Effect of albumin usage during cardiopulmonary bypass on postoperative acute kidney injury in cardiac surgery patients: A historical cohort study.

Introduction: Acute kidney injury (AKI) after cardiac surgery is a common and serious postoperative complication and is associated with an increased risk of mortality, morbidity, length of hospital stay, and costs. We evaluated the effect of albumin usage on postoperative AKI in patients who underwent on-pump Coronary Artery Bypass Graft Surgery (CABG). Methods: This non-randomized cohort study was conducted on data from adult patients who underwent elective CABG, from March of 2015 to March of 2019. We assessed two groups of patients including the albumin (who received 50cc albumin 20% in priming solution) and the non-albumin groups. We recorded demographic data, medical history, and preoperative laboratory data. We compared postoperative changes in serum creatinine (Cr), blood urea nitrogen (BUN), and Glomerular Filtration Rate (GFR) up to 72 hours after surgery with preoperative ones. Also, the stage of kidney dysfunction was assessed according to the AKIN classification. The statistical analysis of the data was processed by SPSS 24 program. Results: Overall, we reviewed 506 patients chart [260 (51.4%) in albumin and 246 (48.6%) in non-albumin group]. In both groups, serum Cr, BUN, and GFR increased in 72 hours postoperatively compared with preoperative levels. This increase was greater in the non-albumin group than in the albumin group. However, the difference was not statistically significant between the two groups (p > 0.05). None of the patients developed renal failure or required dialysis. Conclusion: We concluded that the use of albumin in prime solution did not have a statistically significant effect on postoperative renal dysfunction after CABG.

The effect of melatonin on cognitive functions following coronary artery bypass grafting: A triple-blind randomized-controlled trial.

Background: Cognitive dysfunction presents one of the chief causes of postoperative morbidity. Melatonin as a neurohormone can improve neurocognitive functioning and sleep disorders. We evaluated the effect of melatonin on the postoperative cognitive function of patients undergoing coronary artery bypass grafting (CABG). Materials and Methods: A triple-blind randomized-controlled trial was conducted on 66 CABG candidates in Namazee Hospital (Shiraz, Iran). Patients were assigned equally into two groups receiving melatonin 10 mg or a placebo daily for 4 weeks before surgery and 2 days after surgery in the intensive care unit. The Mini-Mental State Examination (MMSE), Tower of London (ToL), and Wechsler Adults Intelligence Scale-Revised (WAIS-R) cognitive function tests were performed in both groups 4 weeks before surgery (time point 1), 2 days after surgery (time point 2), and 6 weeks after initial administration of melatonin (time point 3). Results: The mean change score (time point 3-time point 1) differed significantly between the two groups in the MMSE (P ≤ 0.001), ToL total score (P = 0.001), and WAIS-R general IQ (P ≤ 0.001), picture completion (P ≤ 0.001), vocabulary (P = 0.024), and digit span (P = 0.01). On the other hand, no significant differences were detected in the WAIS-R block design, ToL total time delay, ToL total lab, and ToL total result scores. Conclusion: The MMSE and WAIS-R tests revealed that melatonin might have prophylactic effects against postoperative cognitive disturbance in patients undergoing elective CABG.

Hemodynamic Changes after Continuing or Omitting Regular Angiotensin Converting Enzyme Inhibitors before Cataract Surgery: A Comparative Study.

AIMS: In this study, we aimed to appraise the effects of interrupting (discontinuing) vs. continuing Angiotensin receptor blockers (ARBs) and Angiotensin-Converting Enzyme Inhibitors (ACEIs) on the hemodynamic changes of patients during and after cataract surgery. METHODS AND MATERIALS: Patients aged 40-70 years, American society of anesthesiologist (ASA) class II, taking ACEI/ARB medications, who were admitted to Khalili hospital (Shiraz, South of Iran) for cataract surgery, were enrolled in the study. Patients were randomly divided into two groups for continuing or withdrawing the use of ACEI/ARBs. Group 1 included the patients who continued ACEI/ARB administration, and group 2 included those who discontinued them before surgery. In the operating room, relevant demographic information was collected in addition to the data on patients' basic clinical status, including heart rate and blood pressure, before induction of anesthesia, during, and after that. The collected data were analyzed using SPSS 21, and p-values < 0.05 were considered statistically significant. RESULTS: Any significant differences were not revealed in demographic variables (age, sex, diabetes, hypertension, Myocardial infarction, Smoking, and duration of drug therapy) between the two groups. Time effect was significant (p<0.001) for systolic blood pressure, diastolic blood pressure, and heart rate, and interaction between time*group was not significant (p = 0.431, p = 0.566, and p = 0.355) for systolic blood pressure, diastolic blood pressure, and heart rate. However, the group effect wasn't significant (p=0.701, p=0.663, and p=0.669) for systolic blood pressure, diastolic blood pressure, and heart rate. CONCLUSION: It seems that in some minor surgeries, such as cataract surgery, withdrawal or continuation of ACEIs/ARBs have no significant effect on the hypotension and heart rate of patients during orafter an operation.

Association of urine output during cardiopulmonary bypass and postoperative acute kidney injury in patients undergoing coronary artery bypass graft.

Acute kidney injury (AKI) is a common complication in patients undergoing coronary artery bypass graft (CABG) surgery and is associated with significant morbidity and mortality. We investigated the association of urine output (U/O) during cardiopulmonary bypass (CPB) with postoperative AKI in a cohort of patients undergoing elective CABG.This single-center retrospective study used data from patients undergoing elective CABG with CPB (March 2015 to March 2020). Demographic data and perioperative information were extracted from the Patients' records. Urine output during CPB and in the first 3 days after surgery was also recorded. Acute kidney injury was defined according to the Acute Kidney Injury Network (AKIN) classification. Spearman's correlation analysis was used to evaluate the relationship between quantitative variables and multiple logistic regression analysis was applied to determine AKI predictors.A total of 532 patients with a mean age of 56.83 ± 7.99 years were analyzed. In the first 48 h after surgery, the incidence of AKI was 18%, of which, 7 (2.7%) patients developed stage II of AKI. There was no significant correlation between U/O during CPB and change in postoperative blood urea nitrogen (BUN) and creatinine. Oliguria during CPB was not observed in any of the patients. Age and duration of bypass were identified as predictors of AKI.In this study, the incidence of AKI was 18% and there was no significant correlation between U/O during CPB and changes in postoperative BUN and creatinine. Age and duration of bypass were independent risk factors of AKI.

Comparative Efficacy of 3 Adjuvant Medications Used in Combination with Intrathecal Bupivacaine for Caesarian Section Anesthesia: A Randomized, Double-Blind Clinical Trial.

Background: A number of different medications are used in combination with intrathecal bupivacaine for cesarean section anesthesia, but their relative efficacy has not been well established. Objective: To study the relative efficacy of adding either intrathecal fentanyl, intrathecal sufentanil, or intravenous acetaminophen-morphine-fentanyl to intrathecal bupivacaine spinal anesthesia for pain control in elective cesarean section operations. Methods: In this randomized, double-blinded, controlled trial, 105 pregnant women eligible for cesarean section received 10 mg intrathecal bupivacaine (0.5%) in combination with 2 µg intrathecal sufentanil (group 1), 10 µg intrathecal fentanyl (group 2), and an intravenous cocktail of 1 g acetaminophen, 5 mg morphine, and 100 µg fentanyl (group 3). Patients were assessed for analgesia, time to block, and adverse effects. Results: The 3 groups were similar in terms of the time to onset of sensory block and the duration of both sensory and motor block. Groups 1 and 3 differed significantly in the time to peak sensory block, whereas group 1 differed significantly from groups 2 and 3 in the time to peak motor block. The sensory block level reached T4 in most patients. Significant differences in pain (visual analog scale) were demonstrated between groups 1 and 3 at 5 minutes after spinal injection, between groups 1 and 2 at the end of the surgery and upon arrival to the recovery room, and between all groups in the recovery room. Conclusions: When used in addition to 10 mg intrathecal bupivacaine, an intravenous cocktail of 1 g acetaminophen-5 mg morphine-100 µg fentanyl was as efficient as either 10 µg intrathecal fentanyl or 2 µg intrathecal sufentanil in terms of sensory and motor block duration and produced a higher dermatomal level of sensory block. However, intrathecal sufentanil provided better anesthesia quality (less time to onset of motor block and peak sensory-motor block) and better pain control. (Curr Ther Res Clin Exp. 2023; 84:XXX-XXX).

Comparison of the effect of melatonin, dexmedetomidine, and gabapentin on reduction of postoperative pain and anxiety following laminectomy: a randomized clinical trial.

BACKGROUND: This study aimed to compare the effects of melatonin, dexmedetomidine, and gabapentin on postoperative pain and anxiety following laminectomy. METHODS: In this randomized clinical trial, 99 patients aged 40-60 years old with American Society of Anesthesiologists physical status I-II undergoing laminectomy were divided into three groups receiving 600mg gabapentin (group G), 10mg melatonin (group M), or starch tablets (group D). The Hospital Anxiety and Depression Scale (HADS) was used to measure postoperative anxiety while a Visual Analogue Scale (VAS) was employed to measure pain severity. Patients' satisfaction with pain treatment was also measured together with the frequency of nausea and vomiting. RESULTS: The postoperative HADS decreased in all groups over time. Time and group had no significant interaction effect on the HADS score. Patients in the melatonin group had lower HADS at 2 and 6h after surgery. According to the VAS, the groups significantly differed in pain scores 6 and 24h after surgery. Lower VAS scores were observed 6h after surgery in the dexmedetomidine group compared with the gabapentin group and 24h after surgery in the dexmedetomidine group compared with the gabapentin and melatonin groups. Narcotic requirements, patients' satisfaction, and vital sign changes did not significantly vary among the groups. Notably, patients in the melatonin group had less nausea and vomiting. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trials (No. IRCT20141009019470N82, 29.06.2019) where the trial protocol could be accessed. CONCLUSION: Melatonin is effective as a postoperative anti-anxiety drug. Dexmedetomidine is useful in reducing postoperative pain.

Analgesic Characteristics of Bupivacaine Alone and in Combination with Dexmedetomidine or Meperidine in Spinal Anesthesia during Cesarean Section: A Double-Blind Randomized Clinical Trial Study.

Background: Comparing bupivacaine's adjuvants in spinal anesthesia, we assessed the specific blocking characteristics and adverse effects of bupivacaine alone and in combination with dexmedetomidine or meperidine in spinal anesthesia during cesarean section. Methods: In this double-blind randomized clinical trial study, ninety pregnant women were divided into groups to receive 10 mg bupivacaine (group B), 10 mg bupivacaine with 5 µg dexmedetomidine (group BD), or 10 mg bupivacaine with 10 mg meperidine (group BM) intrathecal. Patients were assessed for the quality of analgesia during operations. Durations of sensory and motor blocks and anesthesia-related complications were analyzed using SPSS 21, and p values <0.05 were considered statistically significant. Results: The onset of sensory and motor blocks was essentially the same in all treated groups. Block regression time was significantly prolonged in the BD group compared to the B and BM groups (p < 0.001). The duration of analgesia was significantly longer in the BD and BM groups than in the B group (p < 0.001). The level of sedation in the BD group was higher than in the B group. Shivering occurred in 40% of patients in the B group, which was significantly more than that of the BD (16.6%) and BM (33.3%) groups. Itching happened in 33.3% of women in the BM group which was statistically more than that of the B (3.33%) and BD (0) groups. The incidence of adverse effects was the same in all groups. Conclusion: The combination of bupivacaine with dexmedetomidine significantly prolonged sensory and motor regression time and duration of analgesia.

Effect of Preoperative Administration of Oral Melatonin on Pneumatic Tourniquet-Induced Ischemia-Reperfusion Injury in Orthopedic Surgery of Lower Extremities: A Randomized Clinical Trial.

Background: Ischemic reperfusion injury (IRI) causes cellular damage and dysfunction. The present study aimed to evaluate the effect of melatonin on pneumatic tourniquet-induced IRI in orthopedic surgery of the lower extremities. Methods: A randomized clinical trial was conducted at Chamran Hospital, Shiraz University of Medical Sciences (Shiraz, Iran), from September to November 2019. The target population was patients scheduled for elective orthopedic surgery of the lower extremities. A total of 67 patients were randomly divided into two groups, placebo (n=34) and melatonin (n=33). The groups received 10 mg melatonin or placebo the night before surgery and two hours before surgery. Primary outcome variables were the serum levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Hemodynamic parameters, sedation score, and drug side effects were also evaluated. Data were analyzed using SPSS version 21.0 software. P<0.05 was considered statistically significant. Results: In the analysis phase, due to loss to follow-up (n=26), 41 patients divided into two groups of melatonin (n=20) and placebo (n=21) were evaluated. There was no significant difference in demographic data, duration of surgery (P=0.929), and tourniquet time (P=0.496) between the groups. The serum levels of SOD and MDA were not significantly different between the groups (P=0.866 and P=0.422, respectively), nor were the incidence of postoperative nausea (P=0.588) and patients' satisfaction (P=0.088). However, the postoperative sedation score and vomiting between the groups were significantly different (P<0.001). Conclusion: Administration of 10 mg melatonin provided effective sedation, but had no significant effect on the serum levels of SOD and MDA, nor on pneumatic tourniquet-induced IRI in orthopedic surgery of the lower limbs. Trial registration number: IRCT20141009019470N87.

Comparison of the effects of remifentanil and dexmedetomidine on surgeon satisfaction with surgical field visualization and intraoperative bleeding during rhinoplasty.

OBJECTIVE: We aimed to compare the effect of dexmedetomidine with remifentanil on hemodynamic stability, surgical field quality, and surgeon satisfaction during rhinoplasty. METHODS AND MATERIALS: In this double-blind randomized controlled-trial, 60 participants scheduled for rhinoplasty at the Mother and Child Hospital, Shiraz, Iran, was randomely divided into the dexmedetomidine group (IV infusion of 1 µg/kg dexmedetomidine over 20 min before induction of anesthesia then 0.6 µg/kg/hr. dexmedetomidine from the time of induction until the end of the operation) or in the the remifentanil group (an infusion rate of 0.25 µg/kg/min from the time of anesthesia induction until the end of the operation). Bleeding volume, surgeon satisfaction, postoperative pain (visual analog scale (VAS)), Level of sedation (Richmond Agitation Sedation Scale (RASS)), Patient satisfaction, Vital signs & recovery, and the Aldrete Score (used to discharge the patients from recovery) were measured for all participants. RESULTS: The patients in the dexmedetomidine group had less bleeding (p = 0.047) and shorter time to return of respiration, extubation, and the postoperative recovery time (p < 0.001). The surgeon satisfaction was higher in the dexmedetomidine group (p < 0.001). Patient satisfaction was significantly different between the two groups (p < 0.001). VAS scores, intaking paracetamol, and RASS score were significantly lower in the remifentanil group (p < 0.001). SBP, DBP, MAP, and heart rate were lower in dexmedetomidine group. CONCLUSION: Dexmedetomidine was associated with relatively stable hemodynamics, leading to decreased intraoperative bleeding, recovery time, and greater surgeon satisfaction and the level of consciousness in the recovery ward. However, painlessness and patient satisfaction were greater with the use of remifentanil. TRIAL REGISTRATION: IRCT20141009019470N112 .

Comparison of the Effect of Ketamine, Ketamine-Midazolam and Ketamine-Propofol on Post-Tonsillectomy Agitation in Children.

BACKGROUND: Emergence agitation (EA) in children is one of the most common complications following anaesthesia. We aimed to compare the effect of ketamine, ketamine-midazolam and ketamine-propofol on EA after tonsillectomy. METHODS: This study was a randomised, double-blind clinical trial conducted on 162 children undergoing adenotonsillectomy surgery. The participants were randomly divided into three groups of receiving ketamine (0.5 mg/kg) (N = 54), ketamine (0.5 mg/kg) + propofol (1 mg/kg) (N = 54) and ketamine (0.5 mg/kg) + midazolam (0.01 mg/kg) (N = 54) 10 min before the end of the operation. At the time of the patients' entry into the post-anaesthesia care unit (PACU) and at intervals of 5 min, 10 min and 20 min after that, consciousness, mobility, breathing, circulation and SpO2 were recorded. Modified Aldrete recovery score (MARS), the objective pain score (OPS) and Richmond agitation-sedation scale (RASS) were also evaluated. RESULTS: At the time of entrance to the PACU and 5 min later, the ketamine-midazolam and ketamine-propofol groups had lower RASS scores than the ketamine group (P < 0.001); after 10 min and 20 min, the ketamine-propofol group showed the lowest RASS score (P < 0.001). Ketamine-propofol group had a significantly lower MARS score at all-time points (P < 0.001). Recovery time was the longest for the ketamine-propofol group (P = 0.008). CONCLUSION: The ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.

The Effect of Melatonin on the Serum Level of Interleukin 6 and Interleukin 9 in Coronary Artery Bypass Grafting Surgery.

OBJECTIVE: Cardiopulmonary bypass has been recognized as one of the main causes of systemic inflammatory response syndrome, leading to post-operative complications. The aim of this study was to investigate the effect of melatonin on the serum levels of interleukin 6 (IL-6) and IL-9 in patients undergoing coronary artery bypass grafting surgery. METHODS: Forty-four patients undergoing elective coronary artery bypass surgery were randomly allocated into two study groups of melatonin (n = 23) and placebo (n = 21). Patients in the melatonin group received two melatonin tablet, 5 mg daily for 3 days before surgery, 10 mg tablet (two doses of 5 mg) 1 h before induction of anesthesia and finally, 10 mg melatonin tablet in the intensive care unit, placebo group patients received placebo at the same time periods. Serum levels of IL-9 and IL-6 were measured as baseline (T1), before induction of anesthesia (T2), 6 and 24 h after off pump (T3, T4). Data were analyzed using SPSS 23 software (IBM Corp., Armonk, NY, USA). RESULTS: The mean serum level of IL-6 was significantly lower in the melatonin group at T3 and T4 (p ＜ 0.05). Also, in both groups, serum levels of IL-6 in T3 showed a significant increase compared to T1. Serum levels of IL-9 had no significant difference between the two groups at T1, T2, T3, and T4. CONCLUSION: The results of this study showed that pre-operative melatonin administration could modify inflammatory cytokines secretion such as IL-6 while it has no significant effect on the serum levels of IL- 9. Neither of the changes was clinically significant.

Respiratory Burst Process in Diabetic Children.

BACKGROUND: Increased rate of infections in diabetes mellitus (DM) is an accepted fact. Pathophysiologically, several tasks of the immune system could be involved including polymorphonuclear (PMN) functions. OBJECTIVES: The aim of this research was to evaluate the respiratory burst process of PMNs that is an essential part of phagocytosis, in children with DM. PATIENTS AND METHODS: Fifty two children with insulin dependent diabetes and 29 non-diabetic children were enrolled in this cross sectional study from 2010 to 2011. Nitroblue tetrazolium (NBT) test was done on PMNs taken from their heparinized blood. The resultant data was analyzed by SPSS version 16. P values were considered significant when it was under 0.05. RESULTS: Mean NBTs were 72.1 ± 15.84 and 94.68 ± 5.31 in diabetics and non-diabetics, respectively (P < 0.001). Using Pearson correlation, there was no significant correlation between the NBT level and age, gender, duration of diabetes, daily insulin usage and blood HbA1C level. CONCLUSIONS: Compared to non-diabetics, respiratory burst process of polymorphonuclears is obviously decreased in diabetic children. This can explain one of the mechanisms involved in the increased rate of infections in DM.

Attenuation of cardiovascular responses and upper airway events to tracheal extubation by low dose propofol.

BACKGROUND: Hemodynamic changes and respiratory tract complications are often followed by tracheal extubation. These events may be dangerous in neurosurgical patients and those with cardiovascular disease or at an old age. OBJECTIVES: The aim of this study is to investigate the attenuation of cardiovascular responses and upper airway events resulting from tracheal extubation by low dose propofol. MATERIALS AND METHODS: 80 patients with ASA physical status I, undergoing an elective surgery in a double blind manner received 0.5mg/kg propofol or normal saline 2 minutes before extubation. Heart rate and blood pressure and quality of tracheal extubation were recorded. RESULTS: Heart rate and blood pressure in patients receiving propofol were less than the control group (P < 0.05) at the time of injection of propofol, but there were no differences between the two groups at the time of extubation. CONCLUSIONS: We concluded that propofol can reduce SBP, DBP, MAP, HR & cough production at the time of injection but there were no significant changes in these parameters after extubation.