Effect of different induction techniques on the inflammatory response in pediatric cardiac surgery

Many drugs administered for the purposes of anesthesia and sedation, possess potentially important immunomodulatory effects. Most data in this area is experimental. However, developments in this emerging field are worthy of consideration in the light of their future therapeutic potential. This study was designed to determine the effect of using different induction drugs on adhesive molecules plus the anti-inflammatory cytokine 5nterleukin-10 [IL-10] in pediatrics undergoing cardiac surgeries. 45 pediatric 0.1]. Starting after induction [T2] till 4 hours after operation [T6], Ketamine and sevoflurane groups showed significant lower serum soluble intercellular adhesion molecule-1 [sICAM] level compared with Etomidate groups [P <0.0001]. There were statistically increased IL-10 level in ketamine group at T4, T5, T6, compared to the other two groups. Conclusion: In contrast to etomidate anesthesia, ketamine and sevoflurane reduce the up-regulation of slCAM-1 level; therefore the inflammatory response can be attenuated. Only ketamine can potentiate the anti-inflammatory defense through increasing the IL-10 in pediatric patients undergoing cardiac surgeries

Comparative study between the effects of clevidipine and nitroglycerine in patients with pulmonary hypertension undergoing mitral valve replacement

Pulmonary hypertension [PHT] is commonly found in patients undergoing mitral valve replacement [MVR]. Various pharmacologic agents have been used to decrease the pulmonary artery pressure in pulmonary hypertensive patients. Clevidipine is a third-generation IV dihydropyridine calcium channel blocker, specific arterial dilator, with rapid onset and offset. The aim of the present study was to compare between the effects of clevidipine and nitroglycerine on pulmonary and systemic hemodynamics as well as pulmonary oxygenation. Thirty patients with PHT scheduled for elective MVR were enrolled in this study and randomly allocated into 2 groups. Patients received either nitroglycerin infusion at 0.25-10 microg/kg/min [NTG group] or clevidipine infusion at 0.4-8 microg/kg/min [CLV group]. Pulmonary and systemic hemodynamic parameters as well as oxygenation data were measured after induction of anesthesia, after weaning from CPB before the start of the study medication, and after 30 minutes, 2 hours, and 4 hours from the start of the study medication. The incidence of postoperative atrial fibrillation and total ICU and hospital length of stays were also recorded. The mean pulmonary artery pressure [MPAP], pulmonary vascular resistance [PVR], pulmonary capillary wedge pressure [PCWP], mean arterial blood pressure [MAP], and systemic vascular resistance [SVR] were significantly lower in the CLV group compared to the NTG group. In both groups, these parameters were significantly lower at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values. There was no statistical significant change in the heart rate [HR] in the CLV group, however, it was significantly increased at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in the NTG group. The cardiac index [Cl] was significantly increased at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in CLV group and was statistically higher than NTG group. There was a non significant decrease in the PaO[2]/Fi0[2] and no significant change in PaCO[2] and SvO[2] at 30 min, 2 hours, and 4 hours after drug administration compared to pre-drug administration values in both groups with no statistical difference between the two groups. Clevidipine is a valuable alternative to nitroglycerine in the treatment of PHT in patients undergoing MVR as it showed better pulmonary and systemic hemodynamic profiles and did not worsen pulmonar] oxygenation

prognostic value of alveolar recruitment strategy during the intra and postoperative periods in off pump coronary artery bypass surgery

In Off Pump Coronary Artery Bypass [OPCAB] surgery, there is a high incidence of deterioration in lung mechanics and arterial oxygenation. This study aimed at assessing the effect of alveolar recruitment on lung mechanics and oxygenation in patients undergoing OPCAB surgery. In this study, we performed a randomized controlled trial between 2 groups of patients undergoing OPCAB surgery. Group A: patients received a PEEP of 5 cm H20 only. Group 3: Alveolar Recruitment Strategy [ARS] was applied after finishing the proximal anastomotic procedure and repeated in the postoperative period in the ICU. The ARS consisted of raising the peak inspiratory Pressure [PIP] to 30 cm H20 and setting PEEP at 10 cm H20 and maintaining them for 1 minute. Then, both PIP and PEEP were increased to 40 and 15 cm H20 respectively and maintained for another minute. After arrival to the ICU, all patients received 5 cm H20 PEEP, then after 1 hour, the patients received either PEEP only or with the same previous strategy as in O.R. to their groups. In the OR, lung compliance as well as arterial oxygenation were measured after induction of anesthesia, before, and after setting both PEEP and ARS. In the ICU, arterial oxygenation was measured before both PEEP and ARS, as well as one and four hours later. Postoperative pulmonary complications including hypoxemia, hypercapnia, atelectasis, prolonged intubation, pulmonary congestion, pulmonary infection, total ICU stay and mortality werq recorded. There was a significant rise in lung compliance and arterial oxygenation in the ARS [Group B] than in the PEEP group [Group A]. As regards the Arterial Oxygen Tension, there was a continuous statistically significant rise in group B than in group A, 30 minutes after starting the ARS in the OR, before starting the ARS in the ICU, 30 minutes, 1 and 4 hours later [206.5 +/- 23.9,192.2 +/- 23.5, 250.7 +/- 31.9, 211.9 +/- 21.3 mmHg and 195.3 +/- 24.5 mm/Hg respectively in group B versus 126.9 +/- 10.1, 128.7111.6, 129.1 +/- 10.4, 129.8 +/- 9.4 mmHg and 130.1 +/- 9.7 mm/Hg respectively in group A] [P< 0.0001]. Additionally, there was a marked reduction in the postoperative hypoxemia, hypercarnia, atelectasis, prolonged intubation, infection and prolonged ICU stay in the ARS group. OPCAB patients in whom there is a reduction in lung compliance owing to the large volumes of intravenous fluids and compression of the right chest by the rotated heart during revascularization of the postero-lateral coronary vessels, applying an ARS in those patients greatly improves lung mechanics and arterial oxygen tension

Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass

Obese patients may be sensitive to the respiratory depressant effect of opioid analgesics. Alternative methods for analgesia may be beneficial for management of bariatric surgery. We evaluated the effect of dexmedetomidine on anesthetic requirements during surgery, hemodynamic, recovery profile and morphine use in the postoperative period. Eighty adult patients scheduled for elective laparoscopic Roux-en-Y gastric bypass surgery were randomly assigned to one of two study groups; Group D [40 patients] received dexmedetomidine [0.8-micro g/kg bolus, 0.4 micro g.kg[-1]. h[-1] and Group P [40 patients] received normal saline [placebo] in the same volume and rate. Intraoperative and postoperative mean blood pressure and heart rate were recorded. The total amount of intraoperative fentanyl and propofol required to maintain anesthesia were measured. Recovery profile, pain score and total amount of morphine used via patient controlled analgesia [PCA] were assessed. During surgery, dexmedetomidine decreased the total amount of intraoperative fentanyl and propofol required for maintenance of anesthesia compared to placebo. Patients who received dexmedetomidine showed significant decrease of intraoperative and postoperative mean blood pressure, heart rate. In the postoperative period, dexmedetomidine decreased pain scores and PCA morphine use significantly and showed better recovery profile as compared to the placebo group. There was no difference in the incidence of postoperative nausea and vomiting [PONV] between both groups. The intraoperative infusion of dexmedetomidine decreased the total amount of propofol and fentanyl required to maintain anesthesia, offered better control of intraoperative and postoperative hemodynamics, decreased postoperative pain level, decreased the total amount of morphine used and showed better recovery profile compared with placebo