A Study of the Effectiveness of Lidocaine to Treat Severe Pulmonary Vascular Constriction induced by Protamine

Background: Protamine neutralises heparin a?er separa?on from cardiopulmonary bypass. This study aimed to evaluate the effects of lidocaine on protamine induced pulmonary vascular constric?on in paediatric cardiothoracic surgery. Methods: This was a single-centre, prospec?ve, double-blind and randomised study conducted among eighty pediatric pa?ents with acyano?c congenital cardiac disease, scheduled for elec?ve on-pump cardiac surgery under general anaesthesia. In the study, the par?cipants were divided into four groups: Group NPHL- nonpulmonary hypertension with lidocaine precondi?oning, group NPHS- nonpulmonary hypertension with normal saline (as placebo), group PHL- pulmonary hypertension with lidocaine precondi?oning, and group PHS- pulmonary hypertension with normal saline (as placebo). Results: Pulmonary vasoconstric?on occurred in 11.25% of cases a?er protamine administra?on. Both the NPHS and PHS groups exhibited an increase in mean airway pressure (Paw), Respiratory index (RI), alveolar-arterial oxygen difference (A-aDO2), pulmonary artery pressure (PAP) and decreased dynamic pulmonary compliance (Cydn) and oxygen index (OI) a?er protamine administra?on. However, these changes were not observed in the NPHL and PHL groups with lidocaine precondi?oning. Plasma levels of TXB2 in the NPHS and PHS groups were higher than the NPHL and PHL groups, but 6-keto-PGF1 alpha levels were lower in the NPHS and PHS groups than in the NPHL and PHL groups. Conclusion: In congenital heart disease, repair without cardiopulmonary bypass is not possible in most cases. Prior to reversing heparin with protamine, precondi?oning lidocaine reverses protamine-induced pulmonary vasoconstric?on and improves lung func?on.

Factors associated with acute kidney injury recovery in a tertiary hospital in Ghana: a prospective study

Introduction: acute kidney injury (AKI) is a challenging problem in developing countries due to late presentation of its victims to health care facilities. Data on the pattern of AKI, its outcome and factors associated with its recovery is scanty in developing countries therefore impeding AKI management. Aim: to study AKI recovery rate and its associated factors.Methods: an observational study conducted from September 2013 to June 2014 at Korle-Bu Teaching Hospital (KBTH). Participants were adults, admitted with AKI at KBTH. Kidney Disease: Improving Global Outcomes (KDIGO) criteria was used to diagnose and stage AKI.Results: mean age (SD) of the participants was 41.9 (± 19.2) years. About a third of the patients (34.6%) were less than 29 years with 30-39 years and 40-60 years constituting 23.0% and 23.6% respectively. Females were in the majority (56.0%). AKI stages I, II and III accounted for 11.0%, 6.8% and 70.7% respectively. Majority, 82.2% of the patients recovered their kidney function. Stage III AKI was significantly associated with decreasing odds of recovery [OR = 0.4, 95%CI = 0.4-2.6, p = 0.002]. In addition, normal blood sodium was associated with recovery from AKI [OR, 95%CI = 2.3, (1.1-5.3), p = 0.043]. Almost half (45.5%) presented with fever whereas 32.5% and 22.5% presented with peripheral oedema and pulmonary oedema respectively.Conclusion: the study demonstrated high kidney function recovery following AKI. Dominant clinical features were fever, peripheral and pulmonary oedema. Advanced stage was associated with poor recovery whereas normal serum sodium level improves kidney function recovery