Document Detail


Perioperative indicators of stress response and postoperative inflammatory complications in patients undergoing off-pump coronary artery bypass surgery: a prospective observational study.
MedLine Citation:
PMID:  18946173     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Little has been published regarding the association between perioperative stress response and clinical outcomes after off-pump coronary artery bypass surgery (OPCAB). The role of perioperative stress response in postoperative inflammatory complications (PIC) in patients undergoing OPCAB was assessed. METHODS AND RESULTS: The study cohort consisted of 100 patients who underwent elective OPCAB over a 5-month period. Anesthetic management was standardized and blood samples were collected before surgery, immediately after surgery, and 1, 2, 3, and 7 days after surgery. Leukocyte, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, cortisol, D-dimer, and fibrin degradation product were measured at each time point, and the association of each parameter with PIC was assessed. PIC included postoperative pulmonary complications, atrial fibrillation, and wound infections. PIC occurred in 30 patients at the median third postoperative day. Multivariate analysis showed preoperative cortisol (p=0.024) and cortisol on the first postoperative day (p=0.001) were significantly associated with PIC. Intraoperative cortisol release was correlated with intraoperative hemodynamic changes, including pulmonary artery pressure, central venous pressure, and cardiac index. CONCLUSIONS: Patients with PIC after OPCAB have significantly increased preoperative cortisol and cortisol on the first postoperative day. Intraoperative cortisol release was significantly correlated with hemodynamic changes. The neurohormonal environment and inflammatory response during and after beating-heart surgery should be further explored.
Authors:
Suk-Won Song; Gijong Yi; Sak Lee; Young-Nam Youn; Soon-Young Sul; Kyung-Jong Yoo
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Publication Detail:
Type:  Journal Article     Date:  2008-10-21
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  72     ISSN:  1346-9843     ISO Abbreviation:  Circ. J.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2009-03-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1966-74     Citation Subset:  IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University Health System, Republic of Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Atrial Fibrillation / blood,  etiology,  physiopathology
Biological Markers / blood
Blood Coagulation
Blood Sedimentation
C-Reactive Protein / metabolism
Coronary Artery Bypass, Off-Pump / adverse effects*
Coronary Artery Disease / blood,  immunology,  physiopathology,  surgery*
Female
Fibrin Fibrinogen Degradation Products / metabolism
Hemodynamics
Humans
Hydrocortisone / blood*
Inflammation Mediators / blood
Leukocyte Count
Lung Diseases / blood,  etiology,  physiopathology
Male
Middle Aged
Platelet Count
Preoperative Care
Prospective Studies
Stress, Physiological*
Surgical Wound Infection / blood,  etiology,  physiopathology
Systemic Inflammatory Response Syndrome / blood,  etiology*,  immunology,  physiopathology
Time Factors
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/Inflammation Mediators; 0/fibrin fragment D; 50-23-7/Hydrocortisone; 9007-41-4/C-Reactive Protein

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