Efecto organoprotector cardiaco y renal de los sensibilizadores del calcio en pacientes con síndrome de bajo gasto cardíaco durante el postoperatorio de cirugía cardíaca

El Síndrome de Bajo Gasto cardiaco postoperatorio (SGC) es una frecuente complicación de la cirugía cardiaca con elevada mortalidad. En torno a un 30% de los casos se asocia a disfunción renal postoperatoria, que se relaciona independientemente con un incremento de la hospitalización y mortalidad. Levosimendan es un sensibilizador del calcio con efecto inotrópico positivo que actúa sin incrementar el consumo miocárdico de oxígeno. En determinadas circunstancias, este fármaco puede producir un efecto de postcondicionamiento cardiaco. Material y Métodos Ensayo clínico aleatorizado realizado en 60 pacientes intervenidos de cirugía cardiaca en el Hospital Universitario Virgen de la Victoria comparando la evolución de la función renal en pacientes con SBG tratados con levosimendan vs dobutamina. Resultados El grupo tratado con levosimendan presentó en el momento de iniciar el tratamiento una peor situación desde el punto de vista tanto hemodinámico como renal. A las 24 horas las variables hemodinámicas fueron similares en los 2 grupos así como el Índice de Resistencia Vascular Renal. A pesar de esto, la recuperación de la función renal, medida por el descenso de la creatinemia, fue superior en el grupo levosimendan en todos los momentos (a las 24 y 48 horas y en el momento del alta), aunque esta mejoría sólo resultó estadísticamente significativa en las primeras 24 horas (0,21 mg/dl (IC 95%: 0.032-0.38). También se observó una diferencia no significativa a favor del levosimendan en la diuresis a las 24 y 48 horas. Conclusión El tratamiento con levosimendan mejora la función renal a las 24 horas y probablemente al menos los primeros días del postoperatorio. Esta mejoría es independiente de la estabilidad hemodinámica y del flujo renal. El tratamiento con levosimendan produce una recuperación equivalente de la disfunción miocárdica, respecto a los pacientes tratados con dobutamina, partiendo de pacientes inicialmente más graves

Comparison of the Use of Desflurane vs. Propofol in Aortic Valve Replacement Surgery: Differences in Nephroprotection: An Explorative and Hypothesis-Generating Study

Introduction: The cardioprotective effect of halogenated drugs in cardiac surgery has been the subject of several studies. However, there is scarcity of data on their potential nephroprotective effects. Aortic valve replacement and coronary revascularization are the most frequent cardiac surgery procedures. The objective of this explorative study was to examine the effect of desflurane vs. propofol on renal function, when administered in aortic valve replacement surgery, including the extracorporeal circulation period. Method: A quasi-experimental prospective study was performed in 60 patients, who were allocated to receive either desflurane or propofol intraoperatively during aortic valve replacement surgery. As a hypnotic, group 1 received propofol, whereas group 2 received desflurane. Markers of renal function and level of cardiac preservation were determined based on biochemical parameters (troponin I, NTProBNP). Results: In the propofol group, there were significant variations between postoperative values of urinary NGAL and creatinine and baseline values. In contrast, no variations were found in the desflurane group in terms of hemodynamic parameters and myocardial damage. Conclusions: The use of propofol vs. desflurane during aortic valve replacement surgery is associated with a decrease in renal function

Anaesthesia and cancer: can anaesthetic drugs modify gene expression?

Cancer remains a primary cause of morbidity and mortality worldwide, and its incidence continues to increase. The most common cause of death in cancer patients is tumour recurrence. Surgery is the gold standard in the treatment of most tumours. However, cancer surgery can lead to the release of tumour cells into the systemic circulation. Surgical stress and several perioperative factors have been suggested to boost tumour growth, thereby increasing the risk of metastatic recurrence. Preclinical and clinical studies suggest that anaesthetics and adjuvants administered during the perioperative period may impact cancer recurrence and survival. This document summarises the current evidence regarding the effects of anaesthetic drugs and analgesic techniques on the immune system, systemic inflammatory response and tumour cells, as well as their impact on cancer recurrence.Ye

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01.

Low-cardiac output syndrome (LCOS) after cardiac surgery secondary to systemic hypoperfusion is associated with a higher incidence of renal and neurological damage. A range of effective therapies are available for LCOS. The beneficial systemic effects of levosimendan persist even after cardiac output is restored, which suggests an independent cardioprotective effect. A double-blind clinical trial was conducted in patients with a confirmed diagnosis of LCOS randomized into two treatment groups (levosimendan vs. dobutamine). Monitoring of hemodynamic (cardiac index, systolic volume index, heart rate, mean arterial pressure, central venous pressure, central venous saturation); biochemical (e.g. creatinine, S100B protein, NT-proBNP, troponin I); and renal parameters was performed using acute kidney injury scale (AKI scale) and renal and brain ultrasound measurements [vascular resistance index (VRI)] at diagnosis and during the first 48 h. Significant differences were observed between groups in terms of cardiac index, systolic volume index, NT-proBNP, and kidney injury stage at diagnosis. In the levosimendan group, there were significant variations in AKI stage after 24 and 48 h. No significant differences were observed in the other parameters studied. Levosimendan showed a beneficial effect on renal function in LCOS patients after cardiac surgery that was independent from cardiac output and vascular tone. This effect is probably achieved by pharmacological postconditioning. EUDRA CT, identifier 2014-001461-27. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001461-27