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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Perioperative cortisol levels are not associated with early cognitive outcome following cardiac surgery: A prospective cohort study

Background and Purpose of Study

Surgery, particularly cardiac surgery, stimulates a series of hormonal changes that constitute the stress response, in which cortisol plays a key role.1 This stress response to the surgical procedure could be important in the development of postoperative cognitive dysfunction (POCD) following cardiac surgery, given that prolonged exposure to high concentrations of glucocorticoids can be toxic to neural structures, particularly the glucocorticoid receptor-rich hippocampus, which is essential for certain types of memory.2 A recent study reported that patients with higher cortisol levels on the 1st postoperative morning after cardiac surgery exhibited an increased risk of early POCD.3 To gather a deeper understanding of the potential involvement of the stress response to a surgical procedure in the pathogenesis of POCD, we measured the perioperative cortisol levels at multiple time points. We hypothesized that higher postoperative cortisol levels are related to the occurrence of early POCD after cardiac surgery.

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Cardioprotective Effect of Sevoflurane in Patients Undergoing Coronary Artery Bypass Grafting


The cardioprotective effect of sevoflurane have been proven in experimental and clinical studies. However, it has not been studied so far if this effect on the myocardium is more expressed before the onset of myocardial ischaemia (preconditioning) or after (postconditioning). The aim of this study was to determine whether the cardioprotective effect of sevoflurane was more expressed during the preconditioning or postconditioning phase of coronary bypass grafting operations.

Key words: cardioprotective effect, sevoflurane, volatile anaesthetics, myocardial ischaemia, preconditioning, postconditioning

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Cerebral Oximetry in Pediatric Cardiac Surgery Patients – Our Experience in Use of INVOS Technology


Both the brain immaturity of a child undergoing congenital heart surgery and the complexity of surgical procedures increase the risk of brain injury and development of adverse neurological outcomes. The brain remains the most vulnerable organ and the reason of concern of many pediatric cardiac anesthesiologists. Cerebral oximetry by using the INVOS has an important role in early detection of cerebral hypoperfusion.

The aim of this study is to present our experience and review the benefits of cerebral oximetry in pediatric patients.

Key words: cerebral oximetry, pediatric cardiac surgery, in-vivo optical spectroscopy, high risk patients

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Variation in ARNTL1 gene in patients with myocardial infarction


The aim of the study was to establish the association of genetic variants of the ARNTL1 gene with the onset of myocardial infarction.

Study design. Case-control study

Key words: ARNTL1 gene; circadian rhythm; myocardial infarction

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A combination of paravertebral and supraclavicular block and hemodynamics in patient with tuberculosis for a hand skin cancer surgery: a case report

Running title: Paravertebral and supraclavicular block for melanoma hand surgery

Background and aims

Most skin cancer of the hand surgeries with ipsilateral axillar lymphadenectomy are performed under general anesthesia; therefore, patients with present significant cardiorespiratory problems are at high risk for the development of hemodynamic disorders. Here we show the American Society of Anesthesiologist (ASA) III patient scheduled for melanoma skin cancer surgery. Due to a high risk for general anesthesia, we decided to apply a paravertebral and supraclavicular block.

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