RESUMEN
Background: Liver dysfunction during on-pump coronary artery bypass graft surgery [CABG] is a rare complication but is associated with significant morbidity and mortality. The ability to identify high-risk patients may be helpful in planning appropriate management strategies. We aimed to evaluate the factors influencing liver function tests during on-pump CABG
Methods: In 146 patients scheduled for on-pump CABG, the liver function test was done preoperatively and on the first postoperative day. Some preoperative and intraoperative risk factors were checked and then the postoperative liver function tests were compared with the preoperative ones. Probable relationships between these changes and the preoperative and intraoperative risk factors were studied
Results: A medical history of diabetes had a significant relationship with the changes in direct bilirubin. Preoperative central venous pressure had a significant relationship with the changes in aspartate aminotransferase and alanine aminotransferase. Use of intra-aortic balloon pump and duration of aortic cross-clamp were significantly related to the changes in the liver function tests except for alanine aminotransferase and alkaline phosphatase
Conclusion: It seems that the techniques for the reduction of cardiopulmonary bypass and aortic cross-clamp duration may be useful to protect liver function. We recommend that a larger population of patients be studied to confirm these findings
RESUMEN
To ameliorate post spinal anesthesia hypotension in patients undergoing cesarean section. To compare the incidence of maternal hypotension associated with spinal anesthesia for cesarean section when intravenous [IV], intramuscular [IM] or oral prophylactic boluses of ephedrine were used. Prospective randomized double blind Department of anesthesiology, Zainibiae Hospital, Shiraz University, Iran. June 2004 to November 2005. 60 ASA grade I-II pregnant mothers were enrolled. Spinal anesthesia was performed using 60-70 mg of 5% solution of lidocaine. The patients were divided into three equal groups [n=20]. Oral and IM ephedrine [25 mg] was administered to the first two groups 30 to 60 minutes before induction of anesthesia [Group A and B, respectively]. In the last 20 patients, IV Ephedrine [25 mg] was administered immediately after induction of spinal anesthesia [Group C]. Maternal blood pressure and pulse rate was checked every 2 minutes. Hypotension was promptly treated with 10-mg ephedrine boluses. Both IM and IV prophylactic doses of ephedrine significantly decreased the incidence of hypotension, compared to oral prophylactic dose of ephedrine [4/20 and 0/20 in the IM and IV ephedrine groups, respectively vs. 9/20 in the oral ephedrine group [p < 0.05]]. Oral prophylactic dose of ephedrine is not effective in preventing hypotension in pregnant women undergoing cesarean section with spinal anesthesia. Therefore, we only recommend a single bolus of IV ephedrine with a dose of 25mg