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   Table of Contents - Current issue
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September-December 2017
Volume 11 | Issue 3
Page Nos. 31-52

Online since Friday, February 9, 2018

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Terlipressin infusion versus norepinephrine infusion for management of postcoronary artery bypass grafting refractory hypotension: a comparative study p. 31
Ahmed M El-Shaarawy, Tarek A Marei, Hisham M Elbatanony
DOI:10.4103/ejca.ejca_15_17  
Objective The aim was to evaluate outcome of diabetic patients who developed refractory hypotension after coronary artery bypass grafting (CABG) surgery on using terlipressin (TP) versus norepinephrine (NE) infusions. Patients and methods A total of 44 patients were divided into two groups: group NE received NE infusion (0.1 µg/kg/min) and group TP received TP infusion (2 µg/kg/h). On cardiopulmonary bypass weaning (0 h), hemodynamic parameters, levels of blood glucose (BG) and blood lactate, serum creatine kinase-MB, and cardiac troponin T were determined. If systolic less than 90 mmHg and/or mean arterial pressure (MAP) less than 60 mmHg persisted after 5 min of adequate volume resuscitation, vasopressor infusions were started and hemodynamic parameters were recorded. If initial doses failed to achieve adequate hemodynamic stability at 10 min, the dose was increased. Postoperative levels of studied parameters were estimated. Results NE significantly whereas TP nonsignificantly increased heart rate. Both infusions induced persistently higher MAP at 10 min, 30 min, and 4 h compared with 0 h, with nonsignificantly higher MAP with TP versus NE. Both infusions increased BG levels compared with 0 h estimates, with significant difference with NE. At 24 h, serum creatine kinase-MB levels were significantly lower with TP than NE, whereas serum cardiac troponin T levels showed nonsignificant difference. Lactate clearance rate was significantly higher with TP. Conclusion Vasopressor infusion improved hemodynamics. TP did well than NE with significant increase of blood pressure measures but minimized cardiac ischemic risk and the increase of BG and blood lactate levels.
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Comparison of the myocardial protective effect of sevoflurane and isoflurane in high-risk cardiac patients undergoing coronary artery bypass grafting surgery: a randomized study p. 38
Rabie Soliman, Walid Abukhudair
DOI:10.4103/ejca.ejca_17_17  
Objective The aim of this study was to assess the effect of sevoflurane and isoflurane in high-risk cardiac patients undergoing coronary artery bypass grafting surgery. Patients and methods This study included 228 patients undergoing coronary artery bypass grafting surgery. This was a randomized study. This study was carried out at cardiac centers. The patients in this study were divided into two groups. In the sevoflurane group, the patients received sevoflurane (end-tidal concentration of 1–4%) as an inhalational agent during the entire procedure (before, during, and after cardiopulmonary bypass). In the isoflurane group, the patients received isoflurane (end-tidal concentration of 0.5–2%) as an inhalational agent during the entire procedure (before, during, and after cardiopulmonary bypass). The monitors measured the heart rate, mean arterial blood pressure, a continuous ECG with an automatic ST-segment analysis (leads II and V), central venous pressure, mean arterial pulmonary pressure, pulmonary capillary wedge pressure, pulmonary and systemic vascular resistances, cardiac index, urine output, troponin I level, creatine kinase-MB level, required pharmacological, and mechanical support. Results The administration of sevoflurane decreased the heart rate, mean arterial blood pressure, cardiac index, mean arterial pulmonary pressure, and pulmonary and systemic vascular resistances compared with the administration of isoflurane (P<0.05). Also, it decreased the incidence of myocardial infarction, reflected in the troponin I level, creatine kinase-MB, ECG changes, and the development of new regional wall motion abnormalities (P<0.05). Sevoflurane decreased the requirement for pharmacological and mechanical support compared with isoflurane (P<0.05). Conclusion Sevoflurane is more cardioprotective than isoflurane. It decreases the incidence of myocardial infarction and the requirement for pharmacological and mechanical support, and duration of stay in the ICU and hospital.
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Can venous saturations from the central venous line and the venous side of the heart–lung machine be interchangeable with mixed venous saturation from the pulmonary artery in children undergoing open-heart surgery? p. 48
Mohamed S Ali, Sayed K Abd-Elshafy, Essam M Abd Allah, Ahmed F Ghoneim
DOI:10.4103/ejca.ejca_8_17  
Background Mixed venous oxygen saturation has been advocated as an indirect index of tissue oxygenation. This study evaluated whether venous oxygen saturation from the central venous line (CVL) or the venous side of the cardiopulmonary bypass (CPB) was interchangeable with mixed venous oxygen saturation from the pulmonary artery in children undergoing cardiac surgery for correction of congenital heart defects. Patients and methods Forty children ranging in age from 1 to 15 years undergoing correction for congenital heart procedures with CPB were included in this study. Simultaneous samples were taken from the CVL, the pulmonary artery, and from the venous side of the CPB after 10 min on full CPB and at the end of surgery before weaning from CPB. Bland and Altman’s analysis was carried out to study the agreement between different venous oxygen saturation. Results Insignificant correlations were observed between venous oxygen saturation from the pulmonary artery, the CVL, and the venous site of the CPB. Wide limits of agreements were observed between the venous oxygen saturation in the pulmonary artery with that in the CVL (14.21–−15.32), and also with that in the venous side of the CPB (34.34–−33.18). A wide limit of agreement was observed between venous oxygen saturation in the venous side of the CPB with that in the CVL (28.24–−31.67). Conclusion Venous saturations from the CVL, and from venous side of CPB are not interchangeable with mixed venous saturation from the pulmonary artery in children undergoing open-heart surgery.
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