Myocardial Protection Using Fructose-1,6-Diphosphate During Coronary Artery Bypass Graft Surgery: A Randomized, Placebo-Controlled Clinical Trial

Abstract Introduction : Pain management after coronary artery bypass graft (CABG) surgery remains challenging. Objective This study aimed to compare the effects of Ketorolac and Paracetamol on postoperative CABG pain relief. Method: This double-blind randomized clinical trial study was conducted in Ahvaz, Iran, from September 2018- December 2019. Two consecutive groups of 60 patients undergoing elective on-pump coronary artery bypass graft surgery. Intervention The patients were divided into 0.5 mg/kg of ketorolac mg/dl and 10 mg/kg of Paracetamol after surgery for pain management . Primary outcomes were: visual analog pain scale (VAS) at the time point immediately after extubation (baseline) and at 6, 12, 24 and 48 hours and the total dose of morphine consumption. Secondary outcomes included the hemodynamic variables, weaning time, chest tube derange, in-hospital mortality and myocardial infarction. Statistical analysis: The data were analyzed using SPSS version 22(SPSS, Chicago, IL). The Mann-Whitney U-test was used to compare demographic data, VAS scores, vital signs, and side effects. Repeated measurements were tested within groups using Friedman's ANOVA and the Wilcoxon rank-sum test. Values were expressed as means ± standard deviations. Statistical significance was defined as a p-value < 0.05. Results : Compared with baseline scores, there were significant declines in VAS scores in both groups throughout the time sequence (P＜ 0.05). The statistical VAS score was slightly higher in the Paracetamol group at most time points, except for the time of 6 h. However, at 24 and 48 hours, the VAS score in group Paracetamol was significantly higher than in group Ketorolac. There were no significant differences between groups about hemodynamic variables. Conclusion: The efficacy of ketorolac is comparable to that of Paracetamol in postoperative CABG pain relief. Trial registry: IRCT20150216021098N5. Registered at 2019-09-12

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Remote ischemic preconditioning effects on inflammatory markers and myocardial protection in coronary artery bypass graft surgery

Perfusion ◽

10.1177/0267659120979293 ◽

2020 ◽

pp. 026765912097929

Author(s):

Farhad Gorjipour ◽

Tahereh Saeedzadeh ◽

Yaser Toloueitabar ◽

Naser Kachoueian ◽

Sepideh Bahlouli Ghashghaei ◽

...

Keyword(s):

Coronary Artery ◽

Serum Level ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Ischemic Preconditioning ◽

Myocardial Protection ◽

Artery Bypass ◽

Bypass Graft ◽

Remote Ischemic Preconditioning ◽

Artery Bypass Graft

Background: Induction of short episodes of ischemia to remote organs, namely upper or lower limbs, literally known as remote ischemic preconditioning (RIPC) has been suggested as a preconditioning approach to ameliorate ischemia/reperfusion injury (IRI). RIPC has been demonstrated to effectively protect various vital organs, including heart, against the next ischemic events in preclinical studies. However, human studies are required to approve its clinical applicability. Present study was performed to evaluate the effect of RIPC on the myocardial protection and inflammatory response markers in patients undergoing coronary artery bypass graft surgery Methods: In this randomized clinical trial, 43 coronary artery bypass graft (CABG) patients from Imam Hossein educational hospital were allocated in two groups, RIPC (21 patients) and control (22 patients). Serum level of interleukin (IL)-4, IL-8, and IL-10, interferon (IFN)-γ and Cardiac Troponin-I (cTnI) were measured in (1) after induction of anesthesia (before incision of skin), (2) after separation from CPB and (3) 24 hours after ICU arrival. Results: increase pack cell transfusions were observed in control group in ICU. Serum level of IL-10 at 24 hours after ICU admission was significantly higher in the RIPC group. Significantly lower amounts of IL-8 at post-CPB time were observed in the RIPC group in comparison with control. Conclusion: RIPC regulates the circulatory inflammatory cytokines, IL-8 decrement and IL-10 elevation, which could be translated into protection against IRI. However, further studies with larger sample sizes with careful consideration of parameters such as use of propofol as an anesthetic in the patients should be conducted to consolidate the findings from the current study.

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