Search

Un nuevo y sorprendente paradigma se ha conformado con la llegada de las “gliflozinas”. Más allá de su acción antihiperglucémica, estos fármacos han impactado centralmente en la terapéutica de las alteraciones cardio-vásculo-reno-metabólicas responsables de las enfermedades más prevalentes que abordamos en la práctica clínica. Los inhibidores del cotransportador sodio glucosa tipo 2 (iSGLT-2) ayudan a controlar y reducir la progresión del daño de órgano blanco. En esta Toma de Posición, cuatro de las Sociedades Médicas vinculadas con estas temáticas acordaron plasmar el conocimiento de este esperanzador fenómeno generado por más de 7500 publicaciones difundidas en los últimos 10 años sobre el beneficio de las “gliflozinas”. Decidimos revisar de manera rigurosa las evidencias experimentales y los múltiples trabajos controlados que muestran sus efectos metabólicos, vasculares, cardíacos, renales y también celulares, incluyendo aspectos no resueltos y advertencias acerca de las precauciones en su uso.

Introduction: A series of brief distant ischemia periods can limit myocardial damage produced by ischemia or reperfusion. Objective: To analyze the differences between the two groups (control and study) taking into account the consumption of inotropics and/or vasopressors during the intraoperative and postoperative periods, as well as the incidence of major cardiac adverse events and mortality in the postoperative period. Methods: A quasiexperimental, explanatory and comparative study with historical control was conducted on two groups of 247 patients proposed for coronary revascularization. A tourniquet was placed to the right arm, in the study group, alternating three insufflations with three dessufflations with a pressure of 200 mmHg, keeping each for five minutes. This procedure was performed before, during and after the major ischemic event, caused by pinching of the coronary artery. Results: A significant decrease in the consumption of inotropic and vasoactive drugs was achieved. The decrease in the incidence of low reversible cardiac output, ventricular fibrillation, and new acute myocardial infarction was also proven. Conclusions: Distant ischemic conditioning is an important tool to be taken into account for perioperative cardiac protection in coronary revascularization.

Introduction: A series of short periods of distant ischemia, prior to the major ischemic event, can limit the myocardial damage produced by ischemia or reperfusion. Objective: To evaluate the usefulness of remote ischemic conditioning in patients scheduled for surgical procedures of coronary revascularization. Methods: A quasi-experimental, explanatory, comparative study with historical control was conducted in two groups of 247 patients proposed for coronary revascularization. A tourniquet was placed in the right arm in the study group, alternating 3 insufflations with 3 dessufflations with a pressure of 200 mmHg, keeping each for 5 minutes. This procedure was performed before, during and after the major ischemic event, caused by the impingement of the coronary artery. Results: A significant decrease in enzymatic parameters was achieved. No significant differences were found (p> 0.05) according to a set of variables that represent the initial state of the patients.