Reperfusion syndrome
Contents:
Description:
The reperfusion syndrome is the syndrome arising owing to resuming of a blood-groove in the ischemic site of a myocardium i.e. as a result of reperfusion.
Resuming of coronal blood circulation can be caused by the termination of a coronary vasomotor spasm, a lysis of blood clot, destruction of units of blood cells, surgical removal of blood clot, removal of a ligature.
Reperfusion Syndrome symptoms:
Clinically reperfusion syndrome is shown by significant increase in intensity of injury of a myocardium at once after resuming of a coronal blood-groove. Thereof the condition of the patient sharply worsens. The minimum duration of ischemia after which there is an expressed reperfusion syndrome makes 40 min. If duration of ischemia is less than 20 min., the specified syndrome does not develop (such duration is characteristic of stenocardia attacks). Lasting ischemia of 20-40 min. can sometimes be shown reperfusion injuries of heart.
Reperfusion Syndrome reasons:
Pathogenetic basis of a reperfusion syndrome is the so-called "oxygen paradox". The essence of a phenomenon is as follows. If to perfuse heart solution which does not contain oxygen (or supports him a little), and in 40 min. and more to pass to perfusion with solution with the normal tension of O2, then as a result of such perfusion of disturbance, caused by the previous hypoxia, not only do not decrease as it should be expected, and become more expressed (a paradox!). The basis of the specified paradox is made by the sharp activation of processes of peroxide oxidation of lipids caused by intake of oxygen in cells which contain a large number of the recovered components of a respiratory chain. There is a dropping electrons bypassing a respiratory chain directly on oxygen molecules owing to what a large number of free radicals is formed. The last initiate the reactions of peroxide oxidation of lipids which are the important molecular mechanism of damage of cellular membranes.
Injury of a myocardium at a reperfusion syndrome
Treatment of the Syndrome of reperfusion:
1. Preoperative preparation has to include long epidural blockade in combination with administration of opioids in oil.
2. Carrying out the combined technique of anesthesia: the facilitated general anesthesia with IVL in combination with the prolonged epidural blockade.
3. Inclusion in a complex of an intensive care of drugs of antioxidant action: after carrying out induction of anesthesia in/in it is entered:
Dimexidum 10mg/kg and
Mannitol-0,11g/kg
4. The intensive care which is carried out to operative measure time has to be directed to achievement of hyper dynamic type of blood circulation.
For this purpose it is necessary:
1) to support hematocrit level not lower than 30 ± 2%;
2) the ratio of colloidal and crystalloid solutions in the ipfuzionny program has to be 1:1, with providing adequate preloading.
3) it is necessary to carry out inotroppy support: adrenaline (Dobutaminum) of 0,02 ±0,012 mkg/kg/min.
5. Use of long epidural blockade for providing an adequate analgesia in the postoperative period and prevention of paresis of intestines.
