A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization

Velissaris, Theodore; Tang, Augustine; Murray, M A; Mehta, Rajnikant; Wood, Peter; Hett, D.A.; Ohri, Sunil K.

doi:10.1016/s0003-4975(03)01360-2

Cited by 50 publications

(40 citation statements)

References 34 publications

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“…This time course of plasmatic AVP concentrations in patients undergoing general surgical procedures has been reported since the first half of the 1960s [3,6], and their greatest levels has been observed in those patients undergoing heart surgeries, with [4] or without cardiopulmonary bypass [5]. Increasing in plasma AVP levels usually begin just after surgical skin incision, peaking during the intra-operative period [3,23] or just after the first postoperative hours [6], followed by an exponential drop during the first 24 postoperative hours in uncomplicated patients [23].…”

Section: Time Course Of Vasopressin In Our Patientsmentioning

confidence: 75%

“…The pathophysiologic mechanisms responsible for this dramatic increase in plasma AVP in the per-operative period of major scheduled surgical procedures had not yet been fully clarified [5,24], but it can be influenced by the type [4,5,7,8,10] and invasiveness [25] of the surgical procedure, the type of employed anesthesia [24,26], and by hemodynamic [8,27] and/or serum osmolarity alterations in the per-operative period [24].…”

Section: Time Course Of Vasopressin In Our Patientsmentioning

confidence: 99%

“…However, the subjacent mechanisms responsible for this response have not yet been fully clarified [5].…”

Section: Introductionmentioning

confidence: 99%

“…While some authors defend that acute hypotension can stimulate AVP release since arterial pressure drops are often seen during and after anesthetic/surgical procedures [8], others disagree as they had not found a significant correlation between plasma AVP concentrations and arterial pressure levels at different times of surgical procedures [9]. So, despite the well documented plasmatic AVP increase during major surgical procedures, the subjacent mechanisms responsible for this exceptional AVP releasing to remain incompletely understood [5,10].…”

Section: Introductionmentioning

confidence: 99%

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Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

Carvalho¹,

Guillaumon²,

Cintra³

et al. 2011

Rev Bras Cir Cardiovasc

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Objectives: To evaluate plasmatic arginine vasopressin (AVP) levels in patients undergoing scheduled conventional abdominal aortic aneurysm (AAA) repair.Methods: Plasmatic AVP concentrations were measured by radioimmunoassay in 22 non-consecutive adult patients undergoing infra-renal AAA repair. They were under combined general and epidural anesthesia at the following time frames: 1 -pre-operative (T0); 2 -2h (T1) and 6h (T2) after the surgical procedure; 3 -in the morning at the first (T3), second (T4) and third (T5) post-operative days. Some clinical and laboratory variables were also recorded.Results: The mean age of patients was 68±10 years; 17 were males. Plasmatic AVP (mean±SD; pg/mL) was within the normal range at T0 (1.4±0.7; baseline), increasing significantly at T1 (62.6±62.9; P<0.001) and at T2 (31.5±49.7; P<0.001), with a progressive fall, returning to basal levels at T5 (2.1±3.8; P=NS). Positive and statistically significant correlations were found between AVP and glycemia, serum lactate and white blood cells counts, but not with systemic arterial pressure or plasma osmolarity during the postoperative period.Conclusions: Considering that no correlations were found between AVP levels and hemodynamic or plasmatic osmolarity variations in AAA repair, it seems that stress response is mainly secondary to noxious stimulation mediated by the autonomic nervous system that is not completely blocked by anesthetics. Descriptors: Intensive care units. Cardiovascular abnormalities. Receptors, vasopressin. Resumo Objetivos: Avaliar os níveis plasmáticos de vasopressina (AVP) em pacientes submetidos à correção convencional de aneurisma de aorta abdominal (AAA).Métodos: A AVP plasmática foi mensurada por radioimunoensaio em 22 pacientes não-consecutivos submetidos à correção eletiva de AAA infrarrenal sob anestesia geral + epidural nos seguintes momentos: pré-operatório (T0); 2h (T1) e 6h (T2) após a cirurgia; e nas manhãs do primeiro (T3), segundo (T4) e terceiro (T5) dia pós-operatório (PO). Variáveis clínicas e laboratoriais de interesse também foram anotadas.Resultados: A média de idade dos pacientes foi de 68±10 anos, sendo 17 homens. A AVP plasmática (média±DP; pg/ mL) estava dentro de limites normais no T0 (1,4±0,7; basal), aumentando no T1 (62,6±62,9; P<0,001) e no T2 (31,5±49,7; P<0,001), e retornando aos valores basais no T5 (2,1±3,8; RBCCV 44205-1296

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Section: Time Course Of Vasopressin In Our Patientsmentioning

confidence: 75%

Section: Time Course Of Vasopressin In Our Patientsmentioning

confidence: 99%

“…However, the subjacent mechanisms responsible for this response have not yet been fully clarified [5].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

Carvalho¹,

Guillaumon²,

Cintra³

et al. 2011

Rev Bras Cir Cardiovasc

View full text Add to dashboard Cite

show abstract

“…Our findings indicate that, through the mechanisms cited, CPB seems to be associated with the AVP surge recorded here in patients undergoing CABG. Comparable levels of plasma AVP at the end of surgery have been reported by Velissaris et al [12]. These authors, however, examined hormone release related to perioperative stress in patients undergoing CABG with and without CPB, and did not assess AVP changes during the CPB process.…”

Section: Discussionmentioning

confidence: 87%

Plasma levels and vascular effects of vasopressin in patients undergoing coronary artery bypass grafting☆

Novella

Martı́nez

Pagán

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

Møller

Penninga

Wetterslev

et al. 2012

Cochrane Database of Systematic Reviews

143

118

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Our systematic review did not demonstrate any significant benefit of off-pump compared with on-pump CABG regarding mortality, stroke, or myocardial infarction. In contrast, we observed better long-term survival in the group of patients undergoing on-pump CABG with the use of cardiopulmonary bypass and cardioplegic arrest. Based on the current evidence, on-pump CABG should continue to be the standard surgical treatment. However, off-pump CABG may be acceptable when there are contraindications for cannulation of the aorta and cardiopulmonary bypass. Further randomised clinical trials should address the optimal treatment in such patients.

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A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization

Cited by 50 publications

References 34 publications

Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

Plasma levels and vascular effects of vasopressin in patients undergoing coronary artery bypass grafting☆

Off-pump versus on-pump coronary artery bypass grafting for ischaemic heart disease

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