[ cardioprotective effects of N acetylcysteine as an additive to the blood cardioplegia during coronary artery bypass grafting]

During coronary artery bypass graft [CABG] surgery with cardiopulmonary bypass [CPB], the role of cardioplegic solution which results in cardiac arrest, is critical. This study was planned to evaluate the clinical impacts of N acetylcysteine [NAC] enriched cold-blood cardioplegia on early reperfusion injury in patients with ischaemic heart disease undergoing CABG. In a randomized double blind clinical trial, seventy patients undergoing elective CABG surgery with CPB were studied. They all underwent similar methods of preoperative medication, anaesthesia and cardiac surgery. Patients were randomly divided into the case group [cardioplegia plus 50 mg/kg NAC] and the control group [cardioplegia with the equal volume of normal saline]. The incidence of arrhythmias, usage of DC-shock, pacemaker and inotropic agents during and twenty four hours after surgery, EF five days after surgery and ICU staying and hospitalization periods in the two groups were compared. There were no statistically significant differences between the two groups according to demographic features, EF before surgery, CPB or aorta clamping times, intraoperative DC shock and pacemaker requirements and postoperative inotropic necessity [p >0.05]. Two groups showed significant differences in regard to the incidence of arrhythmias [5.7% vs. 22.9%], the inotropic requirement [14.3% vs. 34.3%] during surgery, EF five days after surgery [51.4% vs. 45%] and the mean EF changes postoperatively in comparison with the preoperative period [0.88 vs. -2.28] [p <0.05]. Addition of N-acetylcysteine to cardioplegic solution can reduce some of the clinical complications during and after surgery and has positive effects on the postoperative ejection fraction

Effects of preoperative sub-tenon block on intra- and post-operative complications in retinal detachment surgery

To evaluate the efficacy of sub-tenon block [preemptive analgesia] following general anesthesia and before the beginning of scleral buckling and cryopexy in retinal detachment [RD] surgery on decreasing intra- and post-operative complications. Sixty eight patients scheduled for RD surgical repair with ASA [American Society of Anesthesiologists] class I or II were enrolled in this clinical trial. The patients were randomly divided into two groups. Both groups underwent general anesthesia [GA], but one group received sub-tenon block as preemptive analgesia following induction of general anesthesia [treatment group]. Intra- and post-operative [up to 24 hours] incidence of oculocardiac reflex [OCR], mean blood pressure [BP], heart rate [HR], post-operative ischemic heart disease [IHD] changes, nausea and vomiting [PONV], delirium, total analgesic consumption, severity of ocular pain, frequency of analgesic requirement, and duration of hospitalization were compared between the two groups. There was no statistically significant difference between the two groups regarding age, sex, and preoperative blood pressure [BP] and heart rate. Mean BP of patients in the treatment group and the control group was 126.6/74.8 and 126.4/74.4 mmHg, preoperatively [P>0.2] and 12 6.4/76.4 and 134.6/74.4 mmHg, postoperatively [P=0.01]. Pain complaint of any degree was more frequent in the control group such that 38% in the recovery room and 25% 6 hours after surgery complained of severe pain compared to none in the treatment group. [P= 0.001] Incidence of delirium in the recovery room was 3.7% in the treatment group vs. 24.1% in the control group. [P= 0.001] Mean duration of hospitalization after surgery was 26.6 +/- 1.5 hr in the treatment group and 34.0 +/- 1.5 hr in the control group. [P<0.01]. Sub-tenon block following induction of CA for RD surgery reduces intra- and post-operative complications effectively, therefore it is recommended for routine ophthalmologic procedures

Septic thrombophlebitis of the cephalic vein caused by a peripherally inserted venous catheter

Septic thrombophlebitis of a vein is a rare but life-threatening complication of an intravascular [IV] catheter placed percutaneously in the veins. Most published clinical experiences with IV catheters, mainly in the outpatient settings, have reported very low rates of catheter-related bloodstream infection compared to rates with central venous catheters placed in a subclavian or internal jugular vein. Most of the complications reported with IV catheters have been non-infectious, particularly sterile phlebitis or thrombosis. We report a case of cephalic vein suppurative thrombophlebitis from an intravascular catheter and offer guidelines for diagnosis and management of this complication