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Objective The impact of early resumption of oral intake after cardiac surgery on hemodynamics has not been characterized. The authors examined the effects of early oral intake on the oxygen supply-demand relationship in patients undergoing on-pump cardiac surgery in an early recovery after surgery program. Design Prospective data were collected in postcardiac surgical patients in a multidisciplinary intensive care unit (ICU) during an 18-month period. Setting Single institution study. Participants Forty-three patients who underwent either mitral or aortic valve repair and were successfully liberated from ventilatory support within 10 hours after surgery. Interventions Patients were either allowed to resume oral intake on the morning of the first postoperative day or not at the discretion of the surgical team after extubation. Measurements and Main Results The oxygen supply-demand relationship was assessed continuously with cardiac index and mixed venous oxygen saturation (SvO 2). Among the subjects, 22 patients were allowed to eat, and transient SvO 2 decrease was noted in 13 patients. All transient SvO 2 decreases occurred in the patients with early oral intake. The hemodynamic status and oxygen supply-demand relationship did not differ between the patients with and without transient SvO 2 decrease. All the subjects were discharged successfully from the ICU on the first postoperative day, and the length of hospital stay was similar irrespective of SvO 2 decrease after early oral intake. Conclusions Early oral intake shortly after extubation was associated with transient but significant SvO 2 decrease in patients who underwent fast-track recovery after open-heart surgery. Because this phenomenon did not negatively affect the postoperative outcome, early oral intake may not be harmful. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the cardioprotective effects of nicorandil in patients undergoing coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). Design: A prospective, double-blind, randomized clinical study. Setting: A university hospital. Participants: Thirty-two patients undergoing elective CABG surgery. Interventions: Patients were randomized into 2 groups: the nicorandil and placebo groups. In the nicorandil group, intravenous nicorandil infusion was started after the induction of anesthesia by a loading dose of 0.1 mg/kg, followed by a continuous infusion of 0.1 mg/kg/h until 2 hours after CPB, then decreased to 0.05 mg/kg/h, and discontinued at the end of surgery. The placebo group received the same volume of saline. Arterial blood was sampled, and serum troponin T (TnT) and CK-MB were measured at the following 4 stages: after the induction of anesthesia (baseline), 2 hours after CPB, the first postoperative day (POD), and the third POD. Measurements and Main Results: TnT concentrations were similar at baseline and increased with a peak on the first POD in both groups. In the nicorandil group, TnT concentration returned to the baseline value at the third POD, and the time course of TnT showed significantly lower levels (p = 0.012). CK-MB concentrations were similar at baseline, increased and peaked at 2 hours after CPB, and returned to the baseline on the third POD in both groups. There were no significant differences between the groups with respect to the changes in CK-MB concentrations. Conclusions: The nicorandil group showed lower concentrations of TnT, suggesting that intraoperative administration of nicorandil may provide a degree of myocardial protection in CABG surgery. [Copyright &y& Elsevier]

Objective: The purpose of this study was to assess perioperative platelet function with 2 types of monitors (a whole-blood aggregometer [WBA analyzer; Mebanix, Tokyo, Japan]) and the Sonoclot monitor [Sienco, Wheat Ridge, CO]) in patients undergoing hypothermic cardiopulmonary bypass (CPB). Design: Prospective, observational study. Setting: Single-center study at a university hospital. Participants: Twenty-six patients who underwent coronary artery bypass grafting or valve replacement under hypothermic CPB without platelet transfusion or fresh frozen plasma administration. Interventions: Blood sampling was performed at the following time periods: after anesthetic induction, after CPB, and on the first postoperative day. These samples were assessed with the WBA analyzer and the Sonoclot. Measurements and Main Results: Significant attenuation of adenosine diphosphate–induced platelet aggregation was detected shortly after CPB by 2 WBA analyzer-derived parameters: a decrease in the filtration pressure rate and an increase in the platelet aggregatory threshold index. Platelet aggregation returned to the preoperative level on the next day. There was no correlation between the amount of postoperative mediastinal drainage and defects in platelet aggregation. On the other hand, time to peak obtained by the Sonoclot did not show any significant changes. Conclusions: Whole-blood aggregation measured with the WBA analyzer detected transient platelet dysfunction shortly after CPB, whereas the Sonoclot was less sensitive to this change. [Copyright &y& Elsevier]