Luciano Brandão Machado

Incidência de cirurgia cardíaca em octogenários: estudo retrospectivo

JUSTIFICATIVA Y OBJETIVOS: El aumento de la expectativa de vida hace con que pacientes cada vez mas edosos tengan indicacion de tratamiento quirurgico de cardiopatias. Este estudio tiene como objetivo evaluar la incidencia de pacientes con mas de 80 anos sometidos a cirugia cardiaca en el Instituto del Corazon del Hospital de Clinicas de la FMUSP, en los ultimos 16 anos. METODO: Fueron analizados, en el periodo de 1986 a 2001, el numero de cirugias de revascularizacion del miocardio (RM) y cirugia valvar (CV) y, en cada grupo, el numero de cirugias en pacientes con mas de 80 anos. Los datos fueron analizados descriptivamente. RESULTADOS: Los datos revelan aumento progresivo del numero de octogenarios sometidos a cirugia cardiaca. Las cirugias de revascularizacion del miocardio tuvieron aumento de 0,13% en 1986 para 3,5% en 2001. Las cirugias valvares aumentaron de 0% en 1986 para 1,44% en 2001, registrando el mayor valor de 3,02% en 1999. CONCLUSIONES: Los conocimientos de la fisiopatologia, de la senilidad y los avanzos en el manoseo del trauma quirurgico estan permitiendo extender los recursos de la cirugia cardiaca en el grupo de pacientes mas edosos. La eleccion de la tecnica anestesica debe tener criterio, bien como la hidratacion, la asistencia ventilatoria y la analgesia pos-operatoria, permitiendo reduccion de la morbimortalidad en este grupo de mayor riesgo quirurgico.BACKGROUND AND OBJECTIVES Increased life expectancy makes increasingly older patients to be submitted to cardiac surgeries. This study aimed at evaluating the incidence of octogenarian patients submitted to cardiac surgeries in the Heart Institute, Hospital das Clínicas, FMUSP, in the last 16 years. METHODS The number of myocardial revascularization (MR) and valvar surgeries (VS) was analyzed for the period 1986 to 2001 and, within each group, the number of surgeries in octogenarian patients. Data were descriptively analyzed. RESULTS Data have shown a progressive increase in the number of octogenarian patients submitted to cardiac surgeries. Myocardial revascularization surgeries have increased from 0.13% in 1986 to 3.5% in 2001. Valvar surgeries have increased from 0% in 1986 to 1.44% in 2001, with the highest rate of 3.02% in 1999. CONCLUSIONS The understanding of pathophysiology and senility, and the advances in surgical trauma handling are allowing cardiac surgery resources to be expanded to elderly patients. Anesthetic technique should be carefully chosen, as well as hydration, ventilatory assistance and postoperative analgesia, to provide decreased morbidity and mortality in this higher surgical risk group.

Avaliação dos níveis de citocinas e da função pulmonar de pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

JUSTIFICATIVA Y OBJETIVOS: El Sindrome de la Respuesta Inflamatoria Sistemica es algo habitual en las cirugias cardiacas con circulacion extracorporea (CEC). El objetivo de este estudio fue evaluar los niveles sistemicos y pulmonares de citocinas y la correlacion con la funcion pulmonar en los pacientes sometidos a la revascularizacion miocardica (RM) con CEC. METODOS: El estudio fue aprobado por la Comision de Etica Institucional, con la evaluacion de 13 pacientes sometidos a la RM con CEC. Despues de la induccion anestesica al termino de la CEC, se realizaron dosificaciones plasmaticas y tambien en el lavado broncoalveolar de IL-1β, IL-6, IL-8, IL-10 y TNF-α. Se evaluaron el tiempo de CEC y de cirugia, la relacion PaO2/FiO2, el gradiente alveolo-arterial de oxigeno (GA-aO2), el shunt y la complacencia pulmonares. Los resultados fueron sometidos al analisis de variancia para medidas repetidas (*p < 0,05) y al coeficiente de correlacion de Spearman. RESULTADOS: Se observo un aumento en los niveles de citocinas en el plasma y en el lavado broncoalveolar despues de la CEC y una relacion directa entre el aumento de la IL-1β y la disminucion de la complacencia pulmonar (p = 0,0439), como tambien una relacion inversa entre el aumento de la IL-10 y la reduccion de la complacencia (p = 0,0325). El aumento de la IL-6 tuvo una relacion directa con el tiempo de CEC (p = 0,012), mientras que el aumento de la IL-8 tuvo una relacion directa con el tiempo de cirugia (p < 0,0001). Los niveles de IL-1β, IL-8 y TNF-α fueron mayores en el LBA con relacion al plasma. CONCLUSIONES: Ocurre un aumento de los niveles de citocinas en el plasma y en el lavado broncoalveolar despues de la CEC, con una correlacion entre el aumento de los niveles de citocinas y el tiempo de CEC y de cirugia, y las alteraciones en la complacencia pulmonar.

Evaluation of Cytokine Levels and Pulmonary Function in Patients Undergoing Coronary Artery Bypass Graft

BACKGROUND AND OBJECTIVES Systemic inflammatory response syndrome is commonly observed in coronary artery bypass grafts (CABG) with cardiopulmonary bypass (CB). The objective of this study was to evaluate the systemic and pulmonary levels of cytokines and their correlation with lung function in patients undergoing myocardial revascularization (MR) with CB. METHODS This study was approved by the Institutional Ethics Committee, and 13 patients undergoing MR with CB were evaluated. After anesthetic induction and at the end of CB, plasma and bronchoalveolar lavage levels of IL-1β, IL-6, IL-8, IL-10, and TNF-α were determined. The duration of CB and surgery, PaO(2)/FiO(2) ratio, alveolar-arterial oxygen gradient (A-a gradient), shunt, and lung compliance were evaluated. Results were submitted to analysis of variance for repeated measurements (*p < 0.05) and Spearmans correlation coefficient. RESULTS We observed increased levels of cytokines in plasma and bronchoalveolar lavage after CB and a direct relationship between the increase in IL-1β and decrease in lung compliance (p = 0.0439), as well as the inverse relationship between the increase in IL-10 and a decrease in compliance (p = 0.0325). The increase in IL-6 was directly related to the duration of CB (p = 0.012), while the increase in IL-8 was directly related to the duration of surgery (p < 0.0001). Levels of interleukin-1β, IL-8, and TNF-α in bronchoalveolar lavage were higher than in plasma. CONCLUSIONS There is an increase in cytokine levels in plasma and bronchoalveolar lavage after CB, as well as a correlation between increased cytokine levels and CB duration and surgery and changes in lung compliance.

Broncho-alveolar lavage cellularity in patients submitted to myocardial revascularization with cardiopulmonary bypass: three case reports

BACKGROUND AND OBJECTIVES Cardiopulmonary bypass (CPB) is a primary determinant of systemic inflammatory response (SIRS) during cardiac procedures. It has been shown in an experimental model that CPB may increase cytokine production. This study aimed at evaluating post-CPB lung cell activation by investigating broncho-alveolar lavage (BAL) cellularity in patients submitted to myocardial revascularization (MR) with CPB. CASE REPORTS Participated in this prospective study 3 adult patients submitted to MR with CPB. After general anesthesia induction and tracheal intubation, mechanical ventilation was installed with valve circle system; except during CPB, tidal volume was maintained between 8 and 10 mL.kg-1 with 50% O2 and air. Before aortic unclamping, 40 cmH2O pulmonary inflations were performed. Two BAL samples were collected from all patients at beginning and end of procedure, after anticoagulation reversion. BAL was aspired after 60 mL infusion of 0.9% saline through the bronchofibroscope tube. Material was then referred to laboratorial processing. Analysis has evidenced mean increase in total number of cells from 0.6 x 10(6)cel.dL-1 to 6.8 x 10(6) cel.dL-1 with increased neutrophils from 0.8% to 4.7%; 0.6% to 6.2% and 0.5% to 5.3% for each patient, respectively. There has been increased pulmonary fluid cellularity after CPB. CONCLUSIONS Leukocyte inflow is described in different clinical pulmonary inflammatory conditions, such as adult respiratory distress syndrome. It is known that CPB is related to systemic and pulmonary inflammation with increased number of cells after CPB and predominance of macrophages.JUSTIFICATIVA Y OBJETIVOS: La circulacion extracorporea (CEC) es uno de los principales determinantes de la respuesta inflamatoria sistemica (SIRS) en cirugia cardiaca. Quedo demostrado en modelo experimental que la CEC puede llevar a un aumento en la produccion de las citocinas. Con el objetivo de evaluar la activacion celular en el pulmon despues del CEC, se estudio la celularidad en el lavado bronco-alveolar (LBA) en pacientes sometidos a la cirugia de revascularizacion del miocardio (RM) con CEC. RELATO DE LOS CASOS: Se estudiaron, como sondeo, tres pacientes adultos sometidos a la RM con CEC. Despues de la induccion de anestesia general e intubacion traqueal, la ventilacion mecanica se realizo con sistema circular valvular; excepto durante la CEC, el volumen corriente se mantuvo entre 8 y 10 mL.kg-1 con O2 y aire, en una proporcion de 50%. Antes del despinzamiento de la aorta, se realizaron insuflaciones pulmonares con presion de 40 cmH2O y recolectadas dos muestras de LBA de cada paciente, al comienzo de la intervencion quirurgica y al final del procedimiento, despues de la reversion de la anticoagulacion. Despues de la infusion de 60 mL de solucion fisiologica a 0,9% por el canal del broncofibroscopio, se aspiro el LBA, siendo el material enviado al laboratorio. El analisis mostro un aumento del numero total de celulas, como promedio, de 0,6.106 cel.dL-1 para 6,8.106 cel.dL-1 con aumento de neutrofilos de 0,8% para 4,7%; 0,6% para 6,2% y 0,5% para 5,3% en cada paciente, respectivamente. Se observo en la lamina el aumento de celularidad en el fluido pulmonar despues de la CEC. CONCLUSIONES: El influjo de leucocitos se describe en diversas condiciones clinicas pulmonares inflamatorias como en el sindrome de la angustia respiratoria del adulto. Se conoce que la CEC esta relacionada con la inflamacion sistemica y pulmonar, demostrando aumento del numero de celulas despues de la CEC con el predominio de macrofagos.

[Correlation between end-tidal carbon dioxide levels and cardiac output during cardiac surgery with cardiopulmonary bypass.].

BACKGROUND AND OBJECTIVES: End-tidal carbon dioxide (PETCO2) not only reflects pulmonary ventilation but also carbon dioxide production (metabolism) and pulmonary blood supply (circulation). During constant metabolism and ventilation, PETCO2 reflects pulmonary blood perfusion, thus cardiac output (CO). This study aimed at evaluating the correlation between PETCO2 levels and CO during cardiac surgery with cardiopulmonary bypass (CPB). METHODS: Participated in this study 25 patients submitted to coronary artery bypass grafting (CABG) with CPB. End-tidal CO2 monitoring started after tracheal intubation. Cardiac output was determined by thermodilution with pulmonary artery catheter (Swan-Ganz). Carbon dioxide partial blood pressure (PaCO2) was obtained with arterial blood gases analysis. Studied parameters were evaluated in the following moments: immediately after general anesthesia induction, before cardiopulmonary bypass, at cardiopulmonary bypass completion and at surgery completion. RESULTS: Statistical analysis has not shown correlation between PETCO2 and CO2, or between PETCO2-PaCO2 gradient (Ga-eCO2) and CO. There has been correlation between PETCO2, Ga-eCO2 and CO values variation as compared to baseline values before CPB, with loss of correlation after CPB until surgery completion. CONCLUSIONS: In this study, where patients submitted to cardiac surgery with CPB were evaluated, ventilation/perfusion changes throughout the procedure might have been the factors determining decreased correlation between cardiac output and end tidal CO2.BACKGROUND AND OBJECTIVES End-tidal carbon dioxide (P ET CO2) not only reflects pulmonary ventilation but also carbon dioxide production (metabolism) and pulmonary blood supply (circulation). During constant metabolism and ventilation, P ET CO2 reflects pulmonary blood perfusion, thus cardiac output (CO). This study aimed at evaluating the correlation between P ET CO2 levels and CO during cardiac surgery with cardiopulmonary bypass (CPB). METHODS Participated in this study 25 patients submitted to coronary artery bypass grafting (CABG) with CPB. End-tidal CO2 monitoring started after tracheal intubation. Cardiac output was determined by thermodilution with pulmonary artery catheter (Swan-Ganz). Carbon dioxide partial blood pressure (PaCO2) was obtained with arterial blood gases analysis. Studied parameters were evaluated in the following moments: immediately after general anesthesia induction, before cardiopulmonary bypass, at cardiopulmonary bypass completion and at surgery completion. RESULTS Statistical analysis has not shown correlation between P ET CO2 and CO2, or between P ET CO2-PaCO2 gradient (Ga-eCO2) and CO. There has been correlation between P ET CO2, Ga-eCO2 and CO values variation as compared to baseline values before CPB, with loss of correlation after CPB until surgery completion. CONCLUSIONS In this study, where patients submitted to cardiac surgery with CPB were evaluated, ventilation/perfusion changes throughout the procedure might have been the factors determining decreased correlation between cardiac output and end tidal CO2.

Análise da celularidade do lavado bronco-alveolar em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea: relato de três casos

BACKGROUND AND OBJECTIVES Cardiopulmonary bypass (CPB) is a primary determinant of systemic inflammatory response (SIRS) during cardiac procedures. It has been shown in an experimental model that CPB may increase cytokine production. This study aimed at evaluating post-CPB lung cell activation by investigating broncho-alveolar lavage (BAL) cellularity in patients submitted to myocardial revascularization (MR) with CPB. CASE REPORTS Participated in this prospective study 3 adult patients submitted to MR with CPB. After general anesthesia induction and tracheal intubation, mechanical ventilation was installed with valve circle system; except during CPB, tidal volume was maintained between 8 and 10 mL.kg-1 with 50% O2 and air. Before aortic unclamping, 40 cmH2O pulmonary inflations were performed. Two BAL samples were collected from all patients at beginning and end of procedure, after anticoagulation reversion. BAL was aspired after 60 mL infusion of 0.9% saline through the bronchofibroscope tube. Material was then referred to laboratorial processing. Analysis has evidenced mean increase in total number of cells from 0.6 x 10(6)cel.dL-1 to 6.8 x 10(6) cel.dL-1 with increased neutrophils from 0.8% to 4.7%; 0.6% to 6.2% and 0.5% to 5.3% for each patient, respectively. There has been increased pulmonary fluid cellularity after CPB. CONCLUSIONS Leukocyte inflow is described in different clinical pulmonary inflammatory conditions, such as adult respiratory distress syndrome. It is known that CPB is related to systemic and pulmonary inflammation with increased number of cells after CPB and predominance of macrophages.JUSTIFICATIVA Y OBJETIVOS: La circulacion extracorporea (CEC) es uno de los principales determinantes de la respuesta inflamatoria sistemica (SIRS) en cirugia cardiaca. Quedo demostrado en modelo experimental que la CEC puede llevar a un aumento en la produccion de las citocinas. Con el objetivo de evaluar la activacion celular en el pulmon despues del CEC, se estudio la celularidad en el lavado bronco-alveolar (LBA) en pacientes sometidos a la cirugia de revascularizacion del miocardio (RM) con CEC. RELATO DE LOS CASOS: Se estudiaron, como sondeo, tres pacientes adultos sometidos a la RM con CEC. Despues de la induccion de anestesia general e intubacion traqueal, la ventilacion mecanica se realizo con sistema circular valvular; excepto durante la CEC, el volumen corriente se mantuvo entre 8 y 10 mL.kg-1 con O2 y aire, en una proporcion de 50%. Antes del despinzamiento de la aorta, se realizaron insuflaciones pulmonares con presion de 40 cmH2O y recolectadas dos muestras de LBA de cada paciente, al comienzo de la intervencion quirurgica y al final del procedimiento, despues de la reversion de la anticoagulacion. Despues de la infusion de 60 mL de solucion fisiologica a 0,9% por el canal del broncofibroscopio, se aspiro el LBA, siendo el material enviado al laboratorio. El analisis mostro un aumento del numero total de celulas, como promedio, de 0,6.106 cel.dL-1 para 6,8.106 cel.dL-1 con aumento de neutrofilos de 0,8% para 4,7%; 0,6% para 6,2% y 0,5% para 5,3% en cada paciente, respectivamente. Se observo en la lamina el aumento de celularidad en el fluido pulmonar despues de la CEC. CONCLUSIONES: El influjo de leucocitos se describe en diversas condiciones clinicas pulmonares inflamatorias como en el sindrome de la angustia respiratoria del adulto. Se conoce que la CEC esta relacionada con la inflamacion sistemica y pulmonar, demostrando aumento del numero de celulas despues de la CEC con el predominio de macrofagos.

Análisis de la celularidad del lavado bronco-alveolar en pacientes sometidos a revascularización del miocardio con circulación extracorpórea: relato de tres casos

BACKGROUND AND OBJECTIVES Cardiopulmonary bypass (CPB) is a primary determinant of systemic inflammatory response (SIRS) during cardiac procedures. It has been shown in an experimental model that CPB may increase cytokine production. This study aimed at evaluating post-CPB lung cell activation by investigating broncho-alveolar lavage (BAL) cellularity in patients submitted to myocardial revascularization (MR) with CPB. CASE REPORTS Participated in this prospective study 3 adult patients submitted to MR with CPB. After general anesthesia induction and tracheal intubation, mechanical ventilation was installed with valve circle system; except during CPB, tidal volume was maintained between 8 and 10 mL.kg-1 with 50% O2 and air. Before aortic unclamping, 40 cmH2O pulmonary inflations were performed. Two BAL samples were collected from all patients at beginning and end of procedure, after anticoagulation reversion. BAL was aspired after 60 mL infusion of 0.9% saline through the bronchofibroscope tube. Material was then referred to laboratorial processing. Analysis has evidenced mean increase in total number of cells from 0.6 x 10(6)cel.dL-1 to 6.8 x 10(6) cel.dL-1 with increased neutrophils from 0.8% to 4.7%; 0.6% to 6.2% and 0.5% to 5.3% for each patient, respectively. There has been increased pulmonary fluid cellularity after CPB. CONCLUSIONS Leukocyte inflow is described in different clinical pulmonary inflammatory conditions, such as adult respiratory distress syndrome. It is known that CPB is related to systemic and pulmonary inflammation with increased number of cells after CPB and predominance of macrophages.JUSTIFICATIVA Y OBJETIVOS: La circulacion extracorporea (CEC) es uno de los principales determinantes de la respuesta inflamatoria sistemica (SIRS) en cirugia cardiaca. Quedo demostrado en modelo experimental que la CEC puede llevar a un aumento en la produccion de las citocinas. Con el objetivo de evaluar la activacion celular en el pulmon despues del CEC, se estudio la celularidad en el lavado bronco-alveolar (LBA) en pacientes sometidos a la cirugia de revascularizacion del miocardio (RM) con CEC. RELATO DE LOS CASOS: Se estudiaron, como sondeo, tres pacientes adultos sometidos a la RM con CEC. Despues de la induccion de anestesia general e intubacion traqueal, la ventilacion mecanica se realizo con sistema circular valvular; excepto durante la CEC, el volumen corriente se mantuvo entre 8 y 10 mL.kg-1 con O2 y aire, en una proporcion de 50%. Antes del despinzamiento de la aorta, se realizaron insuflaciones pulmonares con presion de 40 cmH2O y recolectadas dos muestras de LBA de cada paciente, al comienzo de la intervencion quirurgica y al final del procedimiento, despues de la reversion de la anticoagulacion. Despues de la infusion de 60 mL de solucion fisiologica a 0,9% por el canal del broncofibroscopio, se aspiro el LBA, siendo el material enviado al laboratorio. El analisis mostro un aumento del numero total de celulas, como promedio, de 0,6.106 cel.dL-1 para 6,8.106 cel.dL-1 con aumento de neutrofilos de 0,8% para 4,7%; 0,6% para 6,2% y 0,5% para 5,3% en cada paciente, respectivamente. Se observo en la lamina el aumento de celularidad en el fluido pulmonar despues de la CEC. CONCLUSIONES: El influjo de leucocitos se describe en diversas condiciones clinicas pulmonares inflamatorias como en el sindrome de la angustia respiratoria del adulto. Se conoce que la CEC esta relacionada con la inflamacion sistemica y pulmonar, demostrando aumento del numero de celulas despues de la CEC con el predominio de macrofagos.

Avaliação da correlação entre o dióxido de carbono expirado e o débito cardíaco em pacientes submetidos à cirurgia cardíaca com circulação extracorpórea

BACKGROUND AND OBJECTIVES: End-tidal carbon dioxide (PETCO2) not only reflects pulmonary ventilation but also carbon dioxide production (metabolism) and pulmonary blood supply (circulation). During constant metabolism and ventilation, PETCO2 reflects pulmonary blood perfusion, thus cardiac output (CO). This study aimed at evaluating the correlation between PETCO2 levels and CO during cardiac surgery with cardiopulmonary bypass (CPB). METHODS: Participated in this study 25 patients submitted to coronary artery bypass grafting (CABG) with CPB. End-tidal CO2 monitoring started after tracheal intubation. Cardiac output was determined by thermodilution with pulmonary artery catheter (Swan-Ganz). Carbon dioxide partial blood pressure (PaCO2) was obtained with arterial blood gases analysis. Studied parameters were evaluated in the following moments: immediately after general anesthesia induction, before cardiopulmonary bypass, at cardiopulmonary bypass completion and at surgery completion. RESULTS: Statistical analysis has not shown correlation between PETCO2 and CO2, or between PETCO2-PaCO2 gradient (Ga-eCO2) and CO. There has been correlation between PETCO2, Ga-eCO2 and CO values variation as compared to baseline values before CPB, with loss of correlation after CPB until surgery completion. CONCLUSIONS: In this study, where patients submitted to cardiac surgery with CPB were evaluated, ventilation/perfusion changes throughout the procedure might have been the factors determining decreased correlation between cardiac output and end tidal CO2.BACKGROUND AND OBJECTIVES End-tidal carbon dioxide (P ET CO2) not only reflects pulmonary ventilation but also carbon dioxide production (metabolism) and pulmonary blood supply (circulation). During constant metabolism and ventilation, P ET CO2 reflects pulmonary blood perfusion, thus cardiac output (CO). This study aimed at evaluating the correlation between P ET CO2 levels and CO during cardiac surgery with cardiopulmonary bypass (CPB). METHODS Participated in this study 25 patients submitted to coronary artery bypass grafting (CABG) with CPB. End-tidal CO2 monitoring started after tracheal intubation. Cardiac output was determined by thermodilution with pulmonary artery catheter (Swan-Ganz). Carbon dioxide partial blood pressure (PaCO2) was obtained with arterial blood gases analysis. Studied parameters were evaluated in the following moments: immediately after general anesthesia induction, before cardiopulmonary bypass, at cardiopulmonary bypass completion and at surgery completion. RESULTS Statistical analysis has not shown correlation between P ET CO2 and CO2, or between P ET CO2-PaCO2 gradient (Ga-eCO2) and CO. There has been correlation between P ET CO2, Ga-eCO2 and CO values variation as compared to baseline values before CPB, with loss of correlation after CPB until surgery completion. CONCLUSIONS In this study, where patients submitted to cardiac surgery with CPB were evaluated, ventilation/perfusion changes throughout the procedure might have been the factors determining decreased correlation between cardiac output and end tidal CO2.

Evaluación de la correlación entre el dióxido de carbono expirado y el débito cardíaco en pacientes sometidos a la cirugía cardíaca con circulación extracorpórea

BACKGROUND AND OBJECTIVES: End-tidal carbon dioxide (PETCO2) not only reflects pulmonary ventilation but also carbon dioxide production (metabolism) and pulmonary blood supply (circulation). During constant metabolism and ventilation, PETCO2 reflects pulmonary blood perfusion, thus cardiac output (CO). This study aimed at evaluating the correlation between PETCO2 levels and CO during cardiac surgery with cardiopulmonary bypass (CPB). METHODS: Participated in this study 25 patients submitted to coronary artery bypass grafting (CABG) with CPB. End-tidal CO2 monitoring started after tracheal intubation. Cardiac output was determined by thermodilution with pulmonary artery catheter (Swan-Ganz). Carbon dioxide partial blood pressure (PaCO2) was obtained with arterial blood gases analysis. Studied parameters were evaluated in the following moments: immediately after general anesthesia induction, before cardiopulmonary bypass, at cardiopulmonary bypass completion and at surgery completion. RESULTS: Statistical analysis has not shown correlation between PETCO2 and CO2, or between PETCO2-PaCO2 gradient (Ga-eCO2) and CO. There has been correlation between PETCO2, Ga-eCO2 and CO values variation as compared to baseline values before CPB, with loss of correlation after CPB until surgery completion. CONCLUSIONS: In this study, where patients submitted to cardiac surgery with CPB were evaluated, ventilation/perfusion changes throughout the procedure might have been the factors determining decreased correlation between cardiac output and end tidal CO2.BACKGROUND AND OBJECTIVES End-tidal carbon dioxide (P ET CO2) not only reflects pulmonary ventilation but also carbon dioxide production (metabolism) and pulmonary blood supply (circulation). During constant metabolism and ventilation, P ET CO2 reflects pulmonary blood perfusion, thus cardiac output (CO). This study aimed at evaluating the correlation between P ET CO2 levels and CO during cardiac surgery with cardiopulmonary bypass (CPB). METHODS Participated in this study 25 patients submitted to coronary artery bypass grafting (CABG) with CPB. End-tidal CO2 monitoring started after tracheal intubation. Cardiac output was determined by thermodilution with pulmonary artery catheter (Swan-Ganz). Carbon dioxide partial blood pressure (PaCO2) was obtained with arterial blood gases analysis. Studied parameters were evaluated in the following moments: immediately after general anesthesia induction, before cardiopulmonary bypass, at cardiopulmonary bypass completion and at surgery completion. RESULTS Statistical analysis has not shown correlation between P ET CO2 and CO2, or between P ET CO2-PaCO2 gradient (Ga-eCO2) and CO. There has been correlation between P ET CO2, Ga-eCO2 and CO values variation as compared to baseline values before CPB, with loss of correlation after CPB until surgery completion. CONCLUSIONS In this study, where patients submitted to cardiac surgery with CPB were evaluated, ventilation/perfusion changes throughout the procedure might have been the factors determining decreased correlation between cardiac output and end tidal CO2.

Incidencia de cirugía cardíaca en octogenarios: estudio retrospectivo

JUSTIFICATIVA Y OBJETIVOS: El aumento de la expectativa de vida hace con que pacientes cada vez mas edosos tengan indicacion de tratamiento quirurgico de cardiopatias. Este estudio tiene como objetivo evaluar la incidencia de pacientes con mas de 80 anos sometidos a cirugia cardiaca en el Instituto del Corazon del Hospital de Clinicas de la FMUSP, en los ultimos 16 anos. METODO: Fueron analizados, en el periodo de 1986 a 2001, el numero de cirugias de revascularizacion del miocardio (RM) y cirugia valvar (CV) y, en cada grupo, el numero de cirugias en pacientes con mas de 80 anos. Los datos fueron analizados descriptivamente. RESULTADOS: Los datos revelan aumento progresivo del numero de octogenarios sometidos a cirugia cardiaca. Las cirugias de revascularizacion del miocardio tuvieron aumento de 0,13% en 1986 para 3,5% en 2001. Las cirugias valvares aumentaron de 0% en 1986 para 1,44% en 2001, registrando el mayor valor de 3,02% en 1999. CONCLUSIONES: Los conocimientos de la fisiopatologia, de la senilidad y los avanzos en el manoseo del trauma quirurgico estan permitiendo extender los recursos de la cirugia cardiaca en el grupo de pacientes mas edosos. La eleccion de la tecnica anestesica debe tener criterio, bien como la hidratacion, la asistencia ventilatoria y la analgesia pos-operatoria, permitiendo reduccion de la morbimortalidad en este grupo de mayor riesgo quirurgico.BACKGROUND AND OBJECTIVES Increased life expectancy makes increasingly older patients to be submitted to cardiac surgeries. This study aimed at evaluating the incidence of octogenarian patients submitted to cardiac surgeries in the Heart Institute, Hospital das Clínicas, FMUSP, in the last 16 years. METHODS The number of myocardial revascularization (MR) and valvar surgeries (VS) was analyzed for the period 1986 to 2001 and, within each group, the number of surgeries in octogenarian patients. Data were descriptively analyzed. RESULTS Data have shown a progressive increase in the number of octogenarian patients submitted to cardiac surgeries. Myocardial revascularization surgeries have increased from 0.13% in 1986 to 3.5% in 2001. Valvar surgeries have increased from 0% in 1986 to 1.44% in 2001, with the highest rate of 3.02% in 1999. CONCLUSIONS The understanding of pathophysiology and senility, and the advances in surgical trauma handling are allowing cardiac surgery resources to be expanded to elderly patients. Anesthetic technique should be carefully chosen, as well as hydration, ventilatory assistance and postoperative analgesia, to provide decreased morbidity and mortality in this higher surgical risk group.