Effect of colloid versus crystalloid administration of cardiopulmonary bypass prime solution on tissue and organ perfusion

We evaluated the effects of tissue and organ perfusion during and after coronary artery bypass graft surgery with either colloid [Voluven] or crystalloid [Lactated ringer's] as prime solution. In this prospective randomized-controlled trial study, 70 patients undergoing on-pump coronary artery bypass graft surgery were randomly assigned to receive either colloid [Voluven] or crystalloid [Lactated ringer's] as prime solution, for initiation of cardiopulmonary bypass machine procedure. Tissue and organ perfusion markers including lactate, troponin I, liver and renal function tests and electrolytes were measured sequentially, before induction [T1] to second days after surgery [T5]. With exception of chloride and potassium levels no significant differences detected in other measurements, and the laboratory results were entirely identical in both procedures. There was no significant difference between Voluven[registered] [ hydroxyethyl starch, HES 130/0.4] and crystalloid [Lactated ringer's] as priming solution on the basis of organ and tissue perfusion tests assessment

[ effect of low-dose ketamine infusion on hemodynamic change in coronary artery bypass graft surgery]

Cardiopulmonary bypass often causes a stress hormonal response with subsequent changes in hemodynamic and organ perfusion. Human studies involving cardiopulmonary bypass have shown that very low doses of ketamine can attenuate inflammatory and stress markers, without adverse effects. The aim of this study was to investigate whether low dose infusion of ketamine have hemodynamic stability effect in coronary artery bypass surgery. In this double blind-controlled trial, 50 patients undergoing on-pump CABG were randomly assigned to receive either 1.25mcg/kg/min of ketamine infusion [Ketamine group, n=25] or normal saline infusion [Control group, n=25] during 48 hours after induction of anesthesia. hemodynamic measurement including blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, systemic venous resistance, arterial blood gas and lactate were measured previous to induction [T1], 4 h, 24h, and48h after the surgery [T2,T3 and T4]. The data were evaluated with using of variance analyzing test and repeated measurement. There were significant interaction effect between time [pre operation, 4, 24 and 48 hours after operation] and group of study [ketamine and placebo] in assessment of systolic blood pressure [p=0.0001], diastolic blood pressure[p=0.0001], heart rate [p=0.004], central venous pressure [p=0.0001] and lactate [p=0.035]. These indicate that ketamine caused decrement in tissue perfusion. Those interactions were not statistically significant for other parameters [p>0.05]. low dose ketamine during and 48 hours after operation not only didn't show hemodynamic stability effect but also decreased tissue perfusion slightly

effect of low-dose of ketamine infusion on stressresponses in coronary artery bypass graft surgery

Open heart surgery is associated with acute perioperative changes in plasma levels of neurohormonal stress factors, cortisol, interleukin-6 and C-reactive protein. Human studies involving cardiopulmonary bypass have shown that very low doses of ketamine can attenuate the markers of inflammation without adverse effects. The aim of this study was to investigate whether, low dose infusion of ketamine when administered during 48 hours after induction, have anti-inflammatory effect and attenuate stress factors, in on-pump coronary artery bypass graft surgery. In this prospective randomized-controlled trial, 50 patients undergoing on-pump coronary artery bypass graft were randomly assigned to receive either 1.25mcg/kg/min of ketamine [Ketamine group, n=25] or normal saline [Control group, n=25] infusion during and for 48 hours after surgery. Inflammatory and stress response markers including C-reactive protein, cortisol, White blood cell count and differential, glucose and lactate level were measured ,before induction [T1], 4 hours after surgery [T2], and on the first and the second days after surgery [T3 and T4]. The level of lactate were higher in ketamine compared with control group four hours after operation [P< 0.05] without any significant differences detected in other measurements. Low dose ketamine did not cause any change in C-reactive protein, cortisol, White blood cell count and glucose level, however lactate level was higher compared to control group