Impact of high dose aprotinin on cardiac function and cerebral oxygenation in valve replacement

The aim of this study is to evaluate the effects of full dose aprotinin administration on early and late postoperative myocardial function, cerebral oxygenation by monitoring of jugular bulb oxygen saturation and neurological outcome after cardiac surgery. Sixty patients underwent elective single valve [mitral or aortic] replacement were randomly classified into two groups: High dose aprotinin group [n=30] and control group [n=30]. Patients' parameters were recorded perioperatively, early post operative and after 3 months. Patients parameters include echocardiographic evaluation, operative parameters [spontaneous recovery of the heart, the need for inotropic support to wean the heart from cardiopulmonary bypass], ICU parameters [[duration of intropic support, ventilatory hours, ICU stay] and complications [including low COP syndrome, myocardial infraction, and renal impairment]], lastly jugular venous bulb oxygen saturation, neurological deficits, and mortality rate. The patients who received high dose aprotinin showed a significantly less intraoperative and early postoperative blood loss than control group patients, with significant reduction of postoperative ventilator support, need for inotropes and total ICU stay. The early postoperative period showed that high dose aprotinin group had marked improvement in the echocardiographic measurements. This was maintained throughout the follow up period. Significant cerebral desaturation was recorded in control group in the early postoperative period. The neurological deficits and hospital mortality were significantly higher in control group than aprotinin group. We concluded that in elective valve replacement surgery, high dose aprotinin administration provides better intraoperative myocardial and cerebral protection reflected in better postoperative cardiac and cerebral functional recovery

Three modalitis of postoperative pain management for transthoracic endoscopic sympathectomy

Transthoracic endoscopic sympathectomy [TES] has been already a standard method for the treatment of primary hyperhydrosis. Postoperative pain is a problem that usually encountered during TES. Although the surgical procedure is simple and short, the pain is usually severe [Failor and Capell, 2003]. This study was performed in 57 patients of both sex, aged 11-48 years old, divided randomly into three groups. All patients were premedicated with intravenous midazolam 0.02mg/kg. Anesthesia was induced with sleeping dose of thiopentone sodium, lug/kg fentanyl and atracurium 0.5mg/kg to facilitate endotracheal intubation. We evaluated the effect of three methods of management of postoperative pain. I [n=20] was treated by IV pethidine starting with 1mg/kg pethidine with top up doses of pethidine when needed. Group II [n=19] was treated by intrapleural plain bupivacaine 0.25% 1mg/kg. Group III [n=18] was treated by local infiltration of 0,5% plain bupivacaine 2 ml at both sides of cut ends of the sympathetic chain. In conclusion, we found that the systemic use of pethidine was least satisfactory and the intrapleural of injection bupivacaine was the best. However the time to discharge from hospital was the same for all groups