective perioperative pharmacological myocardial protection — cardioprotection. The concept of cardioprotection includes all the mechanisms and ways to prevent heart damage by preventing or reducing the degree of myocardial cell damage. Cardioprotective therapy is the treatment that through direct effects on cardiomyocytes contributes to its survival in ischemia-hypoxia. Another one very important criterion for the anesthesiologist is the absence of hemodynamic actions, such ideal preparation should improve long-term prognosis of the disease. Today, there are about 2000 molecules with a direct protective effect on the heart. However, only a few drugs with cardioprotective properties are being introduced in real clinical practice. Drugs which contain amino acids L-arginine and L-carnitine can be effectively used as cardioprotective drugs. The main feature of cardioprotective therapy infusion from the modern point of view is the use of solutions with balanced multicomponent composition in a small volume of liquid. The results of researches in this field and changes based on them in official recommendations indicate that the introduction of such approaches in clinical practice in the near future will be important to improve the efficiency and safety of perioperative infusion therapy in patients with cardiovascular diseases.

Keywords


cardioprotection; peryoperative period; infusion therapy; L-arginine; L-carnitine

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