Anesthetic management in cardiac surgery patients undergoing coronary artery bypass grafting

Authors

  • V.I. Cherniy State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs, Kyiv, Ukraine
  • Ya.V. Kurilenko State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs, Kyiv, Ukraine
  • P.A. Topolov State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs, Kyiv, Ukraine
  • T.V. Cherniy State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.16.4.2020.207938

Keywords:

cardiac surgery patients, perioperative anesthestic management, phasagraphy

Abstract

Background. Surgical myocardial revascularization is an effective way to treat patients with coronary heart disease. A mandatory step in the process of extracorporeal circulation is an induced cardiac arrest and the associated period of general ische­mia. Therefore, when performing coronary artery bypass grafting in the conditions of artificial circulation, acute heart failure of varying degrees of severity develops. Despite continuous improvement of the methods for artificial circulation, anesthesia and cardioprotection, the incidence of intraoperative myocardial infarction is from 2 to 7.2 %, acute heart failure — from 2.7 to 51.2 %, acute cardiac arrhythmias — from 20 to 63.6 %. The aim of the study: to improve treatment outcomes in cardiac surgery patients with heart failure who underwent coronary artery bypass grafting using extracorporeal circulation, by improving the protocol of periope­rative management. Materials and methods. One hundred cardiac surgery patients with coronary artery disease underwent coronary artery bypass grafting at the State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs. Informed consent to participate in this study was obtained from all patients. They were divided into two groups. In patients of group 1 (n = 40), correction of hemodynamic disorders in the postoperative period was performed according to the standard current protocol. In group 2 (n = 60), a differentia­ted approach to the correction of hemodynamic disorders was used. In subgroup 1 (n = 20), correction of hemodynamic disorders in the postoperative period was performed with dobutamine, and stabilization was achieved. In subgroup 2 (11 patients who were diagnosed with preoperative hypophosphatemia), to correct hemodynamic disorders, fructose-1,6-diphosphate was used in addition to dobutamine according to the scheme: 5 g of the drug was admini­stered immediately before perfusion and 5 g — on 30th minute of artificial circulation. The drug, an endogenous high-energy intermediate metabolite of the glycolytic pathway, directly increases the formation of high-energy phosphate (adenosine triphosphate) [9]. In subgroup 3 (n = 6), in addition to dobutamine, tivorel was used in the postoperative period to correct hemodynamic disorders (1 ml solution contains 42 mg of arginine hydrochloride and 20 mg of levocarnitine). Subgroup 4 (n = 23) had no hemodynamic disorders in the postoperative period, correction was not performed. Results. To monitor the functions of the cardiovascular system, electrocardiography, echocardiography, phasagraphy were used, and heart rate variability was evaluated. Phasagraphy is an innovative method for processing electrocardiogram developed by the National Aca­demy of Sciences of Ukraine. The essence of the method is to study T wave symmetry/asymmetry on the electrocardiogram as a marker of ischemic changes in the myocardium. The results of the stu­dies indicate the possibility of using the method of phasagraphy, in particular the analysis of T wave symmetry as a marker of ischemic changes in the myocardium in cardiac surgery patients who underwent coronary artery bypass grafting with artificial circulation. In the vast majority of patients with ischemic heart disease, T wave symmetry is statistically significantly higher than in individuals without clinical signs of ischemic changes in the myocardium. It was found that in group 2 to stabilize hemodynamics, oxygen status and microcirculation, lower doses of sympathomimetics were used; duration of their use, frequency of hemodynamically significant atrial fibrillation, dose of injected amiodarone, duration of pulmonary ventilation were lower as well. Conclusions. The obtained data indicate that the developed algorithm for preoperative management of cardiac surgery patients with heart failure makes it possible to significantly accelerate their rehabilitation, increase patients’ comfort and to reduce hospital stay to 6–7 days.

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Published

2021-09-30

How to Cite

Cherniy, V., Kurilenko, Y., Topolov, P., & Cherniy, T. (2021). Anesthetic management in cardiac surgery patients undergoing coronary artery bypass grafting. EMERGENCY MEDICINE, 16(4), 101–109. https://doi.org/10.22141/2224-0586.16.4.2020.207938

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Section

Original Researches

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