Effect of colloid versus crystalloid administration of cardiopulmonary bypass prime solution on tissue and organ perfusion

We evaluated the effects of tissue and organ perfusion during and after coronary artery bypass graft surgery with either colloid [Voluven] or crystalloid [Lactated ringer's] as prime solution. In this prospective randomized-controlled trial study, 70 patients undergoing on-pump coronary artery bypass graft surgery were randomly assigned to receive either colloid [Voluven] or crystalloid [Lactated ringer's] as prime solution, for initiation of cardiopulmonary bypass machine procedure. Tissue and organ perfusion markers including lactate, troponin I, liver and renal function tests and electrolytes were measured sequentially, before induction [T1] to second days after surgery [T5]. With exception of chloride and potassium levels no significant differences detected in other measurements, and the laboratory results were entirely identical in both procedures. There was no significant difference between Voluven[registered] [ hydroxyethyl starch, HES 130/0.4] and crystalloid [Lactated ringer's] as priming solution on the basis of organ and tissue perfusion tests assessment

Impact of bispectral index monitoring versus clinical judgment as a guide for conduction of anesthesia on serum cortisol level in coronary artery bypass graft surgery

Inadequate depth of anesthesia leads to release of stress hormones. Electroencephalographic monitoring by bispectral index is a guide to asses the depth of anesthesia. The aim of the present study was to measure the serum cortisol levels as an index of stress response in patients who are candidates for coronary artery bypass graft surgery in two groups of patients. Seventy-six patients who were scheduled for primary elective cardiopulmonary bypass were enrolled in a double- blind randomized study. The patients were divided into two groups. The infusion of anesthetic drugs was guided by bispectral index in group I [n=38], and by clinical judgment in group II [n=38]. For all the patients the blood cortisol level was measured four times during operation. Serum cortisol levels decreased during operation in both groups, reaching 67.8% of the baseline in group I and 63.2% of the baseline in group II. There were no significant differences in mean serum cortisol levels between the two groups [p<0.09]. Preoperatively, the mean blood cortisol level was 19.94 micro g/dl in group I and 16.89 micro g/dl in group II which reached to 10.48 micro g/dl in group I and 6.42 micro g/dl in group II postoperatively. There was no significant difference between two groups regarding bispectral index values. It seems that monitoring of the patients by clinical judgment or bispectral index has equal influences on serum cortisol levels during coronary artery bypass graft surgery

[ case of re-exapansion pulmonary edema after rapid pleural evacuation]

Pulmonary edema after chest tube insertion is a rare complication and is associated with high mortality. The cause of this phenomenon is not clear, although causes such as decrease in surfactant and inflammatory process have been defined. Early diagnosis and treatment decrease the mortality. This study introduces a case of re-expansion pulmonary edema after rapid pleural evacuation. The case is a 4.5 y/o boy, a case of Tetralogy of Fallot, who developed respiratory distress after surgery [Total Correction] in ICU of Namazi Hospital in 1385. Chest X ray showed pneumothorax of left lung. For the patient, chest tube was inserted and the symptoms improved. After few hours the patient developed tachypnea, tachycardia, and CXR showed pulmonary edema of left lung. Appropriate treatment was done for the patient and his condition improved. Pulmonary edema after sudden evacuation of pleura is a rare phenomenon and early diagnosis decreases the mortality