[Hemodynamic and electrophysiological effects of sodium nitroprusside in patients with acute myocardial infarction].
G BellottiF PileggiN GalianoCamargo PrJosé Antônio Franchini RamiresE ChecchiPing WcJ TranchesiDécourt Lv
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Sodium nitroprusside
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Objective To study the effects of different anesthesia drugs on hypotension used for controlled hypotension in nasal endoscopic surgery. Methods Sixty patients undergoing nasal endoscopic surgery were randomly divided into A group (fentanyl and sodium nitroprusside group) and B group (remifentanil and sodium nitroprusside group). Anesthesia was maintained with the continuous infusion of either fentanyl in A group or remifentanil in B group. Controlled hypotension was performed and the MAP was reduced and maintained between 60～ 70 mmHg with the continuous infusion of SNP. Hemodynamic changes before hypotension,at the time of reaching aim,5～ 60 min during hypotension and 5～ 10 min after discontinuing hypotension,recovery profile of anesthesia,and adverse reactions were observed. Results Data in 2 groups showed high satisfaction with hypotension,HR and the dose of SNP were increased significantly in A group than B group (P 0.05). Hemodynamic changes,the time to opening eyes on commond and recovery from anesthesia were better in B group than in A group(P 0.05). Conclusions Remifentanil could potentiate the hypotensive effect of SNP,decrease the doses of SNP and maintain a stable hemodynamics during controlled hypotension. The depth of anesthetic was controlled easily and recovery from anesthesia is faster.
Sodium nitroprusside
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No independent association between coffee drinking and a subsequent first myocardial infarction in 464 patients was found in a study well controlled for cigarette smoking and five other established "risk factors." Coffee drinking and cigarette smoking are strongly correlated habits. Review of other studies of coffee and coronary heart disease indicates that discrepancies in findings may be related either to cigarette smoking or to selection of control subjects. Coffee drinking is not an established risk factor for myocardial infarction.
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Objective:To discuss the clinical characteristics of painless myocardial infarction. Method: 121 patients with acute myocardial infarction (AMI) were divided into 81 cases of CPMI group and 40 cases of NPMI group. The results were compared. Result: Painless myocardial infarction often accompanied by pulmonary heart disease and type 2 diabetes mellitus. It is popular in old people with many complications and high mortality rate (20.5%). Conclusion: Painless myocardial infarction have poor prognosis. It can be improved by timely diagnosis and effective treatment.
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Left ventricular remodeling (LVR), an increase in left ventricular end-diastolic volume index > or = 20%, is an adverse consequence of myocardial infarction. The aim of this study was to assess the association between LVR and adiponectin, which has been shown to protect against myocardial ischemia-reperfusion injury.In 75 patients echocardiographic examination was performed one year after ST-segment elevation myocardial infarction, successfully treated with primary percutaneous coronary intervention (pPCI). Two groups of patients were analyzed: those with LVR (n = 15) and those without LVR (n = 60).The predictors of LVR were: anterior myocardial infarction, glucose at admission, baseline C-reactive protein, adiponectin, and echocardiographic parameters: left ventricular end-diastolic and end-systolic volume indices, ejection fraction < 40% and left ventricular wall motion score index (WMSI) at discharge. On multivariable regression analysis, lower adiponectin level (OR = 0.67, 95% CI 0.49-0.91, p < 0.05) and higher WMSI (OR = 20.14, 95% CI 2.62-154.82, p < 0.01) were the only independent negative predictors of LVR. The optimal cut-off for adiponectin for predicting LVR was < or = 4.7 mg/mL (sensitivity: 73%, specificity: 85%) and this level increased the risk of LVR 15-fold (95% CI 4.05-59.87, p = 0.0001).Baseline low blood adiponectin concentration, along with WMSI, can be considered as a predictor of the LVR in male patients one year after myocardial infarction and pPCI.
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Atrial natriuretic peptide
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Objective To study the efficacy and safety of sodium nitroprusside(SNP) with remifentanil used for controlled hypotension in nasal endoscopic surgery.Methods Sixty children undergoing operation were randomly divided into A and B group.Local anesthesia was in A group;Anesthesia was maintained with the continuous infusion of remifentanil and propofol in B group.Controlled hypotension was performed and the MAP was reduced and maintained between 60~70 mmHg with the continuous infusion of SNP.Hemodynamic changes before operation,in operation and 10 min after operation were observed.Results Data in B groups showed high satisfaction with hypotension,HR was stability in B group.Hemodynamic changes were better in B group than in A group(P0.05).Conclusions Remifentanil could potentiate the hypotensive effect of SNP,decrease the bleeding amount,shorten the operation time and maintain a stable hemodynamics during controlled hypotension.
Sodium nitroprusside
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In 1,395 patients admitted to hospital between 1976 and 1981 due to suspected acute myocardial infarction, the 5-year mortality rate was related to whether they developed infarction or not during the first 3 days. In all, patients with definite myocardial infarction had a 5-year mortality rate of 33.4% as compared with 13.3% in patients not fulfilling the criteria for this diagnosis (p less than 0.001). When separately analyzing patients with no previous myocardial infarction before admission and discharged from hospital, the corresponding mortality rate was 24.1% for myocardial infarction patients versus 8.1% in nonmyocardial infarction patients (p less than 0.001). Among all patients with nonconfirmed myocardial infarction, those who partly fulfilled the criteria (possible myocardial infarction) had a 5-year mortality rate of 16.7% as compared with 12.0% in those in whom myocardial infarction was completely ruled out (p = 0.18). Independent risk factors for death among patients not developing early infarction were high age and a clinical history of previous myocardial infarction and smoking. We conclude that in this study the long-term prognosis among patients admitted to hospital due to suspected acute myocardial infarction was clearly related to whether they developed an infarction or not during the first 3 days in hospital.
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