effect of aminophylline versus milrinone on ischemia-reperfusion myocardial injury during open heart surgery

Cardioplegic arrest during cardiopulmonary bypass [CPB] is essential for the majority of cardiac surgical procedures; Cardioplegia protects the myocardium by providing continuous or intermittent oxygen while simultaneously reducing cardiomyocyte oxygen demand, but it does not inherently increase the ischemic-reperfusion injury tolerance of the cardiomyocytes. Aminophylline and milrinone by their phosphodiesterase inhibitor and anti-inflammatory activity may decrease this type of injury. This study has been designed to compare between the protective effect of aminophylline and milrinone over the heart during open heart surgery for valve replacement with CPB. Sixty adult patients undergoing elective single valve replacement were randomized to receive aminophylline 5 mg/kg [n=20], milrinone 50 microg/kg [n=20], or normal saline as control group [n=20] through intravenous infusion 10 minutes before the aortic cross-clamping. The cardiac troponin I, inotrope score, duration of mechanical ventilation, and length of ICU stay and other hemodynamic variables were measured and recorded. There were no differences between the three groups with regard to clinical variables. Cardiac troponin I raised significantly after declamping in the three groups, however it was significantly lower in aminophylline and milrinone group compared to control group immediately after CPB and after 8 hours with no significant differences between aminophylline and milrinone group, inotrope score duration of mechanical ventilation and length of ICU stay showed no significant differences between the three groups. Administration of aminophylline or milrinone reduces the subclinical myocardial injury with no difference between both agents and with no effect on the hemodynamic parameters or short term clinical outcome in patients undergoing single valve replacement with CPB

effect of aminophylline versus milrinone on ischemia-reperfusion myocardial injury during open heart surgery

Cardioplegic arrest during cardiopulmonary bypass [CPB] is essential for the majority of cardiac surgical procedures; Cardioplegia protects the myocardium by providing continuous or intermittent oxygen while simultaneously reducing cardiomyocyte oxygen demand, but it does not inherently increase the ischemic-reperfusion injury tolerance of the cardiomyocytes. Aminophylline and milrinone by their phosphodiesterase inhibitor and anti-inflammatory activity may decrease this type of injury. This study has been designed to compare between the protective effect of aminophylline and milrinone during open heart surgery for valve replacement with CPB. Sixty adult patients undergoing elective single valve replacement were randomized to receive aminophylline 5 mg/kg [n=20], milrinone 50 -microg/kg [n=20], or normal saline as control group [n=20] through intravenous infusion 10 minutes before the aortic cross-clamping. The cardiac troponin I, inotrope score, duration of mechanical ventilation, and length of ICU stay and other hemodynamic variables were measured and recorded. There were no differences between the three groups with regard to clinical variables. Cardiac troponin I raised significantly after declamping in the three groups, however it was significantly lower in aminophylline and milrinone group compared to control group immediately after CBP and after 8 hours with no significant differences between aminophylline and milrinone group, inotrope score duration of mechanical ventilation and length of ICU stay showed no significant differences between the three groups. Administration of aminophylline or milrinone reduces the subclinical myocardial injury with no difference between both agents and with no effect on the hemodynamic parameters or short term clinical outcome in patients undergoing single valve replacement with CPB

effects of pretreatment with atracurium on serum electrolytes and CPK enzyme changes of succinylcholine

The effects of different preteatment doses of atracurium on serum electrolyte [K+, Na+, Ca++] and creatine phosphokinase enzyme [CPK] were studied in 40 patients divided into 4 groups [n = 10]. Group I [control] received normal saline. Groups II, III and IV received atracurium pretreatment in a dose of 0.04, 0.05, 0.06 mg/kg, respectively. The hyperkalemic response following succinylcholine was ameliorated with atracurium preteatment. The percentage of serum K+ rise was 1.42%, 2.57%, 4.6%, and 9.39% in groups I, II, III and IV, respectively. Atracurium preteatment did not only abolish the hypocalcemia following SCh [6.33% and 0.44% in groups I and II, respectively], but it even led to a minimal increase in serum Ca++ [0.86% and 1.4% in groups III and IV, respectively]. The rise in serum SCh administration was reduced markedly with atracurium pretreatment [133.94%, 50.28%, 15.17% and 12.08% in groups I, II, III and IV, respectively. Serum Na+ changes did not show obvious difference between the control group and atracurium pretreatment groups. In conclusion, pretreatment with atracurium reduced markedly, in a dose dependent manner, the serum electrolytes [K+, Na+, Ca++], and CPK enzyme changes of succinylcholine

Combined spinal Epidural anesthesia for anorectal surgery

This study presented the experience with a new combined spinal epidural system through which regional anesthesia was performed in 40 male patients undergoing anorectal surgery [hemorrhoids and fissure or perianal fistula]. The technique consists of two needles, a 16 G Touhy needle with a hole in its distal curve [backeys] and 26 G spinal needle which is passed through the back eye before being introduced into the subarachinoid space. The study found the back eye combined spinal-epidural system effective and simple to use. The Touhy needles with its back eye did not impede insertion of the epidural catheter and was suitable introducer for the 26 G spinal needle

neuromuscular effects of atracurium pretreatment and its effect on the neuromuscular blocking action of succinylcholine

Pretreatment with atracurium was studied in one hundred and twenty patients divided into four groups [n = 30 in each]. The first group [control] received normal saline [2 ml] as placebo, the second, third and fourth groups received atracurium in a dose of 0.04 mg/kg, 0.05 mg/kg and 0.06 mg/kg, respectively. Saline or atracurium was given three minutes before succinylcholine. Atracurium pretreatment in a small dose [0.04 mg/kg] did not affect the control twitch response. With atracurium 0.05 mg/kg, the twitch response depression was small and insignificant [1.33% +/- 0.79]. A greater effect was observed on increasing the dose of atracurium [0.06 mg/kg] which produced a highly significant decrease in twitch response [12.63% +/- 1.93]. Pretreated groups showed a significant prolongation in onset time of Sch. Such effect being greater and more significant on increasing the pretreatment dose. The mean time to abolition of twitch was 27.5 + 0.58, 30.33 +/- 0.68, 43.5 +/- 1.36 and 49.67 +/- 1.76 seconds in the first, second, third and fourth groups, respectively. All pretreated patients showed a significant decrease in duration of action of Sch. There was a highly significant difference in the intubating conditions between the control group [best intubating conditions] and the pretreated group