The role of venodilators in the perioperative management of heart failure:

NecroX-5 suppresses sodium nitroprusside-induced cardiac cell death through inhibition of JNK and caspase-3 activation

Although sodium nitroprusside (SNP) is an effective hypotensive drug and is often used in pediatric intensive care units and to treat acute heart failure, clinical application of SNP is limited by its cardiotoxicity. NecroX-5 (NX-5) was recently developed and has the capacity to inhibit necrotic cell death. No current literature addresses whether NX-5 suppresses SNP-induced cell death or its mechanism of action. We have investigated the protective role of NX-5 against SNP-induced cell death in cardiomyocyte-like H9c2 cells. SNP treatment induced severe cell death, possibly through phosphorylation of stress-activated protein kinase/c-Jun NH₂-terminal kinase (JNK) and activation of the apoptotic signaling pathway, including downregulation of Bcl-2 and cleavage of caspase-3. However, NX-5 suppresses SNP-induced cell death through inhibition of JNK activation and suppression of both downregulation of Bcl-2 protein expression and caspase-3 cleavage. These findings will provide insights and facilitate development of antidotes to SNP toxicity in cardiac cells.

Complications of general anesthesia

A summary of complications associated with general anesthesia including their incidence, mechanism, risk factors, prevention strategies, and management is presented.

Mechanical Support for Heart Failure

Critically ill patients at extremes of physiology may benefit from mechanical support for heart failure and intensive care practitioners should be knowledgeable about these options. In this article we will discuss the mechanical support for critically ill patients in heart failure. Referral to a specialist centre should be considered early for maximal patient benefit.