Aim of the study was to evaluate the feasibility of using a modified nomogram (the M nomogram) to predict the occurrence of new postoperative hemodynamically significant arrhythmias after elective cardiac surgery with cardiopulmonary bypass within 30 days post operation.Materials and methods. This was a retrospective cohort study. The prognostic value of the model using ROC-analysis of the modified nomogram was estimated based on the medical records of 144 patients who underwent elective cardiac surgery with cardiopulmonary bypass.Results. The incidence of new postoperative hemodynamically significant arrhythmias was 13.9% (20 of 144 patients). For the modified nomogram, the AUC was 0.777 [95% CI: 0.661–0.892] (P<0.001); at a cutoff of 12 points, the sensitivity was 60.0% and specificity was 89.52%. The odds ratio was 10.26 (95% CI: 3.63–29.06) (P<0.001). Conclusion. The modified nomogram has an acceptable prognostic value for the occurrence of new hemodynamically significant arrhythmias after elective cardiac operations with cardiopulmonary bypass based on AUC 0.777 [0.661–0.892] (P<0.001), and is currently the best model for predicting the outcome.

The objective : to investigate the impact of anesthesia method on the severity of oxidative stress in patients after coronary artery bypass grafting with cardiopulmonary bypass. Subjects and methods . Patients were randomized (seed 6556 as of 04.01.2016, www.randomization.com) to Volatile Induction and Maintenance Anesthesia ( VIMA ) with Sevoflurane group ( n = 65) and Total Intravenous Anesthesia with Propofol and Fentanyl ( TIVA ) group ( n = 66). The changes in oxidative stress markers in blood plasma were studied: carbonylated proteins, nitrotyrosine, oxidized forms of lo w-d ensity lipoproteins – ox y- L DL . Results . At the critical stage with 24 hours after the surgery, statistically significant differences in the carbonyls blood levels were found between VIMA with Sevoflurane and TIVA with Propofol groups: 0.88 (0.79–0.96) nmo l/m g protein (nmo l/m g) in TIVA group vs 0.81 (0.75–0.91) nmo l/m g in VIMA group, p = 0.01; and ox y- L DL levels 0.96 ± 0.40 m g/m l vs 0.83 ± 0.33 m g/m l, respectively, p = 0.04. Nitrotyrosine demonstrated no diagnostic value. Conclusion. It has been suggested that sevoflurane possesses antioxidant properties that can be regarded as a positive quality of VIMA in coronary artery bypass grafting with cardiopulmonary bypass.

Many patients undergo surgery under general anaesthesia each day. One of the high-priority tasks for an anesthesiologist is to protect tissues from a systemic inflammatory reaction or oxidative distress (including ischaemia/reperfusion). This review aims to demonstrate the anti-inflammatory and antioxidant properties of general anaesthesia in experimental and clinical studies.Halogenated anaesthetics lead to the inactivation of glycogen synthase kinase-3β (GSK-3β), a key enzyme in the implementation of cellular damage mechanisms and systemic inflammatory response syndrome (SIRS). These mechanisms are implemented through the transcription factor nuclear factor (NF)-κB. As a result of NF-κB activation, gene expression responsible for proinflammatory cytokine synthesis follows, activating leukocytes and disrupts endothelial cell junctions, leading to a disruption of the endothelial barrier, leukocyte infiltration into tissues, and the development of SIRS. Furthermore, GSK-3β phosphorylation causes an increase in the level in neuronal cells and hepatocytes of transcription factor Nrf2, which is a master regulator of enzyme levels of antioxidant defence in the cell.Thus, halogenated anaesthetics interfere with different elements responsible for the implementation of SIRS and oxidative distress in addition to limiting disturbing factors during the development of multiorgan failure and endothelial dysfunction in experimental sepsis and a model of ischaemia/reperfusion. Understanding these processes can help to reduce many complications during the post-operative period.Received 9 January 2020. Revised 6 April 2020. Accepted 7 April 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and study design: O.A. Grebenchikov, Y.V. Skripkin, V.V. Likhvantsev Drafting the article: O.A. Grebenchikov, Y.V. Skripkin, O.N. Gerasimenko, K.K. Kadantseva, A.L. Bachinskiy, L.B. Berikashvili, V.V. Likhvantsev Critical revision of the article: О.А. Grebenchikov, K.K. Kadantseva Final approval of the version to be published: O.A. Grebenchikov, Y.V. Skripkin, O.N. Gerasimenko, K.K. Kadantseva, A.L. Bachinskiy, L.B. Berikashvili, V.V. Likhvantsev

Cardiac surgery is often complicated by oxidative stress (the evidence of this is the increase of carbonyl proteins in blood plasma), however the relation between these changes and post-operative complications and unfavorable outcomes stills remains uninvestigated and lacks the relevant proof. The above facts served as a basis for this research. Goal of the article: to investigate the impact of oxidative stress assessed as per the level of carbonyl proteins in blood plasma on systemic inflammation response syndrome (SIRS), acute heart (AHF) and renal failure (ARF) in cardiac surgery. Methods. Prospective observational cohort study was conducted in order to investigate the relation of oxidative stress intensity, assessed as per the level of carbonyl peptides in blood plasma, and development of SIRS, AHF, ARF in the patients undergoing cardiac surgery. 67 adults patients admitted to Cardiac Intensive Care Department of M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow, were examined. Results. The significant positive correlation has been found between intensity of oxidative stress assessed as per the level of carbonyl peptides in blood plasma, and composite frequency of post-operative complications (SIRS, AHF and ARF) in cardiac surgery (Spearman rank correlation (r) = 0.6; p < 0.0001). It was found out that the area under ROC-curve made 0.81 and 0.83 for the risk of developing acute renal lesions and heart failure respectively (p < 0.01 in both cases) thus the investigated model can be evaluated as "a model of very good quality". Conclusion. The important role pf oxidative stress in the development of SIRS, AHF and ARF has been confirmed. No advantages of off pump technique when performing coronary artery bypass grafting have been detected. Testing carbonyl peptides in blood plasma during first hours after surgery can be recommended in order to predict the risk of developing SIRS, AHF and ARF.

Ischemia, reperfusion, oxidative stress, system inflammatory response – all these events are the cause or important link in the pathogenesis of numerous serious complications of cardiac surgeries. The damaging action of each of the above has been numerously proved by experiments and clinical practice and it seems that these events can be considered to be only very negative ones. However controlled ischemia initiates development of the phenomenon so-called as ischemic pre-conditioning, when the targeted organ develops enhanced resistance to the consequent damaging ischemia. Reperfusion is an inevitable and necessary stage of rehabilitation after previous ischemia. What about oxidative stress? Damaging potential of the active forms of oxygen is a fact, however minimal concentrations of the active oxygen forms are intercellular regulators and it means they are absolutely necessary for normal cellular vital activity. Besides numerous studies have proved noticeable intensification of the oxidative stress during artificial circulation (AC), however stuides failed to demonstrate reduction in the number of complications and peri-operative mortality when performing coronary artery bypass on the beating heart compared to the surgeries performed under AC. What is the true contribution of the oxidative stress into the development of post-operative complications? There have been found no evidences of the clinical efficiency of any of existing antioxidants as per mortality reduction criteria or decrease of hospital stay duration. Unfortunately we do not have unambiguous answers to the set up questions. There is no doubt only about the fact that critical actuality dictates the urgent need for further studying of the oxidative stress role in the pathogenesis of ischemic and reprefusional lesions in cardiac surgery.

The problem of myocardial protection in cardiac surgery is a challenge due to an increased number of interventions and severity of their complications related to the patient's status, pathophysiology of the artificial circulation and the used techniques for replacement of vital functions. Oxidative stress and formation of active oxygen species, as a consequence of the above mentioned processes, may result in systemic injury, such as acute heart failure, central nervous system dysfunction and acute renal injury. Short ischemic episodes before prolonged hypoxia with subsequent reperfusion can decrease cardiomyocyte injury. This phenomenon has been referred to as ischemic preconditioning. A similar effect is caused by inhalation anesthetics. Experimental and clinical data on anesthetic preconditioning suggest that inhalation anesthesia with halogen-containing agents may be used as a method to protect the myocardium from damage by active oxygen species produced during the periods of oxidative stress in cardiac surgery. Studies analyzed in this review have shown benefits of inhalation anesthetics, compared to total intravenous anesthesia, such as effective cardiac protection and, what is most important, in potential reduction of mortality after coronary bypass grafting. The level of evidence for the effects of anesthetic preconditioning on long-term mortality in these studies was not high enough; therefore, a large multicenter randomized controlled trial is needed to confirm these results.

Ischemia, reperfusion, oxidative stress, system inflammatory response – all these events are the cause or important link in the pathogenesis of numerous serious complications of cardiac surgeries. The damaging action of each of the above has been numerously proved by experiments and clinical practice and it seems that these events can be considered to be only very negative ones. However controlled ischemia initiates development of the phenomenon so-called as ischemic pre-conditioning, when the targeted organ develops enhanced resistance to the consequent damaging ischemia. Reperfusion is an inevitable and necessary stage of rehabilitation after previous ischemia. What about oxidative stress? Damaging potential of the active forms of oxygen is a fact, however minimal concentrations of the active oxygen forms are intercellular regulators and it means they are absolutely necessary for normal cellular vital activity. Besides numerous studies have proved noticeable intensification of the oxidative stress during artificial circulation (AC), however stuides failed to demonstrate reduction in the number of complications and peri-operative mortality when performing coronary artery bypass on the beating heart compared to the surgeries performed under AC. What is the true contribution of the oxidative stress into the development of post-operative complications? There have been found no evidences of the clinical efficiency of any of existing antioxidants as per mortality reduction criteria or decrease of hospital stay duration. Unfortunately we do not have unambiguous answers to the set up questions. There is no doubt only about the fact that critical actuality dictates the urgent need for further studying of the oxidative stress role in the pathogenesis of ischemic and reprefusional lesions in cardiac surgery.