The effects of volatile induction and maintenance of anesthesia and selective spinal anesthesia on QT interval, QT dispersion, and arrhythmia incidence

Azevedo, José Raimundo A. de; Azevedo, Renato Palácio de; Lucena, Lara Carneiro de; Costa, Nathalia de Nazaré Rabelo da; Silva, Widlane Sousa da

doi:10.1590/s1807-59322010000800005

Cited by 14 publications

(11 citation statements)

References 39 publications

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“…Complications related to poor glycemic control are challenging for health care practitioners. For example, we found that the occurrence of acute kidney injury (AKI) tended to be higher in Group II, similar to results showing that glycemic control after cardiac surgery was significantly associated with a reduced risk of AKI [ 32 ]. The rate of POAF events was also significantly higher in Group II, similar to findings showing that proper glycemic control could reduce the incidence of POAF after CABG, from 30% to 18% (39% risk reduction; p = 0.042) [ 29 ], and may reduce the rate of POAF-associated mortality [ 33 ].…”

Section: Discussionsupporting

confidence: 75%

Association of time in blood glucose range with outcomes following cardiac surgery

et al. 2015

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BackgroundThe importance of optimal postoperative glycemic control in cardiac patients remains unclear. Various glycemic targets have been prescribed to reduce wound infection and overall mortality rates.Aim of the work: To assess glucose control, as determined by time in range (TIR), in patients with glycemic targets of 6.0 to 8.1 mmol/L, and to determine factors related to poor control.MethodsThis prospective descriptive study evaluated 227 consecutive patients, 100 with and 127 without diabetes, after cardiac surgery. Patients received insulin to target glucose concentrations of 6.0 to 8.1 mmol/L. Data analyzed included patient age, gender, race, Euro score, cardiopulmonary bypass time (CPB), aortic cross clamp time (ACC), length of ventilation, stay in the intensive care unit (ICU) and stay in the hospital. Patients were divided into two groups, those who maintained > 80% and < 80% TIR. Outcome variables were compared in diabetics and non-diabetics.ResultsPatients with >80% and <80% TIR were matched in age, sex, gender, and Euro score. Failure to maintain target glycemia was significantly more frequent in diabetics (p = 0.001), in patients with glycated hemoglobin (HbA1c) > 8% (p = 0.0001), and in patients taking dopamine (p = 0.04) and adrenaline (p = 0.05). Times of CPB and ACC, length of stay in the ICU and ventilation were significantly higher in patients with TIR <80% than >80%. Rates of hypoglycemia, acute kidney injury, and in-hospital mortality were similar in the two groups, although the incidence of wound infection was higher in patients with TIR <80%. Both diabetics and non-diabetics with low TIR had poorer outcomes, as shown by length of stay and POAF. No significant differences were found between the two ethnic groups (Arabs and Asians).ConclusionPatients with >80% TIR, whether or not diabetics, had better outcomes than those with <80% TIR, as determined by wound infection, lengths of ventilation and ICU stay. Additionally, they were not subject to frequent hypoglycemic events. Preoperatively high HbA1C is likely a good predictor of poor glycemic control.

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Section: Discussionsupporting

confidence: 75%

Association of time in blood glucose range with outcomes following cardiac surgery

et al. 2015

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“…Azevedo et al [29] observed that, in critical illness, there was a significant correlation between blood glucose levels and the incidence of AKI. Halkos et al [30] found that HbA 1c levels greater than 7% were associated with renal failure.…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

Koçoğulları

Kunt²,

Aksoy

et al. 2017

Braz J Cardiovasc Surg

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Introduction Elevated hemoglobin A1c levels in patients with diabetes mellitus have been known as a risk factor for acute kidney injury after coronary artery bypass grafting. However, the relationship between hemoglobin A1c levels in non-diabetics and acute kidney injury is under debate. We aimed to investigate the association of preoperative hemoglobin A1c levels with acute kidney injury in non-diabetic patients undergoing isolated coronary artery bypass grafting.Methods202 non-diabetic patients with normal renal function (serum creatinine <1.4 mg/dl) who underwent isolated coronary bypass were analyzed. Hemoglobin A1c level was measured at the baseline examination. Patients were separated into two groups according to preoperative Hemoglobin A1c level. Group 1 consisted of patients with preoperative HbA1c levels of < 5.6% and Group 2 consisted of patients with preoperative HbA1c levels of ≥ 5.6%. Acute kidney injury diagnosis was made by comparing baseline and postoperative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease Improving Global Outcomes (KDIGO) definition.ResultsAcute kidney injury occurred in 19 (10.5%) patients after surgery. The incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2. Elevated baseline hemoglobin A1c level was found to be associated with acute kidney injury (P=0.0001). None of the patients became hemodialysis dependent. The cut off value for acute kidney injury in our group of patients was 5.75%.ConclusionOur findings suggest that, in non-diabetics, elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Prospective randomized studies in larger groups are needed to confirm these results.

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“…In an observational study conducted by Azevedo et al [ 19 ] , a significant correlation was found between high blood glucose levels and AKI incidence in critically ill patients, and Mehta et al [ 19 ] showed that hyperglycemia and insulin resistance directly contributed to AKI development. When we compared the preoperative and postoperative blood glucose levels of our cases, we found that the increase in blood glucose level was significantly higher in the AKI (+) group than in the non-AKI group.…”

Section: Discussionmentioning

confidence: 99%

Investigation of AKI with Early Biomarkers after Cardiac Surgery

Mutlu¹,

Gündüz²,

Titiz³

et al. 2020

Braz J Cardiovasc Surg

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Objective To provide a new interpretation of the effect of intraoperative hemodynamic data on postoperative acute kidney injury (AKI) development and to determine the accuracy of some biomarkers which are thought to be the early markers of renal injury. Methods One hundred adult patients who were connected to the heart-lung pump during open-heart surgery were included in this study. Hemodynamic data, oxygen delivery, and transfusions were recorded intraoperatively, and the preoperative and 3. postoperative hour cystatin C, interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) parameters were measured for early detection of kidney damage. In the analysis, 95% significance level was used to determine the difference. Results According to the Kidney Disease Improving Global Outcomes criterion, AKI developed in 24 patients, 18 of whom were stage 1, two were stage 2, and four were stage 3. AKI (+) patients had more transfusions in the intraoperative period and AKI development was a risk factor for postoperative complications. NGAL and IL-18 levels were found to be approximately two-fold in the postoperative period in AKI (+) patients, whereas cystatin C was not sensitive in AKI detection. Conclusion AKI development increases the risk of postoperative complications. NGAL and IL-18 were successful in detecting AKI in the early postoperative period.

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The effects of volatile induction and maintenance of anesthesia and selective spinal anesthesia on QT interval, QT dispersion, and arrhythmia incidence

Cited by 14 publications

References 39 publications

Association of time in blood glucose range with outcomes following cardiac surgery

Association of time in blood glucose range with outcomes following cardiac surgery

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients

Investigation of AKI with Early Biomarkers after Cardiac Surgery

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