evaluation of perioperative safety of local anesthesia with lidocaine containing epinephrine in patients with ischemic heart disease

The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study. All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2 +/- 10.4, 74.8 +/- 14.4 kg and 164.5 +/- 8 cm respectively. Twelve patients [37.5%] were diagnosed with systemic hypertension and 10 patients with diabetes [31.2%]. The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable [P=0.044]. The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure. These patients experienced a more profound anesthesia with hemodynamic stability and without myocardial ischemic changes.

hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in patients with low myocardial ejection fraction

The aim of this study was to assess the effect of spinal block with low dose of bupivacaine and sufentanil on patients with low cardiac output who underwent lower limb surgery. Fifteen patients who had ejection fraction less than 40% [group 1] were compared with 65 cases with ejection fraction more than 40% [group 2] in our study. Our subjects underwent spinal block with 7.5 mg hyperbaric bupivacaine 0.5% and 5 micro g sufentanil. We recorded early events such as hypotension, bradycardia, vasopressor need and ST segment change in our cases. The average mean arterial pressure decreased 13% [110 mmHg to 95.7 mmHg] in group 1 and 20% [160 mmHg to 128 mmHg] in group 2 [P<0.001]. Hypotension due to spinal anesthesia was observed in none of our subjects in both groups and none of our cases need to vasopressor support. All patients remained alert, and no ST segment changes were observed in two groups. In our study none of subjects complained of pain intraoperatively. The subjects were without complaints during the spinal anesthetic in both groups. Spinal block with low dose local anesthetic and sufentanil was a safe and effective method for lower limb surgery in patients with low ejection fraction

Effect of prophylactic low dose of methylprednisolone on postoperative new atrial fibrillation and early complications in patients with severe LV dysfunction undergoing elective off-pump coronary artery bypass surgery

Atrial fibrillation [AF] is the most common arrhythmia after cardiothoracic surgery. AF following coronary artery bypass graft [CABG] is associated with an increase in morbidity, mortality, hemodynamic instability, thromboembolic events, severity of heart failure and ICU and hospital stay. Corticosteroids have a variety of beneficial effects on recovery after elective surgery. This study was designed to test the hypothesis that low dose of Methylprednisolone [MP] can affect post-CABG AF and early complications in patients with severe left ventricle dysfunction who underwent elective off-pump coronary artery bypass. A total of 120 patients with LV dysfunction undergoing elective off- pump CABG randomly received either MP or placebo. Diabetic patients and those who were receiving corticosteroids were excluded. The MP group received 5mg/kg of MP intravenously after induction of anesthesia and the placebo group received an equal volume of normal saline. We evaluated Post-CABG variables including incidence, duration and frequency of AF recurrence and early morbidity such as bleeding, infection, vomiting, renal and respiratory dysfunctions, ICU or hospital stay and early mortality. The mean age of patients was 62.11 +/- 12.34 years with the 2.4 male to female ratio. AF occurred in 23 [19.2%] patients. No significant difference in the incidence of new AF was found between the placebo [21.7%] and MP group [16.7%] [P=0.47]. MP did not affect postoperative bleeding, infection, vomiting, renal and respiratory dysfunction and mortality; however, MP significantly reduced ICU and hospital length of stay. MP did not affect the incidence, duration and frequency of AF recurrence in patients with severe LV dysfunction undergoing off-pump CABG. However, MP could reduce ICU and hospital stay significantly in these patients

Relation between preoperative mild increased in serum creatinine level and early outcomes after coronary artery bypass grafting

This study evaluates the effect of preoperative increased level of serum creatinine [Cr] on early outcomes after coronary artery bypass graft surgery [CABG]. 1140 patients who underwent CABG in our center were studied. Patients with Cr >2.25 mg/dl or preoperative dialysis and who had off-pump operations were excluded. Group 1 consisted of 892 patients with normal Cr [0.5-1.2 mg/dl] and group 2 consisted of 248 [21.8%] patients with mild increased level of serum Cr [1.3-2.2 mg/dl]. Patients in group 1 were younger than group 2. There were more patients with hypertension in group 2, but there were not statistically significant difference between two groups in terms of the frequency of diabetes, smoking, cerebrovascular disease and New York Heart Association [NYHA] class. Left ventricular ejection fraction [LVEF] was lower in group 2. Cardiopulmonary bypass time [CPB] was longer in group 2. Early mortality was 3.2% in group 1 and 8.4% in group 2 [P<0.001]. Prolonged ICU stay, low cardiac output, prolonged mechanical ventilation, postoperative atrial fibrillation, postoperative re-exploration and sepsis were more frequent in group 2. Mild increase in serum Cr level preoperatively is a marker of increased early mortality and outcome after CABG

Angioplasty and stenting of basilar artery with short term results

Symptomatic basilar artery stenosis has a poor prognosis. Surgical bypasses are technically demanding and of no proven benefit. A new generation of intravascular stents that are flexible enough to navigate the tortuosities of the vertebral artery may provide a new therapeutic approach. Our two cases, 57 and 52 year-old men experienced a vertebrobasilar ischemia with repeat vertigo and falls. Magnetic resonance angiography from vertebrobasilar arteries revealed severe middle basilar artery stenosis in case 1 and Transcranial Doppler [TCD] shown severe vertebrobasilar artery stenosis in the other one. The patients underwent uncomplicated angioplasty and stenting of the basilar arteries, with excellent angiographie results. During follow-up [12 months in case I and 8 months in case 2], the patients were well and free of symptoms. The new flexible intravascular stents provides a novel therapeutic approach for patients with basilar artery stenosis

Pressure measurements during cardiac surgery-internal jugular vs central venous

Although central venous pressure [CVP] is a valuable guide and measurement during cardiac surgery anesthesia, there are many occasions however, when the time consumed in inserting a peripheral catheter, defeats the actual purpose. The purpose of this study was to compare central venous pressure and internal jugular veins pressure, and to see whether the jugular veins pressures were a reliable guide to central venous pressure monitoring. Simultaneous measurements of the internal jugular [both left and right side] and right atrial venous pressures were made in 70 patients undergoing cardiac surgery both at times when the chests were closed and when they were opened. After induction of anesthesia, a 16 gauge catheter was inserted into the internal jugular vein on each side of the neck, and another catheter was passed into the right atrium. Then the CVP and internal jugular veins were measured six times during anesthesia and postoperatively. A good correlation was found between pressures of right and left internal jugular veins with that of CVP both at times when the chests were closed and when they were opened. It is concluded that left and right internal jugular vein pressures are reliable guides to central venous pressures during anesthesia in cardiac surgery