effect of lidocaine and magnesium sulfate on prevention of ventricular fibrillation in coronary artery bypass grafting surgery

One of the most common events, after the release of aortic cross-clamp in patients undergoing coronary artery bypass grafting surgery is reperfusion induced ventricular fibrillation, which occurs in 74% of 96% of patients. Regarding the controversies over the use of lidocaine or magnesium sulfate for the prevention of ventricular fibrillation following the release of aortic cross-clamp, this study was designed to compare the effectiveness of magnesium sulfate and lidocaine to suppress ventricular fibrillation. In a double blind, prospective, randomized, controlled trial study, 76 patients who were candidates for elective coronary artery bypass grafting surgery were divided into three groups including Group A [lidocaine, n=26], group B [magnesium sulfate, n=25], and group C [normal saline, n=26]. Lidocaine [1.5 mg/Kg], magnesium sulfate [30 mg/Kg] and normal saline were administered 5 minutes before the release of aortic cross clamp. The incidence of ventricular fibrillation significantly decreased in patients receiving magnesium sulfate [12% vs. 26.9% and 44% in patients who received lidocaine and normal saline, respectively] There was no statistically significant difference between the groups with respect to age, ejection fraction [L/ min], anesthetic time [min], cross-clamping time [min], PH, HCT [%], and serum K+ level [meq]. The administration of lidocaine and magnesium sulfate before the release of aortic cross-clamp reduces the incidence of postoperative ventricular fibrillation in adult patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass. In our study, magnesium sulfate was more efficient in prevention of ventricular fibrillation than lidocaine. Administration of magnesium sulfate [30 mg/kg] caused no toxic effect and wais safe for patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass

Prevalence and risk factors of acute renal failure after cardiac surgery in Southern Iran

Acute renal failure requiring renal replacement therapy after cardiac surgery is still a cause of major morbidity and mortality worldwide. A number of risk factors for the development of acute renal injury after cardiac surgery have been previously described and based on these variables; several scoring algorithms were proposed. Predictive value of these algorithms in Iran is not described. This study investigates these risk factors among our patients in southern Iran. Two hundred and forty patients with normal kidney function who were candidates for cardiac surgery were enrolled and their baseline data were collected. Diabetes mellitus and age were selected as more controversial preoperative risk factors. Clamp and pump time were also selected as intra-operative risk factors and the type of operation was also considered as an independent risk factor. The patients were categorized in two groups including group 1: Patients with post-operation normal kidney function and group 2: Patients with post-operation ARF. All patients were followed with serial measurement of serum creatinine post-operation. The incidence of acute renal failure was 11.25%. Mean age of the patients in group 1 was 54.24 +/- 15.88 and in group 2 was 52.85 +/- 18.20 years. There was not any significant correlation between duration of clamp time and post operation acute renal failure. Clamp time in group 1 was 51.49 +/- 11.88 and in group 2 was 53.48 +/- 13.40 min. Duration of pump time in group 1 was 63.31 +/- 12.56 min and in group 2 was 78.07 +/- 10.85 min. The difference was statistically significant. Forty two [20%] of the patients in group 1 and 13 [50%] in group 2 were diabetic. Although several scoring algorithms are available for prediction of post-cardiac surgery complications, these can also be matched with our patients' criteria enhancing their accuracy for our situation

Evaluation of hemodynamic changes due to protamine administration by calcium gluconate after coronary artery bypass grafting surgery

Administration of Protamine sulfate for heparin neutralization after cardiopulmonary bypass may be associated with adverse reactions such as transient hypotension to cardiovascular collapse. Although catastrophic events are rare and occur only in 2.6% of cardiac surgeries, it is associated with adverse postoperative outcome. The aim of this study is to investigate whether bolus administration of calcium gluconate can minimize the adverse hemodynamic effects of protamine. This randomized clinical trial [RCT] prospective study was conducted between Feb. 2006 to Dec. 2008. The patients were randomly allocated into three groups including group A [42 patients] who received only protamine after weaning from cardiopulmonary, group B [44 patients] concomitantly treated with protamine sulfate and calcium gluconate, and group C [40 patients] receiving calcium gluconate 5 minutes before administration of protamine. Hemodynamic variables such as systolic and diastolic blood pressures, mean of arterial pressure, central venous pressure and heart rate were obtained 0, 2, 4, 6, 8 and 10 minutes after protamine administration from each group. Systolic blood pressure in groups A [control] and C [calcium administration before protamine] 0,2,4,6,8 and 10 minutes after protamine administration initially decreased and increased subsequently [P=0.228]. Also no statistically significant difference was found in diastolic blood pressure [DBP], mean arterial pressure [MAP], central venous pressure [CVP], and heart rate [HR] in 0,2,4,6,8, and 10 minutes in any of the three groups. In our study, hemodynamic changes in 10 minutes after protamine administration for heparin neutralization in patients with good left ventricular systolic function after coronary artery bypass grafting surgery were mild, and prophylactic calcium gluconate administration concurrent with or before protamine injection was not recommended

Ruptured sinus of valsalva aneurysm initially misdiagnosed as ventricular septal defect by echocardiography

Aneurysms of sinus of valsalva are rare cardiac lesions and most of them are in congenital origin. The malformation consists of a separation or lack of fusion between the media of the aorta and the annulus fibrosis of the aortic valve. The structure becomes aneurysmal and may rupture to form a fistula. We present a case of ruptured sinus of valasalva aneurysm in a 25-year-old man. The diagnosis was made by echocardiography and confirmed at operation

[Hydatic cyst of the pancreas - a case report]

We report a new case of hydatid cyst of the pancreas. The diagnosis has been suspected on the radiological aspect then confirmed by serology. The treatment consisted in a resection of the prominent dome associated to drainage of the residual cavity. The post operative sequences were simple. To the light of this observation and data of the literature, the different clinical aspects, para clinical and therapeutic modalities of this very rare localization of hydatidosis are discussed

Diabetic neuropathy and peri operative period in general surgery: about 164 cases

The objective of our study is to evaluate the morbidity of diabetic neuropathy, during peri operative time in a general surgery unit. This retrospective study was conducted between January 2002 and December 2004 in the Military Hospital Mohamed V in Rabat. All diabetic patients with a diabetic neuropathy and who had surgery were included [164 upon 516 diabetic patients]; mean age is 54.6 +/- 10.2 years and type 1 diabetes was present in 56% of the cases. The diagnosis of diabetic neuropathy was based on a careful clinical examination. A distal and symmetrical neuropathy was found in 91% of the cases; a proximal and symmetrical neuropathy in 10% and a diabetic foot in 68%. In these patients, neuropathy was associated to hypertension [29%], to renal insufficiency [9%] and to cardiac disease 4%. Diabetic neuropathy was significantly associated to a higher hospitalization duration [p<0.05] and to a higher postoperative incidence of infection

fractures bimalleolaires et leurs equivalents: texte integral

We present a series of 100 cases of the fractures bimalleolar and their equivalent * It behaves with young people, the average of age is sibant 29,5 years * We have adapted the common classification We overtake the known percentage * 24% up of the ligament