O objetivo do presente trabalho foi validar micrométodo simples e sensível para a quantificação do propranolol em plasma utilizando CLAE-F com a finalidade de aplicação no monitoramento das concentrações de propranolol durante o washout. Necessitou-se apenas de 200&#181;L de plasma. Os tempos de retenção para o fármaco e o padrão interno (verapamil) foram 8,4 e 17,5min, respectivamente, utilizando coluna de fase reversa C18, (150 x 6mm, 5micra) e fase móvel consistindo de tampão acetato 0,1M, pH5,0 e acetonitrila (60:40, v/v), 0,7 mL/min, detecção 290nm (Ex) e 358nm (Em) em sistema isocrático de eluição. A validação deste método analítico avaliada através dos limites de confiança apresentou sensibilidade de 0,02 ng/mL (LD), linearidade na faixa compreendida entre 0,05 -1000ng/mL e 4,7% e 8,6% para precisão intra- e inter-dias, respectivamente. Observou-se, também, boa exatidão e alta seletividade para este método. Concluindo, o método analítico apresentado para a quantificação do propranolol mostrou elevada sensibilidade para quantificação do propranolol. Após a última dose pré-operatória, as concentrações plasmáticas do propranolol normalizadas com o hematócrito de seis pacientes pediátricos, expressas através das medianas, foram: 7,09 ng/mL no início da cirurgia, 2,69 ng/mL no inicio da CEC, 1,14 ng/mL intra- CEC, 2,79 ng/mL no pós-CEC, e 2,70 ng/mL no final da cirurgia. No pós-operatório tardio, registraram-se as medianas 0,63 ng/mL no primeiro PO e 0,03 ng/mL no segundo PO. Registrou-se declinio de 7,09 para 2,70 (p<0,05) da concentração de propranolol (normalizada) do início da cirurgia comparado ao inicio da CEC. Apesar do prolongado tempo de residência média (MRT) de 35,8 h as concentrações do propranolol mostraram redução significativa do primeiro PO para o segundo PO, indicando que restaurada a redistribuição, a eliminação foi completa. / The objective of the present study was to develop a simple and sensitive micromethod for the quantification of propranolol in plasma using HPLC-fluorescence for drug plasma concentration monitoring during the washout. Only 200&#181;L of biological sample was necessary. The retention times of the drug and its internal standard (verapamil) were 8.4 and 17.5 min, respectively, using a C18 reverse-phase column and a mobile phase consisting of 0.1 M acetate buffer, pH 5.0, and acetonitrile (60:40, v;/v), with detection at &#955;ex 290 nm and &#955;em 358 nm in an isocratic elution system. Validation of this analytical method showed that it was highly sensitive, with a detection limit of 0.02 ng/ml, linearity in the range of 0.05 to 1000 ng/mL, and intra- and inter-day precision of 4.7 and 8.6%, respectively. In addition, the method showed good accuracy and high selectivity. Analytical method validated showed high sensitivity for the quantification of propranolol; then this method was applied to quantify propranolol in plasma of children during the surgery for correction of tetralogy of Fallot including a followup at the first and second days of the intervention. The plasma propranolol concentrations, hematocrit normalized, after the last preoperative dose, expressed as medians, were: 7.09 ng/mL at the beginning of surgery, 2.69 ng/mL at the beginning of cardiopulmonary bypass (CPB), 1,14 ng/mL during CPB, 2,79 ng/mL after CPB, and 2.70 ng/mL at the end of surgery. Median of late postoperative propranolol concentrations were 0,63 ng/mL on postoperative day 1 and 0.03 ng/mL on day 2. A significant decline on the normalized propranolol concentration was observed between the beginning of surgery and the beginning of CPB. In addition, in spite of the prolonged mean residence time of 35.8 hours, the propranolol concentrations decreased significantly at the postoperative period on day 1 up to day 2, indicating that, once the redistribution is restored, the washout of drug was completed.

Surgical myocardial revascularization remains the standard of care for patients with multi-vessel coronary artery disease. A growing body of evidence indicates that systemic inflammation and myocardial oxidative stress are associated with the development of postoperative atrial fibrillation (POAF) and low cardiac output syndrome in patients undergoing cardiac surgery. Statins have been shown to exert rapid anti-inflammatory and antioxidant effects by inhibiting myocardial NOX2 oxidases and by increasing the bioavailability of nitric oxide (NO). However, whether these so-called pleiotropic effects of statins result in improved patient outcomes remains to be established. To provide further insights into the mechanisms of action and impact on clinical outcomes of peri-operative statin treatment in patients undergoing cardiac surgery, I studied the molecular mechanisms underlying the myocardial nitroso-redox balance in samples of the right atrial appendages (RAA) obtained before (PRE) and after cardiopulmonary bypass (CPB) and reperfusion (POST) and setup two double-blind randomised placebo-controlled trials: 1) STARR (Statin Treatment on Atrial Refractoriness and Reperfusion injury), which tested the effect of Atorvastatin (80 mg once daily for up to 6 days before surgery and 5 days after) on the atrial effective refractory period (AERP, over 4 post-operative days) and superoxide production in paired PRE- and POST- RAA samples from 60 patients 2) STICS (Statin Treatment In Cardiac Surgery), which assessed the effects of peri-operative treatment with Rosuvastatin (20mg od) on POAF (assessed by continuous holter ECG monitoring for 5 days postoperatively) and myocardial injury (assessed by serial troponin I measurements) in 1922 patients undergoing elective cardiac surgery. I observed that atrial superoxide production increased significantly after reperfusion due to increased mitochondrial and NOX2 oxidase activity and to uncoupling of NOS activity. NOS activity in RAA samples decreased significantly after reperfusion (by 60&percnt;), but this reduction was not prevented by BH4 supplementation (10 &mu;M) or NOX2 inhibition. Instead, I identified increased endothelial NOS S-glutathionylation as the main mechanism responsible for NOS uncoupling after reperfusion. In STARR, atorvastatin prevented increase in RAA superoxide production, maintained the functionally coupled status of NOS and NO bioavailability after reperfusion but had no measurable effect on postoperative AERP. In STICS, treatment with rosuvastatin significantly reduced LDL-C concentration by 48 hours after surgery but had no effect on the incidence of POAF (203 (21&percnt;) of the Rosuvastatinallocated patients vs. 197 (20&percnt;) of the placebo-allocated patients) or on perioperative myocardial damage (P = 0.80). Pre-defined subgroup analyses (age, sex, prior statin use, baseline troponin concentration, duration of randomized treatment before surgery, type of cardiac surgery, and postoperative use of anti-inflammatory drugs) did not identify any category of patient who benefited from perioperative rosuvastatin treatment. Nor were there beneficial effects on any of the other in-hospital clinical outcomes that were assessed. In conclusion, cardiac surgery on CPB is associated with myocardial nitroso redox imbalance that is reversed by perioperative intensive therapy with statins. However, these effects have no beneficial effects on common in-hospital complications after elective cardiac surgery. Although the benefits of long-term statin therapy in patients requiring myocardial revascularization are well established, the work presented in this thesis does not support routine use of perioperative intensive therapy with statins for the prevention of postoperative complications in patients undergoing elective cardiac surgery.

In the past years, the cardiac surgery performance was very demanding. The limited range of medical performances, imperfect procedures and techniques resulted in frequent postoperative complications and high postoperative mortality. Over time, surgical techniques, heart replacements, extracorporeal circulation and postoperative care have improved. This makes it possible today to operate on much older patients, where surgeries previously were nor feasible. The diploma thesis on the topic Cardiac surgical patient in the RES room and the approach of a nurse to nursing care is dedicated to the patient after heart surgery. It deals with meeting the patient's needs in the RES room and what the patient perceives while staying in the resuscitation unit and what he /she needs from a nurse. In the empirical part of this thesis two objectives were stated. To determine what a cardiac surgical patient perceives and what he /she needs in the RES room, and to find out whether it is possible to improve the quality of patient-oriented care. Based on these objectives, hypotheses and research questions were established. The objectives were successfully achieved, the hypothesis was confirmed and the questions answered. The research was conducted using qualitative quantitative research methods in the RES units of the cardiac surgery department, where the patients with heart disease are operated on. For the quantitative research the questionnaire interview method was selected. The qualitative research method was used to carry out semi-conducted interviews with the patients.

O objetivo do presente trabalho foi validar micrométodo simples e sensível para a quantificação do propranolol em plasma utilizando CLAE-F com a finalidade de aplicação no monitoramento das concentrações de propranolol durante o washout. Necessitou-se apenas de 200&#181;L de plasma. Os tempos de retenção para o fármaco e o padrão interno (verapamil) foram 8,4 e 17,5min, respectivamente, utilizando coluna de fase reversa C18, (150 x 6mm, 5micra) e fase móvel consistindo de tampão acetato 0,1M, pH5,0 e acetonitrila (60:40, v/v), 0,7 mL/min, detecção 290nm (Ex) e 358nm (Em) em sistema isocrático de eluição. A validação deste método analítico avaliada através dos limites de confiança apresentou sensibilidade de 0,02 ng/mL (LD), linearidade na faixa compreendida entre 0,05 -1000ng/mL e 4,7% e 8,6% para precisão intra- e inter-dias, respectivamente. Observou-se, também, boa exatidão e alta seletividade para este método. Concluindo, o método analítico apresentado para a quantificação do propranolol mostrou elevada sensibilidade para quantificação do propranolol. Após a última dose pré-operatória, as concentrações plasmáticas do propranolol normalizadas com o hematócrito de seis pacientes pediátricos, expressas através das medianas, foram: 7,09 ng/mL no início da cirurgia, 2,69 ng/mL no inicio da CEC, 1,14 ng/mL intra- CEC, 2,79 ng/mL no pós-CEC, e 2,70 ng/mL no final da cirurgia. No pós-operatório tardio, registraram-se as medianas 0,63 ng/mL no primeiro PO e 0,03 ng/mL no segundo PO. Registrou-se declinio de 7,09 para 2,70 (p<0,05) da concentração de propranolol (normalizada) do início da cirurgia comparado ao inicio da CEC. Apesar do prolongado tempo de residência média (MRT) de 35,8 h as concentrações do propranolol mostraram redução significativa do primeiro PO para o segundo PO, indicando que restaurada a redistribuição, a eliminação foi completa. / The objective of the present study was to develop a simple and sensitive micromethod for the quantification of propranolol in plasma using HPLC-fluorescence for drug plasma concentration monitoring during the washout. Only 200&#181;L of biological sample was necessary. The retention times of the drug and its internal standard (verapamil) were 8.4 and 17.5 min, respectively, using a C18 reverse-phase column and a mobile phase consisting of 0.1 M acetate buffer, pH 5.0, and acetonitrile (60:40, v;/v), with detection at &#955;ex 290 nm and &#955;em 358 nm in an isocratic elution system. Validation of this analytical method showed that it was highly sensitive, with a detection limit of 0.02 ng/ml, linearity in the range of 0.05 to 1000 ng/mL, and intra- and inter-day precision of 4.7 and 8.6%, respectively. In addition, the method showed good accuracy and high selectivity. Analytical method validated showed high sensitivity for the quantification of propranolol; then this method was applied to quantify propranolol in plasma of children during the surgery for correction of tetralogy of Fallot including a followup at the first and second days of the intervention. The plasma propranolol concentrations, hematocrit normalized, after the last preoperative dose, expressed as medians, were: 7.09 ng/mL at the beginning of surgery, 2.69 ng/mL at the beginning of cardiopulmonary bypass (CPB), 1,14 ng/mL during CPB, 2,79 ng/mL after CPB, and 2.70 ng/mL at the end of surgery. Median of late postoperative propranolol concentrations were 0,63 ng/mL on postoperative day 1 and 0.03 ng/mL on day 2. A significant decline on the normalized propranolol concentration was observed between the beginning of surgery and the beginning of CPB. In addition, in spite of the prolonged mean residence time of 35.8 hours, the propranolol concentrations decreased significantly at the postoperative period on day 1 up to day 2, indicating that, once the redistribution is restored, the washout of drug was completed.

No description available.

Thesis (M. Tech. (Biomed. Tech.)) -- Central University of Technology, Free State, 2010 / The World Health Organization (WHO) has warned in 2005 that: “Coronary heart disease is now one of the leading causes of death worldwide. It is on the rise and has become a true pandemic that respects no borders” (WHO, 2005). The Heart and Stroke Foundation of South Africa more specifically estimates that approximately 33 (thirty‐three) people per day will die of a heart attack in South Africa. Despite the already high death toll resulting from AIDS in South Africa, death from a chronic disease, also including heart disease, will increase from 565 deaths per day in the year 2000, to 666 deaths per day by 2010 (Steyn, 2007). Acute coronary syndrome (ACS) is an ‘umbrella term’ describing a heterogeneous spectrum of clinical symptoms compatible with acute myocardial ischaemia (Monaco, Mathur, Martin, 2005; ACC/AHA, 2007) and an ongoing inflammatory process resulting from atherosclerosis. ACS can either be treated medically (pharmacological treatment), by percutaneous coronary intervention (PCI), or by performing coronary artery bypass graft (CABG) surgery either through on‐pump or offpump CABG surgery. By treating the ACS patient by means of CABG surgery, an inflammatory response is further triggered on top of the already existing inflammation resulting from atherosclerosis. This leads to a systemic inflammatory response (SIR), which may eventually lead to systemic inflammatory response syndrome (SIRS). This study focuses on the inflammatory response initiated by the CABG technique applied during the revascularisation of the ACS patient. Many past studies compared on‐pump and off‐pump CABG surgery, arguing not only the advantages and disadvantages of these surgeries, but also the outcomes regarding SIRS. Both types of surgery are associated with an inflammatory response resulting from tissue trauma and the use of the extracorporeal circulation (EC) in CABG surgery (Quaniers, Leruth, Albert, Limet, Defraigne, 2006). This non‐randomised, observational study primarily aimed to assess and compare the pre‐ and the post‐operative inflammatory markers between (n=60) patients with ACS undergoing either on‐pump CABG (n=30) or off‐pump CABG surgery (n=30). A secondary objective was to ascertain whether a correlation exists between the pre‐operative risk factors, the surgical procedure and the pre‐ and post‐operative inflammatory markers. Three inflammatory markers ‐ full blood count (FBC), procalcitonin (PCT) and C‐reactive protein (CRP) ‐ were analysed employing normal routine laboratory analysis. Interleukin‐6 (IL‐6) and tumour necrosis factor alpha (TNF‐α) were analysed using an enzyme amplified sensitivity immunoassay (EASI) method. The inflammatory markers were analysed pre‐operatively (baseline) and post‐operatively and at different time intervals (24, 48, 72, 96 and 120 hours post‐operatively). Pre‐operatively, all the leucocytes were already elevated in both CABG groups, as could be expected in patients with ACS resulting from the already existing atherosclerotic process and the consequent pre‐operative existing inflammatory response. A significant pre‐operative difference was moreover detected in respect of the lymphocytes between the two CABG groups (p=0.03024). A significant post‐operative difference was also detected between the two CABG groups. The following significantly elevated levels were detected in the on‐pump CABG surgical group: for WCC at 24 hours (p=0.00761), 48 hours (p=0.01520) and 72 hours (p=0.00004); for neutrophils at 24 hours (p=0.17422), 96 hours (p=0.18611) and 120 hours (p=0.12872); for lymphocytes at 48 hours (p=0.04829) and at 96 hours (p=0.01982); and, for PCT at 24 hours (p=0.00811), 48 hours (p=0.00966) and 72 hours (p=0.01823) . However, measurable values of IL‐6 levels were found to be higher in the off‐pump CABG surgical group, with significant differences manifesting between the two CABG groups at 96 hours (p=0.05352) and 120 hours (p=0.09729). No differences between the two groups could be demonstrated for eosinophils, basophils, monocytes, CRP and TNF‐α. In conclusion: despite the demonstrable inflammatory responses in both CABG groups, no difference in clinical outcomes was observed. The inflammatory responses evoked by on‐pump and off‐pump CABG procedures will, for some time to come, remain an area of interest for future research, but they are certainly not the only factors to have a bearing on surgical outcomes. The impact of intraoperative events needs to be elucidated further ‐ and in more detail ‐ in order to attempt to determine the relationship of these events on the extent of inflammatory responses and clinical outcomes, irrespective of whether the procedure is performed with or without cardiopulmonary bypass.

Thesis (M. Tech. (Clinical technology)) - Central University of technology, Free State, 2012 / The objective of this study was to investigate whether intra-operative regional cerebral tissue oxygen saturation (NIRS) and hemodynamic monitoring in patients with Acute Coronary syndrome (ACS) during coronary bypass graft surgery (CABG on-pump vs. off-pump) can predict clinical outcomes and complications. Data from 60 CABG patients (30 on-pump and 30 off-pump) were analyzed. The regional cerebral tissue oxygen saturation was monitored by using near-infrared spectroscopy (NIRS). The sensors were positioned in the middle of the patient's forehead and the cables were connected to the sensors and to the INVOS 5100C® Oximeter. According to NIRS values obtained, patients were subdivided into two groups. Patients in Group 1 had absolute NIRS values more than 50 or less than a 20% drop from the baseline value. Patients in Group 2 had absolute NIRS values of less than 50 or a drop of more than 20% from the baseline value. The lowest value recorded during the procedure was recorded for this purpose, irrespective of the time this value was obtained. Intra-operative hemodynamic monitoring was captured by a computer software program (Supplier Datex Ohmeda, South Africa). In order to describe surgical outcomes several parameters were analysed and compared. This included a Pre- and Post-operative Mini-Mental state examination that was performed to identify neurological outcomes or impairment. The NIRS values and trends in relation to renal function (U&E and creatinine, urine output, and urine electrolytes), as well as clinical outcomes were analyzed post-operatively for the different groups. Clinical outcomes were described using the Society of Thoracic Surgeons Database (STS database) data fields, and specifically the recording of complications. The overall clinical outcomes were analysed between the on-pump and off-pump groups as well as the NIRS results between the two groups. In order to elucidate the predictive role of NIRS the patients were divided into groups with either impaired /reduced NIRS values or acceptable NIRS values according to published results where a reduction of more than 20% from baseline or absolute values of less than 50 were associated with inferior outcomes. Finally, the predictive value of NIRS was evaluated within the on- and then the off-pump groups. In this analysis the outcomes of patients with reduced NIRS values was compared to those of patients with acceptable NIRS values. The study demonstrated that by far the majority of patients with reduced cerebral flow/oxygen delivery as reflected in cerebral NIRS, had on-pump CABG procedures (84% fell in risk group 2). It also showed that a NIRS reduction of more than 20 % from baseline and values of less than 50, has an impact on post–operative renal function. Monitoring of cerebral oximetry intra-operatively by using near-infrared spectroscopy during cardiac surgery (especially in on-pump cardiac surgery patients) allows the perfusionist and anaesthesiologist to detect cerebral desaturation and to intervene as necessary. This study also showed a tendency towards less renal function impairment in patients with absolute NIRS values > 50 or where there was < 20% drop from baseline. It is probably important to consider studying the time spend below 50 or a drop of more than 20% from baseline NIRS values, or the “area under the curve” as a specific factor contributing to the increased risk for post-operative complications applied on an increased study population. The study supports the routine use of NIRS as a non-invasive trend monitor of cerebral saturation and certainly initiated interventions by both anaesthetic and perfusion staff which contributed to excellent clinical outcomes in this research study.

Submitted in fulfillment for the degree of Master of Technology, Clinical Technology: Cardiovascular Perfusion, Durban University of Technology, Durban, South Africa, 2016. / Introduction: A large volume of residual haemodilute blood remains in the cardiopulmonary bypass (CPB) circuit after termination of the bypass. It is common practice in many centres to process residual pump blood with an autologus cell salvage system (ACSS), thereby producing a re-suspended red blood cell (RBC) concentrate and attenuating the need for donor blood RBC concentrate. It has also become standard practice to wash donor pack red blood cells (PRBC) before adding it to neonate cardiopulmonary circuits (Swindell et al., 2007). Manufactures of ACSS recommend 0.9% sodium chloride (NaCl) as a wash solution for processing salvaged blood. Previous studies have demonstrated that washing PRBC with normal saline results in acid-base (Huber et al., 2013) and electrolyte derangements (Varghese et al., 2007). Infusion of normal saline in healthy volunteers also results in significant changes in osmolality (Williams et al., 1999). The use of normal saline as a wash solution in processing residual CPB blood requires investigation. Aims and Objectives: This was a prospective, quantitative in vitro investigation to analyze and compare the quality of residual pump blood post CPB that had been washed with either an unbalanced electrolyte solution (0.9% normal saline) or a balanced electrolyte solution (Balsol®). Both are crystalloid solutions. The primary objective of the present study was to measure and compare the pH, electrolytes, metabolites, osmolality and strong ion difference (SID) of residual pump blood to the pH, electrolytes, metabolites, osmolality and SID of processed cell saver blood, which was washed with either 0.9% normal saline or Balsol® solution. The secondary objective was to measure and compare protein levels (albumin and total protein) in residual pump blood to protein levels in processed cell saver blood, that is washed with either 0.9% normal saline or Balsol® solution. The final objective was to determine the volume, haematocrit and haemoglobin yield post cell saver processing, from the input volume of residual pump blood when washed with either 0.9% normal saline or Balsol® solution. This was the first study of this nature done in the South African population group. Methodology: In this investigation in a series of forty patients (n=40) undergoing elective cardiac surgery with CPB, the first twenty patients were allocated to the NaCl control group (n=20) and the second twenty patients were allocated to the Balsol® interventional group (n=20). The extracorporeal circuit consisted of a standard integral hollow fibre membrane oxygenator and tubing that was primed with 1500-1800 millilitres of balanced crystalloid solution (Balsol®), for both the control group and the interventional group, and addition of 5000 iu heparin. The balanced crystalloid solution (Balsol®) is the approved standard CPB priming solution for all cardiac procedures at Inkosi Albert Luthuli Central Hospital. This setup was used with the Stockert S5 roller pump heart lung machine. The operations were performed as per protocol with standard non-pulsatile CPB and hypothermia was maintained at 28 – 32 ºC (core) and haemodilution (haematocrit 20 % to 30 %). A standard flow rate of 2.4 L/min/m² was used. Cardio protection consisted of either cold Blood Cardioplegia using the Buckberg 4:1 ratio, being four parts blood to one part cardioplegia (with the 35ml of 20 % Dextrose + 1 gram Magnesium Sulphate added per 500ml), or 20ml/kg cold St Thomas II cardioplegia (with addition of 10ml of 8.5% NaHCO3 + 100mg lignocain per litre). Topical cooling was achieved with ice cold 0.9 % saline. Maintenance fluid used during CPB was Balsol® for both the control and the interventional groups. Calcium, potassium and sodium bicarbonate was administered as required during CPB to correct deficits for both groups. Weaning of CPB was performed after re-warming to a rectal temperature of at least 35 ºC for both study groups. Immediately on termination of CPB a blood sample was taken from the sampling manifold of the CPB circuit for pre wash analysis. Residual pump blood was then flushed out with one litre of Balsol® solution for both groups and collected into the Medtronic autolog cell saver reservoir to be processed. In the control study group 0.9% NaCl was used as the wash solution and in the interventional study group Balsol® solution was used as the wash solution. After processing of the salvaged blood is complete, a blood sample was taken for post wash analysis. Clinical data recorded for pre and post wash samples included: pH, pCO2, pO2, [K+], [Na+], [Cl-], [Ca2+], lactate, glucose, [HCO3-], TCO2, haematocrit, haemoglobin (GEM 4000® premier™ blood gas analyser) blood volume (Medtronic autolog) and SID (calculated as per equation). Inorganic phosphate, total magnesium, albumin, total protein (Siemens Advia 1800 blood gas analyser) and osmolality (Gonotech osmometer) were also measured. Results: There was a highly significant decrease (p < 0.05) within the NaCl group after washing with pCO2 (28.3 ± 2.9 vs. <6.0 ± 0.0), [K+] (4.5 ± 0.5 vs. 1.0 ± 0.7), total magnesium (1.7 ± 0.7 vs. 0.29 ± 0), ionized calcium (1.0 ± 0.09 vs. 0.1 ± 0.03), inorganic phosphate (0.9 ± 0.4 vs. 0.09 ± 0.04) and SID (27.1 ± 2.1 vs. 18.4 ± 2.2). There was a highly significant increase (p < 0.05) within the NaCl group after washing with pH (7.5 ± 0.1 vs. 7.7 ± 0.1), [Na+] (132.9 ± 3.2 vs. 146.3 ± 1.9), [Cl-] (107.8 ± 3.1 vs. 127.4 ± 2.1) and osmolaltity (256.9 ± 38.4 vs. 296.2 ± 57.5). There were highly significant decrease (p < 0.05) within the Balsol® group after washing with pCO2 (30.15 ± 6.0 vs. 18.9 ± 4.9), [Na+] (134.7 ± 2.2 vs. 125.6 ± 1), [Cl-] (108.8 ± 2.7 vs. 100.2 ± 1.4), ionized calcium (0.9 ± 0.1 vs. 0.02 ± 0.04), inorganic phosphate (0.8 ± 0.2 vs. 0.1 ± 0.024) and osmolality (288.8 ± 20.6 vs. 272.8 ± 19.9). There were highly significant increase (p < 0.05) within the Balsol® group after washing with pH (7.5 ± 0.1 vs. 7.7 ± 0.1), [K+] (4.2 ± 0.4 vs 4.6 ± 0.3). Total magnesium and SID were similar after washing within the Balsol® group. Albumin and total protein revealed similar significant decreases within both groups after washing. There was a highly significant difference (p < 0.05) in the change between groups after washing in all the variables measured, except for pH, inorganic phosphate, lactate, glucose, albumin, total protein, haematocrit, haemoglobin, and blood volume. Total carbon dioxide and [HCO3-] were not compared because they were incalculable by blood gas analyser in the NaCl group. Conclusion: This investigation concluded that the balanced electrolyte solution Balsol® used for washing residual CPB blood results in a re-suspended RBC concentrate, with an osmolality and electrolyte profile that is superior compared to washing residual CPB blood with 0.9% NaCl solution. / M

In den letzten Jahren haben sich die Empfehlungen für eine Antibiotikaprophylaxe in der Herzchirurgie bezüglich Antibiotikawahl und Applikationsdauer verändert und gehen nicht speziell auf die Kinderherzchirurgie ein. Im Deutschen Herzzentrum Berlin wurde seit 1988 bei Operationen aufgrund angeborener Herzfehler die Kombinationsprophylaxe mit Piperacillin und Cefotaxim angewandt. Neue internationale Empfehlungen schlagen jedoch ein Cephalosporin der I. oder II. Generation vor. Fragestellung dieser prospektiven Beobachtungsstudie ist deshalb, ob eine Umstellung der im DHZB üblichen Kombinationsprophylaxe auf eine Monoprophylaxe mit Cefotiam gerechtfertigt ist. Vom 1.3. - 31.8. 1995 wurden 180 Patienten mit Operationen am offenen Herzen in die Studie eingeschlossen. 99 Patienten erhielten die bisher im DHZB etablierte Kombinationsprophylaxe mit Cefotaxim und Piperacillin (Cx/P-Gruppe). 81 Patienten bekamen eine Monoprophylaxe mit Cefotiam (Ct-Gruppe). Die postoperative Infektionsrate betrug in der Ct-Gruppe 14,8 % und in der Cx/P-Gruppe 17,2 %. Die Prophylaxe erfolgte für beide Gruppen durchschnittlich 103 Stunden bzw. 110 Stunden. Die Studie konnte aufgrund geringer Patientenanzahl aus statistischer Sicht keinen Beweis für einen Unterschied erbringen. Dafür zeigte die Metaanalyse, daß auch bei einer großen Patientenanzahl (n=4177) kein statistischer Unterschied zwischen einer Schmalspektrum- und einer Breitspektrumprophylaxe besteht. Es wurde ferner gezeigt, daß Cefotiam den Anforderungen einer effektiven Prophylaxe gerecht wird und Vorteile gegenüber der Kombinationsprophylaxe aufweist. Die Studie hat dazu beigetragen, daß seit 1996 in der Kinderherzchirurgie im DHZB eine Monoprophylaxe mit einem Cephalosporin der I. Generation - Cefazolin - durchgeführt wird und hat weiterhin eine Verkürzung der Prophylaxedauer bewirkt. / Perioperative antibiotic prophylaxis for patients with congenital heart diseases Recommendations for antimicrobial prophylaxis regarding the choice of antibiotics and the application time have changed and do not include cardiac surgery for infants. A combination of piperacillin and cefotaxim has been used since 1988 in the German Heart Institute of Berlin. Updated recommendation now propose the use of a I. or II. generation cephalosporin. The purpose of this prospective study was to evaluate whether a change from the so long used combined prophylaxis towards a monoprophylaxis with cefotiam is justified. From 1st of March until 31st of August 1995 a total number of 180 patients with an open heart surgery were included into the study. 99 patients received a combination with cefotaxim and piperacillin (cx/p-group), which was the standard combination in the German Heart Institute of Berlin. 81 patients received a monoprophylaxis with cefotiam (ct-group). The postoperative rate of infections was 14,8 % in the ct-group and 17,2 % in the cx/p-group. For both groups the duration of prophylaxis was on average 103 respectively 110 hours. Due to a relatively small number of patients the study could not show a statistically significant difference between both prophylactic regimes. The performed meta-analysis comparing the postoperative infections in small spectrum and broad spectrum prophylaxis in the open heart surgery did not find a significant difference in a large group of patients (n=4177). Our study supports the fact, that cefotiam meets the criteria of an effective antibiotic prophylaxis and has additional benefits compared to the combined prophylaxis scheme. The results of this study have led to a replacement of the old perioperative prophylaxis regime by cefotiam for open heart surgery for infants in the German Heart Institute of Berlin since 1996 and have led to a reduction of the application time during the prophylaxis.

Bakgrund: Att genomgå hjärtkirurgi kan rädda en patients liv men det kan även leda till en ökad risk att drabbas av en komplikation som postoperativt delirium. Delirium är inte ett sjukdomstillstånd utan ett tillstånd av mental förvirring som påverkar patientens uppmärksamhet, medvetenhet och kognitiva förmåga. Postoperativt delirium kan leda till många negativa konsekvenser vilket kan medföra lidande för patienten. Vården ska ha som mål att lindra patientens lidande genom att se till hela patienten i den vårdande relationen, det är det som är kärnan i vårdvetenskap. Forskning har visat att det är viktigt för patientens postoperativa återhämtning att tidigt kunna upptäcka och förebygga postoperativt delirium. Det har framkommit att intensivvårdssjuksköterskor behöver ha ökad förståelse och kunskap om ämnet för att kunna upptäcka och förebygga postoperativt delirium efter hjärtkirurgi. Syfte: Syftet med studien är att identifiera riskfaktorer som kan påverka utvecklingen av postoperativt delirium bland intensivvårdspatienter efter hjärtkirurgi. Metod: En systematisk litteraturstudie där kvantitativa artiklar har analyserats efter Bettany-Saltikov och McSherry (2016) analysmetod. Resultat: Analysen resulterade i fyra kategorier: Patientens bakgrund, Tiden i hjärt-lungmaskin, Längden av respiratorbehandling samt Komplikationer till följd av hjärtkirurgi som är riskfaktorer som visade sig påverka utvecklingen av postoperativt delirium. Slutsats: Den samlade kunskapen som föreliggande studie har givit kan ligga till grund för intensivvårdssjuksköterskor i vården av patienter med postoperativt delirium. Intensivvårdssjuksköterskor ska ha med sig i den vårdande relationen att patientens situation är komplex och att det de utsätts för kan bidra till ökat lidande för patienten. Mer forskning behövs kring riskfaktorer för postoperativt delirium och hur den mentala förvirringen påverkar patienten och dess anhöriga. / Background: Heart surgery can save a patient's life but can also lead to an increased risk of suffering from a complication such as postoperative delirium. Delirium is not an illness but a state of mental confusion that affects the patient's attention, awareness and cognitive ability. Postoperative delirium can lead to many negative consequences which can cause patient suffering. Nursing care has aimed to alleviate a patient's suffering by seeing the entire patient in the caring relationship. This is the core in nursing science. Research has shown that it is important for the patient's postoperative recovery to be able to detect and prevent postoperative delirium in an early stage. It has appeared that intensive care nurses need more education and knowledge in this area in order to be able to detect and prevent postoperative delirium after heart surgery. Aim: The aim of the study is to identify risk factors that are associated with the development of postoperative delirium after heart surgery within patients in the intensive care unit. Method: A systematic literature review that analyzed quantitative articles according to a method of analysis by Bettany-Saltikov and McSherry (2016). Result: Four categories emerged from the analysis: Patients background, length of mechanical ventilation, Heart- and lung machine duration and Complications after heart surgery that were risk factors which affected the development of postoperative delirium. Conclusion: The overall knowledge that the study has provided can form a basis for intensive care nurses in the care of patients with postoperative delirium. Further research is needed on risk factors for postoperative delirium and how the mental confusion affects both the patient and relatives. More research is also needed about how postoperative delirium can be prevented.