[ comparison of insulin and metformin effects on blood pH, bicarbonate, potassium and magnesium of the non-diabetic patients undergoing coronary artery bypass surgery]

Introduction: There is controversy regarding the effects of insulin and metformin usage in postoperative hyperglycemia after coronary artery bypass graft surgery. The purpose of this study is to compare the effect of insulin and metformin on blood acidity, bicarbonate, potassium and magnesium in nondiabetic patients undergoing coronary artery bypass graft surgery

Materials and Methods: In a clinical trial, 56 nondiabetic patients who underwent coronary artery bypass graft surgery in the Kowsar Hospital in Semnan and suffered post-operative hyperglycemia, randomly received insulin and metformin. Levels of blood glucose, acidity, bicarbonate, potassium and magnesium were measured and recorded for both groups before and after surgery. Data was analyzed [significant level 0.05] using Chi-square, Mann-Whitney and Friedman tests

Results: At the time of admission of patients in the ICU, means of arterial blood acidity, bicarbonate, potassium and magnesium were 7.37+/-0.07, 21.8+/-2.5 mEq/l, 4.3+/-0.5 mmol/l, and +/- 2.1+/-0.3 mg/dl respectively in the insulin group and in the metformin group these values were 7.40+/-0.05, 22.2+/-2.8 mEq/l, 4.1+/-0.5 mmol/l, and 2.1+/-0.4 mg/dl respectively. There was no significant difference between the means of potassium, magnesium and bicarbonate in the two groups at different times [P>0.05]. However, there was a significant difference between the mean values of arterial blood acidity 72 hours after admission in ICU in the two groups of insulin [7.41+/-0.03] and metformin [7.39+/-0.04] [P=0.047]. However mean PH of the blood remained normal

Conclusion: In nondiabetic patients who have hyperglycemia following coronary artery bypass graft surgery, the use of metformin and insulin does not affect bicarbonate, potassium and magnesium of blood. However, overtime the use of metformin may gradually increases the pH of the blood. Therefore, it is recommended that metformin should be used in patients with blood pH control

The Role of Nasopharyngeal Temperature Monitoring in detection of a Malpositioned Superior Vena Cava Cannula in an Emergency Coronary Artery Bypass in a Patient With Ventricular Septal Defect

55 year-old woman was admitted to the CCU ward of our university hospital due to typical chest pain. The patient received supportive care and was transferred to the operating room for an emergency repair of the ventricular septal defect [VSD] and myocardial revascularization. The surgical team was notified regarding the tolerance to cooling detected by the temperature monitoring and also, the congestion of eye and blanching of forehead. After a few maneuvers, the cannula was repositioned. In a few seconds, the forehead was cooled, while the airlocking episodes were lifted completely and the blanching and chemosis in the face and eyes all resolved. The septal defect was approached through the left ventricle; a 15 in 20 mm foramen, due to the ischemic rupture of the superior portion of the anteroseptal wall, was repaired with a patch of hemoshield. The incision over the LV was then repaired with 2 parallel bands of felt. The patient was operated on and transferred to the intensive care unit