ABSTRACT
Up to 12% of patients undergoing coronary artery bypass graft have pulmonary complications. Smoking can cause a six-time increase in pulmonary complication after major surgery. The most common pulmonary changes after CABG are decrease in FRC, VC and atelectasis. In this study, the effect of oral N-acetyl-cystein in reduction of severity of hypoxemia and atelectasis in current smokers who smoked more than 10 packs/year and had undergone CABG was evaluated. In the study, 54 current smoker patients were selected randomly and allocated to two drug and placebo groups. In the study group, 300mg N-acetyl-cystein [ACC long] containing vitamin C was prescribed two times a day from 4 days before operation up to 3 days after surgery and in control group, effervescent vitamin C tablet was prescribed as placebo. Patients with body mass index more than 35, NYHA class IV, those who needed intra aortic balloon pump and those who needed reoperation due to bleeding were excluded from the study. In all patients, spirometry was done in the preoperative visit and FEV1/FVC was determined. Induction and maintenance of anesthesia was similar in all patients. Arterial blood gas samples were obtained immediately after anesthesia induction and 4 to 6 hours after extubation. Chest X ray was taken before, 6 to 10 hours after extubation and 3 rd postoperative day. Severity of atelectasis was also measured. Quantitative and qualitative data was analyzed by ANOVA and Chi-square tests, respectively. P value <0.05 was considered as statistically significant. Both groups were similar with respect to demographic data including ejection fraction, NYHA class, FEV1/FVC, cigarette smoking and Lima harvesting. The ratio of arterial oxygen pressure to fraction of inspiratory oxygen Pao2/FIo2 was not significantly different after induction but this difference was strongly significant [P value<0.005] after extubation. Duration of mechanical ventilation was significantly shorter in patients who had N-acetyl-cystein, but duration of ICU stay was similar. Linear and segmental atelectasis was significantly less in the study group. N-acetyl-cystein can improve oxygenation and ventilatory parameters in pathological lungs, but further studies with different doses and different situations are needed
Subject(s)
Humans , Treatment Outcome , Coronary Artery Bypass , Smoking/adverse effects , Lung/pathologyABSTRACT
Doppler ultrasonography [DUS] is the most preferable method for screening of carotid artery disease in patients undergoing CABG. The purpose of this study was to investigate the frequency of carotid artery disease and determine the relation between known risk factors of atherosclerosis and rate of carotid artery narrowing in order to identify high-risk groups among patients scheduled for isolated elective coronary artery bypass grafting [CABG] procedures. Two-hundred ninety-one patients [222 males and 69 females] undergoing isolated coronary artery bypass grafting were preoperatively evaluated by carotid artery Doppler ultrasomography and the morphology of carotid artery was determined. Age, sex, cervical bruit, diabetes mellitus [DM], hypertension, hyperlipidemia, smoking, history of cerebrovascular event [CVE] and coronary angiographic findings were investigated to define the high-risk group for carotid artery disease. Data were analyzed by SPSS software and P<0.05 was considered significant. Patients ages ranged from 35 to 95 years [mean of 57.6 +/- 10.4 years]. Eleven patients [3.8%] had history of cerebrovascular events [CVE]. 13 patients [4.5%] had cervical bruit. Left main coronary artery involvement was observed in 19 patients [6.4%]. In 127 patients [43.6%] carotid scanning was normal, fifty nine patients [20.4%] had less than 50% stenosis [mild stenosis], ninty seven patiens [33.3%] had 50-70% stenosis [moderate stenosis], and eight patiens [2.7%] had more than 75% stenosis [severe stenosis]. Calcified plaque was observed in 109 patients [37.5%]. Previous cerebral ischemic events [P=0.297], diabetes mellitus [P=0.467], hypertension [P=0.110], hyperlipidemia [P=0.08], smoking [P=0.401], age >60 years [P=0.84], female sex [P=0.730], and left main coronary disease [P=0.390] were not identified as high-risk factors for carotid artery stenosis greater than 50%. But positive MI history [P=0.025], and cervical bruit [P=0.002], were significantly related to 50% carotid artery stenosis. Based on the results of this study, we can not suggest DUS as a routine screening method in all patients undergoing CABG, except for patients with history of MI and cervical bruit. Another important finding was that 56.4% of patients posted for CABG had different degrees of carotid artery stenosis which requires a long term CVA prophylaxis program
ABSTRACT
Atrial fibrillation is the most common arrhythmia following CABG. This complication can cause palpitation, significant hemodynamic instability and thromboembolic events. This prospective randomized study evaluate prophylactic effects of propranolol low dose amiodarone and high dose amiodarone in patients candidate for CABG. Three hundred consecutive patients undergoing elective CABG were randomly categorized into three groups [each group contains 100 patients]. Patients in group1 [control group] received 10mg/TDS propranolol per oral [P.o], preoperatively. Patients in group 2 received 10mg propranolol TDS, P.o plus 350mg/24h amiodarone. Patients in group 3 received 10mg propranolol TDS P.o plus 1000mg/24h amiodarone 24 hours before operation. Atrial fibrillation occurred in 12 patients [12%] in group 1, four patients [4%] in group 2 and 10 patients [10%] [P=0.035] in group 3. AF occurred in 10.36% of men and 3.84% of women. There was no AF in off- pump groups and 9.73% in on-pump groups This study suggested the combination of propranolol plus low dose amiodarone for post CABG atrial fibrillation prophylaxy