efficacy of tramadol used with ketamine or morphine in pain control after coronary artery bypass graft surgery

Sufficient analgesia after coronary artery bypass graft surgery [CABG] is important to prevent postoperative complications. One of these analgesic techniques is patient controlled analgesia [PCA], in which the patient has self-controlled administration of anesthetics. The purpose of this study was to evaluate the analgesic effect and side effects of tramadol used with ketamine or morphine for post-CABG surgery analgesia. In this prospective, controlled randomized study, we selected 150 patients who were candidates for CABG. The inclusion criteria were adult patients aged 30-60 with coronary artery disease, candidates for CABG, elective surgery, surgery using cardiopulmonary bypass, and ASA II and III. The patients with uncontrolled and significant underlying diseases [diabetes, liver and kidney disease and clotting disorders], excessive obesity and weight over 115 kg, and non-consenting patients were excluded. The patients were divided into three groups of 50 each. At the end of surgery, all the patients were transferred to the post-surgical intensive care unit, where they were extubated. PCA was commenced when the patients were able to communicate. The first group was provided with 100mg of tramadol with normal saline, the second group 50mg of tramadol plus 20mg of morphine, and the third group 50mg of tramadol plus 50mg of ketamine. During the use of the PCA pump, the patients were observed for respiratory depression [respiratory rate and SPO[2], PaCO[2] every two hours during the first 8 hours and then every 4 hours]. The severity of pain was evaluated with the visual analog scale [VAS] method, where zero was no pain and ten was severe pain. The VAS results were recorded 1, 3, 6, 12, 18, 24, 36, and 48 hours after awareness and extubation and recording the base VAS of the patients. The average respiratory rate was 14 in all the three groups and respiratory depression was not seen in any of them. At the third hour, the VAS was similar in all the groups [p value<0.05]. The decrease in VAS at 6, 12, and 18 hours was significant and the minimum VAS was seen in the second group [tramadol + morphine]. PCA is a safe and appropriate method for analgesia after CABG. It seems that the combination of tramadol plus morphine can be an effective solution for analgesia after CABG with fewer respiratory complications than other combinations

Intraoperative magnesium sulfate can reduce narcotic requirement after coronary bypass surgery

Narcotics are the most common drugs used after cardiac surgery and their side effects, including respiratory depression, hemodynamic instability, nausea and vomiting, and itching are dose dependent. Magnesium is both an N Methyl D Aspartate [NMDA]-receptor and a calcium-receptor antagonist and can modify the important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on the pain score and reducing narcotic requirement in coronary artery bypass grafting surgery [CABG] patients. This randomized, double blinded, placebo-controlled trial recruited 185 patients [105 male and 80 female] undergoing elective CABG. Mean age was 58 +/- 11 years [range 24 to 79 years]. The patients were divided into two groups randomly: Group I received magnesium sulfate as an IV infusion [80 mg/kg] during a one-hour period post induction and Group 2 received the same volume of normal saline as a placebo. During the postoperative period, the patients' morphine requirement and pain score [visual analogue seale scaled as 0 to 10, 0=no pain and 10= worst possible pain] at 6[th], 12[th], 18[th], and 24[th] hours were recorded and documented. There were no significant differences between the two groups with respect to the baseline data. In the magnesium sulfate group, only 30 [32%] patients needed morphine sulfate, whereas 75 [83%] patients in the placebo group required some doses of morphine sulfate [p value < 0.001]. The odds ratio showed that magnesium sulfate could strongly prevent the need for opioid analgesics for pain control. The intraoperative use of magnesium sulfate can reduce the need for opioids post CABG

effect of primary bolus dose of pancuronium versus cisatracurium without maintenance dose on extubation time in adult coronary artery bypass crafting

Given the importance of the effect of muscle relaxants on the extubation time in coronary artery bypass grafting [CABG] patients, we sought to assess the difference in "time to extubation" and "intensive care unit [ICU] length of stay" between the primary bolus doses of Pancuroniuni and Cisatracurium without using the maintenance dose of them during surgery. This double blind clinical trial divided 110 patients into two equal groups receiving either Cisatracurium or Pancuronium. The patients' surgical and cardiopulmonary bypass variables were evaluated, and the extubation time and ICU length of stay were compared between the two groups. There was no difference between the two groups regarding the depth of anesthesia, train-of-four [TOF] scores at the beginning of anesthesia, and the surgical and cardiopulmonary bypass variables. However, the Cisatracurium patients were extubated earlier and had a shorter ICU length of stay than the Pancuronium patients. An appropriate depth of anesthesia facilitates the administration of the niduction dose of Cisatracurium, which confers earlier extubation and shorter ICU length of stay by comparison with Pancuronium

Cardiovascular responses to orotracheal intubation in patients undergoing coronary artery bypass grafting surgery. Comparing fiberoptic bronchoscopy with direct laryngoscopy

The intubation by using fiberoptic brochoscop [FOB] can avoid the mechanical stimulus to oropharyngolaryngeal structures thereby it is likely to attenuate hemodynamic response during orotracheal intubation. Based on this hypothesis, we compared the hemodynamic responses to orotracheal intubation using an FOB and direct laryngoscope [DLS] in patients undergoing general anesthesia for coronary artery bypass grafting [CABG] surgery. Fifty patients with ASA physical status II and Mallampati score I and II were scheduled for elective CABG surgery under general anesthesia requiring orotracheal intubation were randomly allocated to either DLS group [n = 25] or FOB group [n = 25]. The same protocol of anesthetic medications was used. Invasive systolic and diastolic blood pressure [SBP and DBP] and heart rate [HR] were recorded before and after anesthesia induction, during intubation and in the first and second minutes after intubation. The differences among the hemodynamic variables recorded over time and differences in the circulatory variables between the two study groups were compared. Duration of intubation was shorter in DLS group [19.3 +/- 4.7 sec] compared with FOB group [34.9 +/- 9.8 sec; p = 0.0001]. In both study groups basic SBP and DBP and HR were not significantly different [P >0.05]. During the observation, there were no significant differences between the two groups in BP or HR at any time points or in their maximal values [all p values >0.05]. We conclude that the FOB had no advantage in attenuating the hemodynamic responses to orotracheal intubation in patients undergoing CABG surgery