Scientific Debate Abstract Prize Winners Weimar 2001 Best Poster Presentation The uptake and elimination of desflurane and enflurane by different membrane oxygenators - an in vitro study Haupt U., Fiehn A., Vietor U. Department of Cardiothoracic Anesthesiology, Klinikum Kassel, 34125 Kassel, Germany Introduction: Cardiac anaesthesia is based on opioids, sedatives and inhalation agents (INH). Overdosage of INH will increase the risk of haemodynamic instability at the beginning and end of extracorporeal circulation (ECC).1 Underdosage may cause intraoperative awareness. Pharmacokinetics of the INH, and design and composition of the oxygenator (OXY) are important for anaesthetic management.2 We studied the uptake and elimination of desflurane (DES) and enflurane (ENF) by five different membrane OXY in an in-vitro experiment. Methods: The OXY (Avecor Affinity, Dideco Module 7500, Jostra Quadrox, Medos HiLite 7000, Medtronic Maxima Plus) were incorporated into a standard bypass system. The system was filled with fresh swine blood, heparinized (5000U/I) and primed to a haematocrit of 25-30% by Ringer's Lactate. Alpha-stat management was used for acid-base status control. Reflecting typical endpoints of temperature management in mild hypothermic conditions, the experiment was done at 28°C and 36°C. After cooling to 28°C equipotent concentration of F,DES (3.6 vol.%) and F,ENF (1.2 vol.%) were added to the fresh gas using a Draeger vaporizer adjusted to a volatile anaesthetic agent monitor (PM8050 Draeger, Luebeck, Germany). Samples for gas chromatography were taken at 1, 3, 5, 8, 12, 20 minute intervals and gas concentration in the exhaust line were noted. After turning off the vaporizer the experiment was repeated following a wahs-out time of 30 min.. The bypass system was warmed to 36°C and blood samples etc. were obtained in the same manner. Three types of each OXY were tested with each INH. Results: Uptake and elimination of DES by blood produces a comparable graph at both temperatures for all five OXY. Uptake of ENF by blood was significantly slower while the elimination graph was similar to DES. The elimination time of DES was significantly faster compared to ENF. The Medtronic Maxima Plus OXY showed a significantly slower uptake and elimination for DES and ENF. Discussion: The higher blood-gas coefficient of DES, compared to ENF, is the reason for the rapid uptake and elimination by blood for all the OXY. All OXY were composed of polypropylene hollow fibres. The difference between OXY are given by design and membrane surface (1.8-2.5 m2). This has to be taken in to consideration for anaesthetic management especially at the end of ECC. Control of haemodynamics and prevention of intraoperative awareness seems to be better with DES even if added to the ECC and an OXY. References: Rödig G, Keyl C, Kaluza M, et al: Effects of rapid increases of desflurane and sevoflurane to concentration of 1.5 MAC on systemic vascular resistance and catecholamine response during cardiopulmonary bypass. Anesthesiology 1997;87:801-7 Price SL, Brown DL, Carpenter RL, et al. Isoflurane elimination via a bubble oxygenator during extracorporeal circulation. J Cardiothorac Anesth 1988; 2:41-4 Most Innovative Poster Presentation Magnesium sulphate vs. lignocaine for off-pump CABG Muralidhar K, Narasimha Prasad Manipal Heart Foundation. Bangalore, India Introduction: Off-pump coronary artery bypass grafting (OP-CABG) involves mechanical stabilization of a segment of the myocardium at the site of anastomosis e.g. by the use of the Octopus tissue stabilizer. Myocardial ischaemia and arrhythmias are not uncommon during distal grafting. Prophylactic administration of anti-arrhythmic agents is recommended to prevent ventricular arrhythmia during OP-CABG. In this study, the efficacy of magnesium sulphate was compared to that of lignocaine in a prospective randomized fashion. Methods: Sixty patients suffering from coronary artery disease (CAD) were subjected to OP-CABG during the study period. They were randomly allocated to three groups of twenty each; group A received magnesium sulphate (1g loading dose followed by lg/hour infusion) and group B received lignocaine (1.5mg/kg loading dose followed by 2mg kg-1 hr-1) during the period of bypass grafting. Group C patients did not receive any prophylactic medication. The mean systemic arterial pressure (MAP) was maintained between 70-90 mmHg during the distal anastomosis with the use of a phenylephrine infusion in all three groups. The heart rate, MAP, ST segment changes of the ECG and incidence of arrhythmias were noted and statistically analysed. Plasma concentration of Mg++, Ca++ and K+ were estimated at periodic intervals during and after grafting. Numerical data was analysed using Student's t test. Results: The three groups were comparable with regard to the age, sex, body weight, NYHA class, previous Ml, EF, diabetes and number of grafts performed. Table. Mean (± SD) heart rate. blood pressure and percentage of patients exhibiting ST segment abnormality and arrhythmia : A (Mg) n=20 B (lig) n=20 C (Contr) n=20 P HR beat/min 70±3 69±3 75±2 NS MAP mmHg 78±6 76±4 80±5 NS ST1 % patients 0 10* 25* <0.01 ST2 % patients 5 18* 30* <0.01 STV5 % patients 5 20* 40* <0.01 Non-sinus rhythm % 5 20* 25* <0.01 Plasma Mg mmol/l 1.3±0.3 0.9±0.3* 0.9±0.4* <0.01 * when compared to group A. HR = heart rate, MAP = mean arterial blood pressure, ST1 = ST in lead I, ST2 = ST in lead II, STV5 = ST in V5 Discussion: Patients undergoing OP-CABG are at particular risk of developing myocardial ischaemia and malignant ventricular arrhythmias. Magnesium has been shown to possess class IV and class I antiarrhythmic properties. Hypomagnesaemia documented in OP-CABG has multifactorial causes and magnesium supplements during OP-CABG are associated with reduced postoperative atrial tachyarrhythmia.1 This study demonstrates that intraoperative administration of magnesium is associated with significantly decreased incidence of ischaemic episodes and cardiac arrhythmias during OP-CABG. References : Maslow AD, Regan MM, Heindle S. et al. Postoperative atrial tachyarrhythmias in patients undergoing coronary artery bypass graft surgery without cardiopulmonary bypass: a role for intraoperative magnesium supplementation. J Cardiothorac Vasc Anesth 2000; 14:524.30 Best Oral Presentation Depression and anxiety in cardiac surgical patients: preliminary results Székely A.*, Benkö E.+, Varga A.*, Jákics J.*, Mészáros R.* Dpt. of Anaesthesiology, + Dpt of Rehabilitation Care, Gottsegen National Institute of Cardiology, Budapest-H-1097 Hungary Introduction: Depression and anxiety play important roles in the outcome and in the further rehabilitation of patients undergoing open heart surgery.1 Methods: Following Ethics Committee approval, 77 patients had been enrolled between May and November 2000. Depression and anxiety scores were measured before surgery and 6 weeks after discharge from the hospital. Beck Depression Inventory (BDI) test, based on the cognitive behaviour theory and STAIs and STAlt (slate-trait anxiety inventory, Spielberger type2) were used. The following factors were considered: age, gender, marital state, education, pre-surgical hospital stay, aortic cross clamp time and bypass time. Additional data collected were: type of anaesthesia (propofol, isoflurane or midazolam, all combined with fentanyl), incidence of hypotension, cardioversion, duration of ICU stay, hospital stay and neuropsychiatric disorders. Statistical analysis was performed with forward stepwise regression and ANOVA tests. Results: Preoperative BDI score showed significant correlation with the preoperative hospital stay (r=O.81) and pre-existing psychiatric disorders (r=0.74). BDI score under 10 points is considered to be normal. Preoperative anxiety scores (below 40 points normal) were significantly higher in valve disease (r=0.57). Type of anaesthesia, age, gender or education did not affect these scores. Postoperative depression and anxiety (response 67%) were both correlated with long hospital stay, singles and depressive disorders. Conclusion: Our results indicate, that patients with valve disease, singles and long hospital stay require special psychological attention during the perioperative period. References: Selnes OA, Goldsborough MA, Borowicz LM, et al. Neurobehavioural sequelae of cardiopulmonary bypass Lancet 1999; 353: 1601-6 Spielberger CD, Gorsuch RL, Lushene RE. Manual for State-Trait Anxiety Inventory. Arch Gen Psych 19A1; 4: 561-71 Most Innovative Oral Presentation Efficacy of inhaled iloprost changes after pulmonary thrombendarterectomy in chronic thromboembolic pulmonary hypertension B. Eberle;T. Kramm, S. Guth, E. Mayer Depts. of Anaesthesiology and Cardiothoracic/Vascular Surgery, Johannes Gutenberg University, Mainz, Germany Introduction: In primary pulmonary hypertension (PPH), inhalation of an aerosol of a prostanoid improves pulmonary haemodynamics, right ventricular function and exercise capacity.1 We investigated the haemodynamic effects of inhaled iloprost (ILO), a stable prostacyclin analogue, in patients with chronic thromboembolic pulmonary hypertension (CTEPH) prior to and after pulmonary thrombendarterectomy (PTE). Methods: With 1RB approval and informed consent, 9 anaesthetized patients were studied (5 m, 4 f; mean age 49 yr (32-70); NYHA III (6) - IV (3); ASA-PS IV; fentanyl/propofol; pressure-constant normoventilalion, PaO2, set to ~90 mmHg). After a control period (normal saline aerosol, NS), patients inhaled an aerosol of ILO (33 µg each dose) prior to incision, after PTE on admission to ICU, and 12 h post-op. Gas exchange, systemic and pulmonary haemodynamics were recorded prior to and during NS/ILO inhalation. Effects were compared between NS/ILO and between time periods. Values are medians [max/min]. Statistics: Wilcoxon signed rank test, Bonferroni correction for multiple testing; *NS vs. ILO significant at p<0.05. Results: Preoperatively, ILO did not significantly affect mean pulmonary arterial pressure (mPAP), cardiac index (Cl) or pulmonary vascular resistance (PVR). On admission after PTE and 12 h postop, ILO reduced PVR significantly both by reducing mPAP and enhancing Cl. ILO effects were apparent for 80 min. Preop. PTE ICU admission 12 h postop. CI (l-m-1) NS 1.8 [1.2-2.8] 2.1 [1.3-3.8] 2.2 [1.8-3.1] ILO 1.5 [1.1-3.1] 2.6 [1.8-4.4]* 2.5 [2.1-3.6]* MPAP (mm Hg) NS 44 [32-70] 36 [26-62] 29 [17-75] ILO 47 [33-71] 33 [16-59]* 27 [12-62]* PVR (dyn.s.cm-5) NS 805 [562-1770] 498 [223-1582] 304 [133-1283] ILO 820 [386-2133] 325 [126-1100]* 267 [90-1052]* Discussion: ln contrast to findings in PPH, inhalation of an ILO aerosol failed to reduce PVR and unload the right ventricle in CTEPH patients prior to PTE. Early after disobliteration, however, pulmonary vasculature responded to inhaled ILO. We conclude that in CTEPH, an ILO aerosol is effective only after PTE. This may be useful during the early postoperative period to stabilize haemodynamics and improve early outcome. References: Hoeper MM, Schwarze M, Ehlerding S, et al. Long-term treatment of primary pulmonary hypertension with aerosolized iloprost, a prostacyclin analogue. N EngI J Med 2000. 342: 1866-70

18th National Congress of the Cardiovascular and Thoracic Anesthesia and Intensive Care Society
12-15th April 2012
Bodrum Turkey
» Read more

EACTA NEWS LETTER
October 2011

» Click here

EACTA on Linkedin
» Click here

EACTA ICU on Facebook
» Click here

17th Annual Update on Cardiopulmonary Bypass
March 11 - 16, 2012
Aspen/Snowmass Village, CO
» Read more

Thoracic Anesthesia Symposium
April 27 - 28, 2012
Boston, MA
» Read more

34th Annual Meeting & Workshops
April 28 - May 2, 2012
Boston, MA
» Read more

Cardiothoracic Symposium
Iguazu Falls, Argentina
March 19th-21st 2012
» Read more

Abstracts from EACTA 2011
Abstracts from EACTA 2011 are published online by the Journal of Cardiothoracic and Vascular Anesthesia. Please go to:
» www.JCVAonline.com

2012 Combined Meeting of the 13th International Congress of Cardiothoracic and Vascular Anaesthesia and the New Zealand Anaesthesia Annual Scientific Meeting, to be held 14 - 17 November 2012, Auckland, New Zealand.
» Read more

EACTA Perioperative Echocardiography DVDs now available
Buy your copy as an EACTA member for €50.
» Read more

JCVA



The Journal of Cardiothoracic and Vascular Anesthesia (JCVA) is now the official journal of the European Association of Cardiothoracic Anesthesiologists (EACTA)......
» Read more

ACTA Autumn Meeting
Holywell Park
Loughborough, Leicestershire
16th - 18th November 2011
» Homepage
» Brochure