Association between vasopressor dependence and early outcome in patients after cardiac surgery

Abstract

SummaryArterial hypotension with vasopressor dependence is a major problem after cardiac surgery. We evaluated the early postoperative course of 1558 consecutive patients scheduled for cardiac surgery, and compared the outcome of patients with and without vasopressor dependence (defined as the need for > 0.1 lg.kg )1 .h )1 noradrenaline for > 3 h in the face of normovolaemia).Vasopressor dependence was diagnosed in 424 patients (27%) and was associated with a higher incidence of postoperative renal failure (67 (15.7%) vs 7 (0.6%), respectively; p < 0. .

Is incidence of postoperative vasoplegic syndrome different between off-pump and on-pump coronary artery bypass grafting surgery?

“…This occurs frequently when the incidence of a clinical event is very low. Preoperative decreased EF is one of the most documented predictors for PVS after on-pump cardiac surgery [1,[12][13][14]. This conclusion was confirmed by our study in the on-pump CABG group.…”

“…This conclusion was confirmed by our study in the on-pump CABG group. Weis et al [13] found more than half of patients developed postoperative vasopressor dependency when the preoperative EF was less than 37%, whereas in patients with normal left ventricular function only 25% did so. Preoperative heart failure is associated with marked activation of inflammatory factors, the rennin-angiotensin system, and a higher vasopressin level.…”

Bispectral index guided titration of sevoflurane in on-pump cardiac surgery reduces plasma sevoflurane concentration and vasopressor requirements

“…33 Our data demonstrated a lower sevoflurane concentration in the fresh gas supply of the oxygenator and a lower SPC with BIS-guided delivery during CPB, compared with 1.8% sevoflurane in the oxygenator fresh gas supply in the control group. 36,37 In addition to the dosage of hypnotic agents, there are several factors that could potentially influence BIS monitoring and vasopressor requirements during CPB, particularly hypothermia. The small differences in BIS values between our groups (which ranged from a mean of 37 to 43 in the Sevo 1.8% group vs. a mean of 42 to 44 in the Sevo BIS group) can be explained by the study protocol.…”

Intraoperative Hemodynamic Instability During and After Separation From Cardiopulmonary Bypass

“…Both the duration of CPB and cross-clamping are surgical variables that predict hemodynamic complications in several studies. 9,20-22,25-27,67, 68 We have also documented that hemodynamic complications were observed in 53% of patients undergoing coronary revascularization in whom CPB was used, as opposed to 14% of patients undergoing surgery with off-pump bypass. 27 The use of CPB was indeed an independent predictor of hemodynamic complications (P < .0001), and this was also observed by other authors.…”