Alteration of tissue perfusion is a main contributor of organ dysfunction. In cardiac surgery, the importance of organ dysfunction is associated with worse outcome. Central venous-arterial difference in CO tension (ΔCO) has been proposed as a global marker of the adequacy of tissue perfusion in shock states. We hypothesized that ΔCO could be increased in case of postoperative organ failure or worse outcome. In this monocentric retrospective cohort study, we retrieved, from our database, 220 consecutive patients admitted in intensive care after an elective cardiac surgery. Four time points were formed: ICU admission, and 6, 24 and 48 h after. A ΔCO below 6 mmHg defined the normal range values. The SOFA score, intensive care unit and hospital length of stay, hospital and 6-month mortality rate were recorded. We compared patient with low ΔCO (<6 mmHg) and high ΔCO (≥6 mmHg). We included 55 (25 %) and 165 patients in low and high ΔCO groups, respectively. The SOFA score, the hospital and 6 months mortality rate were higher in patients with low ΔCO. Surprisingly, we did not find results previously published in other surgical settings. In cardiac surgery, ΔCO has a low predictive value of outcome.
Studies in animals and in healthy volunteers have demonstrated the central serotonergic analgesic mechanism of action of paracetamol involving the inhibition of this analgesia by tropisetron, a 5-HT3 antagonist. This randomized, double-blind, controlled study aims at studying this interaction in post-operative patients after ear surgery. Thirty-six patients are included in two parallel groups with intravenous paracetamol (1 g) and either tropisetron (T, 5 mg/mL) or placebo (c, NaCl 0.9%) administered at the end of surgery. Numerical pain evaluations are performed every 30 min, six times after awakening. The difference between the sums of numerical scales of both groups [9 ± 10 (T) vs. 6 ± 7 (c)] is not significant, but the tropisetron group displays higher pain scores despite additional rescue analgesia. The limits of this trial call for a much larger study to investigate further this pharmacodynamic interaction.
The described approach appears to be safe and feasible with adequate clamp times. Video assistance allows optimal visualization of the aortic root and accurate valve delivery, without conflict between the device, the camera, and the instruments, making this setting an encouraging baseline towards the assessment of the totally endoscopic approach.
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