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   2014| September-December  | Volume 8 | Issue 3  
    Online since March 17, 2015

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A prospective randomized comparative study between two different milrinone regimens in adult patients with pulmonary hypertension undergoing cardiac surgery
Rabie Soliman, Reda Abuel Atta
September-December 2014, 8(3):91-96
Context Milrinone is an inodilator commonly used to improve myocardial function and to decrease pulmonary hypertension. Aim The aim of this study was to compare two different regimens of milrinone administration in adult cardiac surgery patients with pulmonary hypertension. Setting and design A prospective, randomized, comparative study was conducted in Madinah Cardiac Center, Almadinah Almonourah, Saudi Arabia. Material and methods The study included 100 adult patients undergoing cardiac surgery with mean pulmonary artery pressure greater than 25 mmHg, as estimated preoperatively by Doppler echocardiography. The patients were classified randomly into two groups (n = 50): group A and group B. In group A, milrinone was started by infusion at a rate of 0.5 μg/kg/min without a loading dose at the beginning of CPB and continued postoperatively at a rate of 0.5-0.75 μg/kg/min in the cardiac surgical ICU. In group B, milrinone was given as a loading dose of 50 μg/kg over 10 min before weaning from CPB followed by infusion at a rate of 0.5-0.75 μg/kg/min postoperatively in the cardiac surgical ICU. Statistical analysis used Data were statistically described in terms of mean ΁ SD or frequencies and percentages, when appropriate, using the paired t-test. Measurements and main results Early milrinone using significantly decreased pulmonary artery pressure and pulmonary and systemic vascular resistances; it increased the right ventricular fractional area change, cardiac index, and urine output; and it decreased the serum lactate, pharmacological and mechanical supports, and ICU and hospital length of stay (P < 0.05). Conclusion The early administration of milrinone in adult cardiac surgery was associated with better hemodynamic effect, and it decreased the need for pharmacological supports. In addition, it was associated with shorter ICU and hospital length of stay without any side effects related to milrinone.
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What the cardiac surgeons have to know about cold agglutination management
Mahnoosh Foroughi, Masoud Majidi, Manouchehr Hekmat, Mahmood Beheshti
September-December 2014, 8(3):101-103
Cold agglutinin has specific importance in cardiac surgery field due to routine use of the systemic, topical hypothermia in cardiopulmonary bypass and cold cardioplegic solutions (4-12΀C). We describe a case of coronary artery bypass in which cold agglutinin was detected intraoperatively; hence, cardiopulmonary bypass and myocardial protection strategies were changed. A simple and not expensive test is introduced to screen these patients before operation, as screening is not routine before cardiac surgery in many heart centers. In addition, we provide a literature review for surgical consideration and highlight some important concerns that need to be addressed.
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Prophylactic use of a preoperative intra-aortic balloon pump in patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting
Imran Khan, Hadia M Mian, Madiha Iqbal, Hira Ijaz, Zafar Tufail
September-December 2014, 8(3):97-100
Objective The aim of this work was to study the effectiveness of preoperative intra-aortic balloon pump (IABP) in patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting (CABG). Materials and methods We studied 80 consecutive patients of both sexes undergoing elective on-pump CABG having an ejection fraction less than 30%. Thirty patients received preoperative IABP support prophylactically, whereas 50 patients did not. The decision to put an IABP was made by the individual surgeon operating the patient. Preoperative, intraoperative, and postoperative variables were recorded and 30 days' follow-up was obtained. Results were subjected to statistical analysis. Results Fifty one patients (63.7%) were male while 29 (36.25%) were female with a mean age of 55.62 ΁ 9.65 years. Patients who received preoperative IABP had high in-hospital mortality (P = 0.002) and decreased rate of postoperative acute kidney injury (P = 0.048), ICU stay (P = 0.031) and less requirement for postoperative inotropic support (P = 0.047) compared to those who did not receive IABP preoperatively. Conclusion The prophylactic use of IABP in patients with a low ejection fraction undergoing CABG does not decrease the mortality, but it has a favorable effect on postoperative major complications.
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Anaesthetic management of posterior mediastinal mass: a case report
Anjum Saiyed, Reema Meena, Babita Ambesh, Indu Verma
September-December 2014, 8(3):104-107
Posterior mediastinal mass surgery is a challenge to the anaesthetist in terms of airway obstruction, compression of great vessels due to mass effect of tumour and severe cardiovascular and/or respiratory collapse. This may occur following decrease in chest wall tone associated with neuromuscular blockade. In this case study, we report an 8-year-old male child presented with a large posterior mediastinal mass, displacing and partially encasing the aorta at our institution, SMS Medical College & Hospitals, Jaipur, Rajasthan. Mass was removed by left thoracotomy; endotracheal tube was advanced into the right bronchus to ventilate the right lung to improve access in the surgical field because tumour was situated on the left side. While dissecting the mass, there was considerable blood loss. This was replaced with hydroxyethyl starch and whole blood. Patient was extubated next day with uneventful recovery.
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Management of bronchial dehiscence immediately following video-assisted thoracoscopic lobectomy
Mostafa Eladawy, Leena Pardeshi
September-December 2014, 8(3):108-111
Bronchial dehiscence is a rare complication following lung surgery. It might be life threatening if not diagnosed and treated immediately and appropriately. This case report high-lights an immediate presentation of bronchial dehiscence in a patient after video assisted thoracoscopic lobectomy. The complication was managed initially with an emergency insertion of single lumen tube which was swapped later on to double lumen tube for a better control of the ventilation.Ventilation improved when the single lumen tube was exchanged for a double lumen tube and the patient was taken back to the Operating theatre for repair and suturing of bronchial stump.In conclusion, leakage testing inside the operating room must be given full attention and should warrant a thorough revision and reassessment of all the stumps by the surgeons, but exclusion of the leak intraoperatively does not guarantee prevention of its occurence postoperatively. Dislodgement of staples can happen and leads to deleterious effects if not treated promptly. Respiratory distress, arterial hypoxia and chest drain bubbling immediately after lung surgery should be managed with fiberoptic bronchoscopy followed by immediate intubation with double lumen tube and exclusion of the operated lung.
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