ABSTRACT
Cardiac surgery involving cardiopulmonary bypass (CPB) is known to be associated with many major complications. A rare complication following a re-do mitral valve replacement (MVR) which turned out to be fatal is discussed.
ABSTRACT
Clonidine, a preferential alpha 2 adrenergic agonist has been reported to have perioperative effects including reduction of anaesthetic requirements, improving haemodynamic stability and providing analgesia, however its clinical usefulness in cardiac surgery is not widely studied. Thirty-four consecutive patients undergoing coronary artery bypass graft surgery (CABG) were preoperatively administered clonidine and studied for its possible desirable effects. Seventeen patients (Gr B) received 2 microg/kg clonidine orally the previous night and again one hour prior to surgery. Seventeen patients did not receive the drug and served as control (Gr A). Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), requirement of isoflurane, requirement of nitroglycerin, sedation score, extubation score and urine output were studied throughout the perioperative period. HR was observed to be lower at all time points in the clonidine group though the difference between groups was not statistically significant (p > 0.1). MAP was higher at all time points and significantly so after intubaton in the control group (P < 0.01). Patients receiving clonidine required significantly less isoflurane and nitroglycerin (P < 0.05). sedation score was significantly higher in the clonidine group. Other aspects studied were comparable in both groups. At the doses described in this study, clonidine seems to be a safe useful adjunct to anaesthesia for CABG surgery.
ABSTRACT
The inflammatory response to major surgery, especially cardiac surgery using cardiopulmonary bypass (CPB) is now a well established entity. A whole body inflammatory response can lead to severe organ dysfunction, postoperative bleeding disorders, respiratory distress syndrome and sometimes death. There is, however, controversy over various methods and their efficacy towards suppression of this response. We studied forty consecutive patients undergoing coronary artery bypass grafting (CABG) using CPB. Ten patients in group A served as control while ten patients in group B received piroxicam, a non steroidal anti-inflammatory drug (NSAID). Ten patients in group C received aprotinin, a kallikrein inhibitor and ten patients in group D underwent haemofiltration during CPB. Inflammatory response by way of increase in total white blood cell (WBC) count (p<0.007), decrease in lymphocyte count (p<0.005), increase in C-reactive protein (CRP, p <0.005) was observed in all four groups at 24 hour after CPB. A decrease in complement C3 and C4 (p<0.01) was observed in groups A and C at 24 hours after CPB. The response observed was not severe enough to cause any organ damage in any group. None of the methods studied could effectively suppress the inflammatory response to CPB but the response was altered in some way by each method.