effect of acute normovlumic hemodilution in reducing allogenic red blood cell transfusion during and after cardiac surgery

In this study, effect of acute normovlumic hemodilution [ANH] to reduce consumption rate of allogenic blood transfusion was compared with the traditional protocol during and after cardiac surgery. One thousand patients who underwent elective cardiac surgery [CABG, valve surgery were entered into study. In ANH group [n=500/ blood obtained from patients by using a new formula and re-transfused the collected blood at the end of operation. Total amount of a2logenzc packed red blood cell [PRBC] and fresh frozen plasma PFP] transfusion in ANH group was compared with 500patients that had been operated one year ago in our hospital [Historical Control]. Considering the patients baseline hematocrit values A M technique was used in 59% of patients in ANH group, and 12% in control group. In ANH group fewer patients during operation transfused with PRBC and FFP than control group [23.2% vs. 71.4%; p = 0.001 and 3 1.2% vs 77.4%; p = 0.008, respectively. Significantly lower mean PRBCs units transfused in ANH group comparing with control group [1.1 +/- 0.5 vs. 2.4 +/- 1.3 units; p = 0.006]. After surgery PRBCs and FFP transfusion were lower in ANH group than control group. Mean postoperative bleeding was not significantly different in the two groups [884 +/- 304 ml vs 790 +/- 291 ml; p = 0.312]. The incidence of postoperative complications, ICU stay and in-hospital mortality between the two groups were not significantly different [p > 0.05]. In this stu4, using the A M significantly reduce consumption of allogeneic red blood cell and FFP in cardiac surgery patients

Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathy

Patients with peripartum cardiomyopathy may require analgesia/ anesthesia for delivery or cesarean section. Many different methods of anesthesia has been used for this purpose. Remifentanil was used safely in peripartum cardiomyopathic patients, but there is not any report about etomidate usage in such patients. We report on a 19 years old patient, at 32 weeks of gestation, with severe peripartum cardiomyopathy, in uncompensated heart failure and pulmonary edema. She was scheduled for emergency cesarean section because of threatening mother's life and fetal distress. General anesthesia was induced with etomidate and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn

Preoperative transcranial and carotid Doppler study in coronary artery bypass graft patients

To assess the correlation of postoperative neurologic complications with preoperative transcranial and carotid Doppler study findings of coronary artery bypass graft [CABG] patients. In a descriptive, analytic, follow up study we prospectively studied 201 patients undergoing elective and isolated CABG surgery during a 12 month period from October 2003 to September 2004 at Madani Hospital of Tabriz Medical Sciences University, Iran. Neurologic examination, intracranial cerebral arterial study using transcranial Doppler [TCD] and carotid duplex were performed preoperatively. Intraoperative and postoperative complications were followed up for one month. Two hundred and one patients [158 male, 43 female] with a mean age of 57.29 +/- 9.67 were studied. Out of these, 131 patients had 3 coronary vessels disease, 64 had 2 vessels, 5 had one vessel, and one patient had diffuse coronary disease. A TCD was performed in 183 patients and disclosed abnormalities in 22 patients and was normal in 161 cases. The total number of involved arteries was 34. Among 154 carotid duplex studied patients, 102 had plaque, inducing <50% stenosis in 99, 50-74% stenosis in one, and 75-90% stenosis in 2 cases. Postoperative neurologic complication occurred as follows: 4 stroke, 7 delirium, and 3 amnesia. One of the operated patients died. Nine of 161 patients with normal TCD [5.6%] and 5 of 22 [22.7%] with intracranial cerebral arterial disease [ICAD] showed central nervous system [CNS] complications [p=0.015]. There were significant correlations between number of involved cerebral arteries and post CABG CNS complications [p=0.0001], including stroke [p=0.007], and between diabetes mellitus history with these complications [p=0.012]. Our results suggest that lCAD is an independent risk factor for CNS complications after CABG surgery. Hence, we recommend pre-CABG evaluation of the cerebral arteries by TCD, for the risk assessment of CABG surgery