ABSTRACT
The objective of this clinical trial is to study the effectiveness of administering recombinant activated factor VII [rFVIIa] in reducing the amount of bleeding and the need for homologous blood and products transfusion in cardiac surgical coronary revascularization procedures done under cardiopulmonary bypass [CPB]. In a randomized controlled prospective observational study, 30 patients were scheduled for elective cardiac revascularization under CPB. Patients were randomly allocated into two groups. In Group I [Control group], no rFVIIa was administered following CPB. In Group II [Study group], a dose of 90 ug/Kg of rFVIIa was administered following weaning off CPB. The total amount of chest tube drain during the 1[st] 24 h following surgery was recorded as well as the qualitative and quantitative assessments of homologous blood and products transfusion. Serial analysis of hematological parameters including hemoglobin level and coagulation test in a definite data points was done. T0=baseline readings prior to CPB, T1=off CPB after protamine administration and before administration of the study drug, T2=on Cardiac Intensive Care Unit [CICU] admission, T3=12 h post-CICU admission, and T4=24 h post-CICU admission. Considering the total chest tube drainage, mean values showed statistically significant results with a P value of 0.001. Homologous blood and products transfusion were statistically lower in the study group. Regarding the mean values for hematological assessment, results showed statistically lower International Normalized Ratio values at CICU admission and 12 h post-CICU admission with a P value of 0.018 and 0.004, respectively. Also, the Partial Thromboplastin Time mean values were statistically lower at same timings with estimated P values of 0.04 and 0.001, respectively. It is concluded that the prophylactic use of rFVIIa in patients undergoing coronary revascularization surgery under the management of CPB had a remarkable significant results on both the amount of post-operative bleeding and the amount of blood and products transfusion
Subject(s)
Humans , Female , Male , Factor VIIa , Coronary Artery BypassABSTRACT
This study was designed to determine the efficacy of dexmedetomidine [a highly selective alpha-2 agonist] in achieving fast tracking and improved postoperative pain control in off-pump coronary artery bypass [OPCAB] patients. Thirty patients scheduled for elective OPCAB were prospectively randomized into two groups: Group I [15 patients] started dexmedetomidine at 0.5 ug/kg/hour after the induction of anesthesia; this was reduced to 0.3 ug/kg/hour on admission in the cardiac intensive care unit and continued for 12 hours post extubation. Group II [15 patients] received a similar volume and infusion rate of normal saline. Visual analog scale [VAS] of 10-100 was explained thoroughly to the patients during the preoperative visit. Postoperative pain was managed with morphine. The total dose of morphine was recorded. Extubation time and VAS was recorded every two hours for 12 hours post extubation. Extubation time in group I was 72 +/- 8 minutes and 186 +/- 22 minutes in group II. Mean total use of narcotics in group II was 23.5 +/- 20.7 mg compared to 11.4 +/- 6.3 mg in group I. VAS median figures were lower at all data points in group I than in group II. Dexmedetomidine showed an effective and safe profile as an anesthetic adjunct in OPCAB, achieving fast tracking of patients and higher quality of pain control with a lower consumption of narcotics
Subject(s)
Humans , Female , Male , Pain/therapy , Coronary Artery Bypass, Off-Pump , Pain, Postoperative , AnesthesiaABSTRACT
To examine the validity of central venous oxygen saturation [ScvO 2] as a numerical substitution of mixed venous oxygen saturation [SvO 2] in adult patients undergoing normothermic on pump beating coronary artery bypass grafting [CABG]. Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter [PAC] as a part of our routine intraoperative monitoring. SvO 2 and ScvO 2 were simultaneously measured 15 minutes [T1] and 30 minutes [T2] after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass [T3 and T4], and 15 and 30 minutes after admission to intensive care unit [T5 and T6]. ScvO 2 showed higher reading than SvO 2 all through our study. Our results showed perfect positive statistically significant correlation between SvO 2 and ScvO 2 at all data points. Individual mean of difference [MOD] between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. In on pump beating CABG patients; ScvO 2 and SvO 2 are not interchangeable numerically. ScvO 2 is useful in the meaning of trend; our data suggest that ScvO 2 is equivalent to SvO 2, only in the course of clinical decisions as long as absolute values are not required