R Re ed du uc ce ed d e en nd do og ge en no ou us s n ni it tr ri ic c o ox xi id de e i in n t th he e e ex xh ha al le ed d a ai ir r o of f s sm mo ok ke er rs s a an nd d h hy yp pe er rt te en ns si iv ve es s ABSTRACT: We wanted to determine whether the production of endogenous nitric oxide (NO) is affected by cigarette smoking and various pathological conditions. Endogenously produced NO was measured by chemiluminescence in the exhaled air of 81 healthy volunteers (21 nonsmoking females (NSF), 12 smoking females (SF), 24 nonsmoking males (NSM) and 24 smoking males (SM)) and 38 patients (10 with hypertension, 10 intra-and 10 postoperative, 5 with renal failure and 3 with sepsis) entered the protocol. Subjects inspired from a NO-free air supply, which was also used to calibrate the NO-analyser.Endogenous NO production of volunteers was 18±8 per billion (ppb) depending on smoking habits. In exhaled air of NSF, NO concentration was 21±7 ppb, in SF 16±6 ppb, in NSM 19±8 ppb and in SM 15±6 ppb. Differences between smokers and nonsmokers were significant. Increased diastolic blood pressure was noted in SM compared to NSM (86±7 versus 78±7 mmHg). Patients with documented and treated hypertension (systolic and diastolic blood pressure: 141±18 and 82±9 mmHg) exhaled 13.7±5.3 ppb NO; hypertensive males 10±2 ppb NO and females 17±5 ppb NO. In patients with renal failure NO concentration in exhaled air was 20.2±6.8 ppb before and 19.8±6.4 ppb one hour after the onset of dialysis. In patients undergoing major surgery NO concentration was 5.6±2.5 ppb intra-and 10.3±3.5 ppb postoperatively. In three mechanically ventilated patients with documented septic syndrome, exhaled NO was 29.3±24 ppb.We conclude that smokers and patients with hypertension exhale significantly less NO than healthy volunteers. This suggests that exhaled NO can be used as a marker and therapeutic target in disease.
We concluded that severe sepsis mainly developed in cardiac surgery patients with serious operative and postoperative complications and was associated with a longer stay in both ICU and hospital, and a higher mortality.
Levosimendan is a safe and efficient choice in the management of low-output syndrome during and after open-heart surgery. The shortening of hospitalisation and the trend for better outcome confirm its clear superiority when the infusion starts from the operating theatre.
We randomized prospectively 144 patients, undergoing elective coronary artery bypass surgery, to either early or to routine extubation [mechanical ventilatory support for 4-7 h (Group A), or 8-14 h (Group B)]. Anaesthesia was modified for both groups. The groups were well matched in terms of sex, age, NYHA class, preoperative left ventricular ejection fraction, bypass time and aortic cross-clamp time, number of grafts used, and blood units transfused. All patients had normal preoperative respiratory, renal, hepatic and cerebral functions. Mechanical ventilatory support (mean +/- SD) was 6.3 +/- 0.7 h for Group A and 11.6 +/- 1.3 h for Group B. Mean ICU stay was 17 +/- 1.3 h for Group A and 22 +/- 1.2 h for Group B, while the mean hospital stay was 7.3 +/- 0.8 days and 8.4 +/- 0.9, respectively. There were no statistically significant differences in the frequency of all postoperative complications among the two groups. There were no reintubation, readmission to the ICU or death in either group. We concluded that change in anaesthesia practice and early postoperative sedation in patients undergoing elective coronary artery bypass graft (CABG) surgery resulted in earlier tracheal extubation, shorter ICU and hospital length of stay without organ dysfunction or postoperative complications. Early extubation was only possible due to the modification of anaesthesia and ICU sedation regime.
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