scholarly journals Influence of arm position during infraclavicular subclavian vein catheterization in coronary artery bypass graft surgery

2018 ◽  
Vol 10 (4) ◽  
pp. 192-196 ◽  
Author(s):  
Masoud Tarbiat ◽  
Maryam Davoudi ◽  
Sayed Ahmadreza Salimbahrami
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Success Rate ◽  
Subclavian Vein ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Neutral Group ◽  
Significant Difference ◽  
Vein Catheterization

Introduction: Percutaneous subclavian vein catheterization via infraclavicular approach is one of the most widely used cannulation techniques for inserting catheters into a central vein. The aim of this study was to evaluate influence of arm position during infraclavicular subclavian vein catheterization with landmark-based technique in coronary artery bypass graft (CABG) surgery. Methods: Between September 2017 and June 2018, this prospective randomized clinical trial was performed in 320 patients. The patients were randomly assigned to the Neutral group (the arms kept by the side) or Abduction group (the arm was abducted to 90°). The success and complication rates were compared in the two groups. The data were analyzed using SPSS software. Results: In the first attempt of subclavian vein cannulation, the success rate had no significant difference between the two groups (P = 0.185). In the second attempt of catheterization, the success rate in Abduction group (40.5%) was lower than Neutral group (81.2%). The overall success rate in two attempts were (84.4%) in the Abduction group and (96.2%) in the Neutral group. There was a significant difference between two groups in the second and overall success rates (P = 0.0001). In 34 (10.6%) patients, subclavian artery puncture occurred, 30 (18.8%) in the Abduction group and 4 (2.5%) in the Neutral group. There was a significant difference between two groups (P = 0.0001). Pneumothorax was occurred in 15 (9.4%) in the Abduction group and 3 (1.9%) in the Neutral group. There was also a significant difference between two groups (P = 0.004). The differences in other complications on two groups were statistically insignificant. Conclusion: Compared with Abduction group, the Neutral group resulted in higher success rate and fewer subclavian artery puncture and pneumothorax. The incidences of other complications were similar on both groups.

scholarly journals Comparison of urinary KIM-1 and NGAL and plasma creatinine in patients undergoing coronary artery bypass graft surgery

2020 ◽  
Vol 10 (1) ◽  
pp. e04-e04
Author(s):  
Maryam Saeedi Ghaheh ◽  
Saeed Mardani ◽  
Afsaneh Malekpour ◽  
Farzaneh Kadkhodaei Elyaderani ◽  
Fatemeh Salehi Choliche ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Serum Creatinine ◽  
Coronary Artery Bypass Graft ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Kidney Injury ◽  
High Ability ◽  
Urinary Ngal ◽  
Artery Bypass Graft ◽  
Significant Difference

Introduction: Serum creatinine level is currently being used as an indicator to detect acute kidney injury (AKI) after cardiac surgery, which is delayed and unreliable. Objectives: This study was conducted to determine the AKI in patients undergoing coronary artery bypass graft (CABG) surgery by measurement of urinary creatinine and plasma kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL). Patients and Methods: In this cross-sectional study, 96 patients undergoing CABG were divided based on their serum creatinine level of the fourth day after procedure into two groups of AKI (an increase of creatinine more than 0.3 mg/dl or more than 150 % of its baseline level) and non-AKI. In both groups urinary KIM-1 and urinary NGAL were measured on the first day of surgery (first 24 h). Results: No significant difference was observed in baseline creatinine between the two groups (P>0.05). However postoperative serum creatinine, creatinine changes, urinary NGAL and KIM1 showed significant difference between the groups (P<0.05). Serum creatinine was positively correlated with KIM-1 (r = 0.666, P<0.001) and NGAL (r = 0.660, P<0.001). KIM-1 and NGAL had high ability to detect AKI [area under the ROC (receiver operating characteristic) curve of 0.929 and 0.838, respectively]. The NGAL at cut-off point of 97.4 had 86% sensitivity and 80% specificity and KIM-1 at cut-off point of 14.8 had 84% sensitivity and 89% specificity. Conclusion: KIM-1 and NGAL had high ability to detect AKI. However, KIM-1 had higher detection ability than that of NGAL.

scholarly journals Blood Glucose Profile Post Coronary Artery Bypass Graft in Rsup H. Adam Malik Medan

2018 ◽  
Vol 5 (1) ◽  
pp. 3470-3472
Author(s):  
Farhan Syarif ◽  
Marshal . ◽  
Doddy Prabisma Pohan
Keyword(s):  
Blood Glucose ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Glucose Level ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Significant Difference

Cardiopulmonary bypass (CPB) is widely used for systemic and oxygenated systemic settings during open heart surgery. (Simon L, 2004) To date there is yet to be found a definitive biochemical marker that can be considered prognostic in patients who subside. using a CPB machine. Hyperglycemia is defined as a glucose level above the normal physiological range. Normal blood glucose level is 70-120 mg and levels > 120 mg/dL is a diagnostic level for diabetes. During CPB and coronary artery bypass off-pump (OPCAB), most patients tend to have elevated blood glucose levels despite no previous diabetes medical history. This study uses a descriptive study design study with a retrospective approach. The study was conducted in the Division of Cardiac and Cardiac Surgery of the Department of Surgery of the Faculty of Medicine USU/ RSUP H. Adam Malik Medan. The study was conducted after the proposal was approved. The population in this study were patients who performed Coronary Artery ByPass Graft surgery using Cardiopulmonary Bypass (CBP) at RSUP H. Adam Malik Medan in 2016 (01 January - 31 December 2016). The study involved patients who performed Coronary Artery ByPass Graft surgery using a CPB machine in RS. Haji Adam Malik Medan. The number of research subjects was 41 people. . Based on sex it is seen that more men (84.3%) than women. The mean of postoperative KGD H + 3 was the highest KGD that was 218,28 + 23,5 mg / dL. The use of Humulin R is most commonly used in insulin therapy with patients with postoperative CPB hyperglycemia. Based on the ANOVA test there was a significant difference in the value of KGD in H + 1 post CPB operation compared to H + 2 post CPB operation (p = 0.013, p <0.05).

What is the Role of Preoperative Breathing Exercises in Reducing Postoperative Atelectasis after CABG?

2019 ◽  
Vol 14 (4) ◽  
pp. 275-279 ◽  
Author(s):  
Seyed Tayeb Moradian ◽  
Amir Abas Heydari ◽  
Hosein Mahmoudi
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Pulmonary Complications ◽  
Artery Bypass Graft ◽  
Breathing Exercises ◽  
Arterial Blood ◽  
Significant Difference

Background: Atelectasis and hypoxemia are frequently reported after coronary artery bypass graft surgery (CABG). Some studies confirm the benefits of breathing exercises on pulmonary complications, but the efficacy of preoperative breathing exercises in patients undergoing CABG is controversial. In this study, the effect of preoperative breathing exercises on the incidence of atelectasis and hypoxemia in patients candidate for CABG was examined. Methods: In a single-blinded randomized clinical trial, 100 patients who were undergoing coronary artery bypass graft surgery were randomly allocated into two groups of experimental and control, each consisted of 50 patients. Before the operation, experimental group patients were enrolled in a protocol including deep breathing, cough and incentive spirometer. In the control group, hospital routine physiotherapy was implemented. All the patients received the hospital routine physiotherapy once a day for 2 to 3 minutes in the first four days postoperatively. Arterial blood gases and atelectasis were compared between groups. Results: There was no significant difference between groups in terms of atelectasis and hypoxemia (p Value>0.05). Conclusion: Preoperative breathing exercise does not reduce pulmonary complications in patients undergoing CABG.

A Comparative Study of the efficacy of preoperative of oral Pregabalin and placebo on acute Postoperative Pain After Coronary Artery Bypass Graft Surgery

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahmoud Ahmed Ibrahim Ahmed ◽  
Hatem Said Abdel Hamed ◽  
Nevein Gerges Fahmy ◽  
Wael Abdel Aziz Mohamed
Keyword(s):  
Coronary Artery ◽  
Postoperative Pain ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Pain Control ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Acute Postoperative Pain ◽  
Significant Difference

Abstract Background Pain that pursues coronary artery bypass graft (CABG) surgery is usually associated with increased both recovery duration and hospital stay. Patient outcome could be worsened owing to large doses of opioids for pain control through over sedation, and prolonged mechanical ventilation. This study was designed to evaluate the effect of preemptive pregabalin on post CABG surgery pain control. Objective To study the effect of pregabalin administration before surgery in the treatment of acute postoperative pain after coronary artery bypass surgery. To study the effect of pregabalin on the consumption of opioids for acute postoperative pain. Patients and Methods Type of Study: Prospective double – blinded, randomized controlled Trial. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Study Setting: National Heart Institute, Egypt. Study Period: 6 months. Study Population: adult undergoing coronary artery bypass graft surgeries. Results Analysis of VAS in the first 24 hours after extubation showed significant difference between Groups 1 and 2. Analysis of systolic blood pressure and heart rate in the first 24 hours showed no significant difference between Groups 1 and 2. It is important to note that because the observed “average” differences in systolic blood pressure and heart rate between groups were small, the clinical significance of such differences can be questioned. Furthermore, it would not be realistic to expect a big, dramatic benefit from a single intervention in a complex, multifactorial care process, such as in cardiac surgery. Given the complexity of these cases, we believe that even a small reduction in pain intensity is a meaningful improvement as we all try to improve care for these patients. Conclusion Pregabalin can be effective for reduction of post CABG pain and have better patient satisfaction if given preemptively with single dose preoperatively.

scholarly journals Female Gender Is an Independent Predictor of Operative Mortality After Coronary Artery Bypass Graft Surgery

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Ron Blankstein ◽  
R. Parker Ward ◽  
Morton Arnsdorf ◽  
Barbara Jones ◽  
You-Bei Lou ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Operative Mortality ◽  
Independent Predictor ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Female Gender ◽  
Artery Bypass Graft ◽  
Significant Difference

Background— Women have a higher operative mortality (OM) after coronary artery bypass graft (CABG) surgery than men. Suggested contributing factors have included women’s increased age, advanced disease, comorbidities, and smaller body surface area (BSA). It is unclear whether women’s increased risk factors fully account for this difference or whether female gender within itself is associated with increased OM. We attempted to determine whether, all other factors being equal, there is a significant difference in OM between men and women undergoing CABG. Methods and Results— We retrospectively reviewed a clinical database of 15,440 patients who underwent CABG at 31 Midwestern hospitals in 1999–2000. Each patient record consisted of >400 data elements. Risk-adjusted mortality rates were computed using a predictive equation derived by stepwise logistic regression. Overall, women were older, had a higher incidence of diabetes and valvular disease, and were more likely to be presenting in shock. The OM for the entire population was 2.88% (women 4.24% versus men 2.23%, P <0.0001). Lower BSA was found to be an independent predictor of increased mortality, and a direct inverse relationship between BSA and OM was noted. After adjusting for all comorbidities including BSA, female gender remained an independent predictor of increased mortality (risk-adjusted OM was 3.81% for women and 2.43% for men). Thus, whereas risk adjustment reduced women’s OM from 90% higher than men’s to 22% higher, a significant difference remained. Conclusions— In this contemporary data set from 31 Midwestern hospitals, female gender was an independent predictor of perioperative mortality, even after accounting for all comorbidities, including low BSA.

scholarly journals The effect of N-acetyl cysteine injection on renal function after coronary artery bypass graft surgery: a randomized double blind clinical trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fatemeh Javaherforooshzadeh ◽  
Zahra Shaker ◽  
Mahboobeh Rashidi ◽  
Reza Akhondzadeh ◽  
Fatemeh Hayati
Keyword(s):  
Clinical Trial ◽  
Renal Function ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Significant Difference ◽  
Acetyl Cysteine

Abstract Background This study aimed to compare the effects of N-acetyl cysteine on renal function after coronary artery bypass graft surgery. Methods In this randomized clinical trial conducted in Golestan Hospital, Ahvaz, Iran, 60 candidates for coronary artery bypass graft surgery were selected and divided into two N-acetyl cysteine and control groups (30 people each). Patients received 3 (2 intraoperative and 1 postoperative) doses of IV N-acetyl cysteine (100 mg/kg) (n = 30) or placebo (n = 30) over 24 h. Prescription times were as follows: after induction of anesthesia, in the Next 4 h, and in the 16 h after on. Primary outcomes were serum levels of BUN and Cr, at baseline,4 and 48 h after surgery. And also need renal replacement therapy (RRT). Secondary outcomes included the hemodynamic variables, Blood products transfusion. Results There were significant differences in BUN between groups at 4 h (P = 0.02) and 48 h after surgery (P = 0.001) There were significant differences in Cr level between groups at 4 h (P < 0.001) and 48 h after surgery (P = 0.001). MAP at different times (at 4 h p = 0.002 and 48 h after surgery P < 0.001) were significantly different between the two groups. There was a significant difference between the two groups in terms of the unit of Packed cell transfusion (P = 0.002) and FFP transfusion (P < 0.001). Conclusion In the present study, we found that administration of N-acetyl cysteine can reduce the incidence of acute kidney injury in patients undergoing coronary artery bypass graft surgery and improved kidney functions. Trial registry IRCT20190506043492N3 Registered at 2020.06.07.

scholarly journals Comparison of Sevoflurane and Isoflurane for Myocardial Protection During Coronary Artery Bypass Surgery in a Tertiary Care Center in Nepal

2019 ◽  
Vol 41 (2) ◽  
pp. 45-49
Author(s):  
Priska Bastola ◽  
Bishwas Pradhan ◽  
Madindra Basnet
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Secondary Outcome ◽  
Artery Bypass Graft ◽  
Time Intervals ◽  
Significant Difference

Introduction: Myocardial protection during Coronary Artery Bypass Graft (CABG) has always been an area of concern so we aimed to evaluate the level of release of Creatine Phosphokinase (CPK-MB) and Troponin I (cTnI) at various time intervals in the first 24 hours after on pump CABG in patients receiving either Sevoflurane or Isoflurane. Furthermore clinically relevant patient outcomes were also evaluated in patients undergoing on pump coronaryartery bypass grafting. Methods: This was a prospective randomized trial in patients undergoing on pump coronary artery bypass graft surgery, which was conducted from January 2016 till June 2017. A total of 105 patients were enrolled out of which there were 53 in Isoflurane and 52 in Sevoflurane group who received the respective volatile anesthetic agents throughout the surgery except during bypass at 1-1.5 MAC. The primary outcome was comparison of the CPK MB and cTnI levels at 0 hr, 6 hr, 12 hr and 24 hr after surgery from baseline, whereas the secondary outcomes were duration of intensive care unit stay, usage of vasopressors and inotropes, renal dysfunction, stroke. Results: No significant difference in CPK MB and cTnI levels at all time intervals in both the groups, the other secondary outcome parameters were comparable. Conclusion: The study found no difference in the cardiac markers between the two anesthetics. Based on the data, Sevofluraneand Isoflurane might be used equivalently in patients undergoing coronary artery bypass graft surgery with extracorporeal circulation without any difference in their myocardial protection function.

The effect of melatonin on interleukins 22 and 13 in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass: A Clinical Trial

2020 ◽  
Author(s):  
Reza Jouybar ◽  
Mansour Jannati ◽  
Saeed Khademi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The Body ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Significant Difference

Abstract Objective: Coronary artery bypass graft surgery with cardiopulmonary bypass (CABG) is one treatment for patients with coronary artery disease. After CABG, a series of inflammatory processes occur which affect other organs of the body and even cause severe organ damage and subsequently a worse prognosis. The purpose of this study was to evaluate the effect of pre-surgically administered melatonin on interleukins 22 and 13 in patients undergoing CABG.Results: In this study, 22 patients were evaluated, 10 patients (45.5%) in the Melatonin group, and 12 patients (54.5%) in the control group. The mean level of IL-22 at all time-points in T2, T3, and T4 was significantly lower in the Melatonin group (P <0.05). There was also a significant increase in IL-22 in both groups at T4 compared to T1. There was no significant difference between the two groups in IL-13 at any time, but the Melatonin group at T2 had a significant decrease in IL-13 compared to T1. This study showed that preoperative melatonin administration could prevent the increase of IL-22 but not IL-13.

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