Comparison of Bispectra Index [BIS] and AEPEX monitoring systems in coronary bypass surgery

Spontaneous recall of events during general anesthesia is called awareness. Awareness during the operation is common in coronary artery bypass grafting [CABG], especially in urgent cases and in patients with unstable hemodynamic condition before the operation. A standard method for the measurement of the depth of anesthesia [DoA] has not yet been introduced. A variety of techniques have been used for monitoring DoA like electroencephalography [EEG], monitoring muscle movement in the distal esophagus, and new methods of auditory evoked potentials [AEPs] and bispectra index [BIS]. Recently, a more sensitive method, called aepEX which is a modified form of AEPs, has been used for the monitoring and controlling of DoA. This study was designed to compare the sensitivity of the aepEX system with the BIS system for DoA monitoring using current clinical and paraclinical methods. In this prospective, controlled trial, 36 patients who were candidates for CABG were enrolled in the study. All the patients underwent a standard induction method for anesthesia with remifentanil, atracurium, and midazolam. Before anesthesia, both aepEX and BIS monitoring systems were controlled simultaneously in each patient. These systems had no effect on each other. Finally, all data about DoA, clinical data of awareness including BP, tear secretion, hemodynamic information, and demographic characteristics were collected and analyzed. This study compared the monitoring techniques for DoA, BIS, and aepEX. Results of this study were diagrams for the comparison of BIS and aepEX in different stages during CABG. According to these diagrams, essential analysis could be done about the quality of these two systems in DoA. Our data demonstrated that the aepEX monitoring system had greater sensitivity in all the stages of anesthesia compared to the BIS system

efficacy of tramadol used with ketamine or morphine in pain control after coronary artery bypass graft surgery

Sufficient analgesia after coronary artery bypass graft surgery [CABG] is important to prevent postoperative complications. One of these analgesic techniques is patient controlled analgesia [PCA], in which the patient has self-controlled administration of anesthetics. The purpose of this study was to evaluate the analgesic effect and side effects of tramadol used with ketamine or morphine for post-CABG surgery analgesia. In this prospective, controlled randomized study, we selected 150 patients who were candidates for CABG. The inclusion criteria were adult patients aged 30-60 with coronary artery disease, candidates for CABG, elective surgery, surgery using cardiopulmonary bypass, and ASA II and III. The patients with uncontrolled and significant underlying diseases [diabetes, liver and kidney disease and clotting disorders], excessive obesity and weight over 115 kg, and non-consenting patients were excluded. The patients were divided into three groups of 50 each. At the end of surgery, all the patients were transferred to the post-surgical intensive care unit, where they were extubated. PCA was commenced when the patients were able to communicate. The first group was provided with 100mg of tramadol with normal saline, the second group 50mg of tramadol plus 20mg of morphine, and the third group 50mg of tramadol plus 50mg of ketamine. During the use of the PCA pump, the patients were observed for respiratory depression [respiratory rate and SPO[2], PaCO[2] every two hours during the first 8 hours and then every 4 hours]. The severity of pain was evaluated with the visual analog scale [VAS] method, where zero was no pain and ten was severe pain. The VAS results were recorded 1, 3, 6, 12, 18, 24, 36, and 48 hours after awareness and extubation and recording the base VAS of the patients. The average respiratory rate was 14 in all the three groups and respiratory depression was not seen in any of them. At the third hour, the VAS was similar in all the groups [p value<0.05]. The decrease in VAS at 6, 12, and 18 hours was significant and the minimum VAS was seen in the second group [tramadol + morphine]. PCA is a safe and appropriate method for analgesia after CABG. It seems that the combination of tramadol plus morphine can be an effective solution for analgesia after CABG with fewer respiratory complications than other combinations

Intraoperative magnesium sulfate can reduce narcotic requirement after coronary bypass surgery

Narcotics are the most common drugs used after cardiac surgery and their side effects, including respiratory depression, hemodynamic instability, nausea and vomiting, and itching are dose dependent. Magnesium is both an N Methyl D Aspartate [NMDA]-receptor and a calcium-receptor antagonist and can modify the important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on the pain score and reducing narcotic requirement in coronary artery bypass grafting surgery [CABG] patients. This randomized, double blinded, placebo-controlled trial recruited 185 patients [105 male and 80 female] undergoing elective CABG. Mean age was 58 +/- 11 years [range 24 to 79 years]. The patients were divided into two groups randomly: Group I received magnesium sulfate as an IV infusion [80 mg/kg] during a one-hour period post induction and Group 2 received the same volume of normal saline as a placebo. During the postoperative period, the patients' morphine requirement and pain score [visual analogue seale scaled as 0 to 10, 0=no pain and 10= worst possible pain] at 6[th], 12[th], 18[th], and 24[th] hours were recorded and documented. There were no significant differences between the two groups with respect to the baseline data. In the magnesium sulfate group, only 30 [32%] patients needed morphine sulfate, whereas 75 [83%] patients in the placebo group required some doses of morphine sulfate [p value < 0.001]. The odds ratio showed that magnesium sulfate could strongly prevent the need for opioid analgesics for pain control. The intraoperative use of magnesium sulfate can reduce the need for opioids post CABG

12-year experience with primary cardiac tumors

We report our experience with 117 patients with primary cardiac tumors who underwent surgery at our institute [a referral center] between March 1995 and February 2006.The patients comprised 47 men and 70 women with a mean age of 44.97 years [range: 2.5- 81 years]. The predominant symptom was dyspnea on exertion and palpitation. In all the patients, echocardiography was the main diagnostic tool, but magnetic resonance imaging [MRI] and CT scan and coronary angiography were also performed if indicated. Most of the tumors were found in the left atrium [LA] [77.77%], but the other chambers were also involved with lesser prevalence [right atrium: 7.5%, left ventricle: 5.1%, and right ventricle: 2.5%]. Involvement of multiple chambers was found in 8 [6.8%] patients.All the patients survived the surgical procedure and were discharged from hospital. Follow-up ranged from 1-10 years [mean: 2.4 years]. The most prevalent tumor was myxoma [104 cases], followed by sarcoma [4 cases] and fibroma [2 cases]. Four patients had secondary [metastatic] cardiac tumors [two Hodgkin lymphoma, one renal cell carcinoma, and one osteosarcoma] and were consequently excluded from the study