ABSTRACT
BACKGROUND: We evaluated the role of pre-emptive stellate ganglion block (SGB) in preventing radial artery spasm and increasing radial artery graft patency in patients undergoing off-pump coronary artery bypass surgery. METHODS: In this prospective randomized study, 100 patients were divided into two equal groups (n= 50). In group A, SGB was achieved using 10 ml of ropivacaine and, in group B, SGB was not performed. Radial artery blood flow was measured pre- and intra-operatively. Post-operative clinical determinants (S-T segment elevation, use of inotropic agents, incidence of atrial fibrillation) were recorded. Early coronary angiography was performed. RESULTS: According to blood flowmeter measurements, the radial artery blood flow was significantly increased in patients with SGB. The incidence of atrial fibrillation, the need for inotropic agents and S-T segment elevation were all decreased in the SGB group. Angiographic intervention revealed that the incidence of graft spasm was also lower in the SGB group. CONCLUSION: Pre-emptive SGB is an effective method for increasing radial artery blood flow and preventing radial artery spasm. Complications related to radial artery spasm may be decreased and patients may have a more comfortable post-operative period with this method.
Subject(s)
Coronary Artery Bypass/methods , Nerve Block/methods , Radial Artery/drug effects , Stellate Ganglion/drug effects , Vascular Patency/drug effects , Amides/administration & dosage , Analysis of Variance , Anesthetics, Local/administration & dosage , Coronary Disease/surgery , Coronary Vasospasm/prevention & control , Female , Humans , Male , Middle Aged , Postoperative Complications/prevention & control , Prospective Studies , Radial Artery/diagnostic imaging , Radial Artery/transplantation , Radiography , Regional Blood Flow/drug effects , RopivacaineABSTRACT
BACKGROUND: We aimed to show the impact of leukodepletion on renal function in patients undergoing on-pump coronary revascularization. PATIENTS AND METHODS: Fifty patients awaiting elective on-pump coronary revascularization with normal preoperative cardiac functions and with plasma creatinine levels ranging between 1.5 and 2.0 mg/dL were prospectively randomized into two groups: on-pump CABG with (group A: n = 25) and without leukodepletion (group B, n = 25). Renal glomerular and tubular injury were assessed by urinary alpha glutathione s-transferase (GST), plasma creatinine, and blood urea nitrogen (BUN) levels. RESULTS: The patients consisted of 14 females and 36 males with a mean age of 57.6 +/- 5.3 years. In the leukodepletion group, the mean levels of creatinine, BUN and urinary GST were found to be decreased on the first, third and fifth postoperative days compared with the control group. There was no mortality. Three patients in the control group needed postoperative dialysis. CONCLUSION: Patients with renal dysfunction undergoing on-pump CABG surgery seem to benefit from leukodepletion as a measure to prevent tubular damage and renal impairment compared with a control group.
Subject(s)
Acute Kidney Injury/prevention & control , Coronary Artery Bypass , Coronary Disease/surgery , Leukocyte Reduction Procedures , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/metabolism , Acute Kidney Injury/physiopathology , Aged , Analysis of Variance , Biomarkers/blood , Biomarkers/urine , Blood Urea Nitrogen , Coronary Artery Bypass/methods , Creatinine/blood , Female , Glutathione Transferase/urine , Humans , Incidence , Isoenzymes/urine , Male , Middle Aged , Postoperative Period , Potassium/blood , Prospective Studies , Renal Dialysis , Research Design , Treatment Outcome , Turkey , Water-Electrolyte BalanceABSTRACT
Glanzmann thrombasthenia is a rare, hereditary, congenital disorder of platelet function characterized by inappropriate bleeding that is difficult to control. Recombinant activated factor VII (rFVIIa) is a new treatment that is used to stop bleeding and provide surgical support for these patients. This report describes the use of rFVIIa to prevent serious bleeding during and after open-heart surgery in a child with Glanzmann thrombasthenia.
