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   2015| January-April  | Volume 9 | Issue 1  
    Online since July 9, 2015

 
 
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ORIGINAL ARTICLES
Comparison of the cardioprotective effect of isoflurane versus sevoflurane during cardiopulmonary bypass in congenital heart surgery
Passaint Hassan
January-April 2015, 9(1):1-7
DOI:10.4103/1687-9090.160325  
Aims This study aimed to detect the difference in the preconditioning effect between isoflurane and sevoflurane when they are used just before aortic cross-clamp and continued throughout the bypass period by measuring cardiac troponin I (cTnI) in the postbypass period. Settings and design This individual closed-envelope randomization study was carried out in the Abou Ell-Resh Pediatric Hospital, Cairo University Unit of congenital heart surgery in collaboration with the anesthesia department. The study was approved by the local ethical committee and a written informed consent was obtained from the guardians of the patient. This study was carried out from March 2011 to September 2012 (18 months). Patients were allocated randomly to two equal groups of 30 patients each. Participants and methods Acyanotic and cyanotic patients were allocated randomly to two equal groups of 30 patients each using individual closed-envelope randomization. Patients were allocated randomly to two equal groups as follows: group I, isoflurane group (n = 30) (received isoflurane) and group S, sevoflurane group (n = 30) (received sevoflurane). cTnI, a baseline sample was obtained before cardiopulmonary bypass (T0), 8 h after bypass (T8), and 24 h after bypass (T24). Parametric data were described as mean, SD, median, and SEM. The two groups studied were compared using Student's t-test. Repeated measures of the same group were compared using two-way analysis of variance, followed by post-hoc Tukey's comparison tests. For nonparametric data, nonparametric tests were used for comparison such as the Mann-Whitney U-test, median, or quartiles. P value less than 0.05 was considered significant (size estimation with two means is 28). Results Comparison of sevoflurane and isoflurane acyanotic cases showed that the cTnI (P = 0.02 and 0.01, respectively). Comparison of isoflurane and sevoflurane cyanotic cases showed that the cTnI values 8 and 24 h after bypass were higher in cyanotic cases of the isoflurane group than those of the sevoflurane group, but the difference was statistically insignificant. In terms of the difference between cyanotic and acyanotic cTnI results in the isoflurane group, cTnI values 8 h after cardiopulmonary bypass were higher in cyanotic cases compared with acyanotic cases, but this difference was insignificant, with a P value of 0.42. At 24 h after CPB, cTnI values were significantly higher in cyanotic cases with a P value of 0.015. In terms of the difference between cyanotic and acyanotic cTnI results in the sevoflurane group, the cTnI level 8 h after CPB was significantly higher in cyanotic cases compared with acyanotic cases with a P value of 0.001; it was also significantly higher in cyanotic cases 24 h after CPB with a P value of 0.005. Conclusion The present study showed that sevoflurane is superior to isoflurane in myocardial protection in surgical correction of congenital heart diseases only in acyanotic cases, with no difference in cyanotic cases.
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A prospective randomized comparative study between Macintosh and GlideScope in adult patients undergoing cardiac surgery
Rabie Soliman, Mohammed Mofeed, Osama Alamoudy, Abeer Farouk
January-April 2015, 9(1):8-13
DOI:10.4103/1687-9090.160326  
Context The GlideScope laryngoscope is a new device for intubation that provides an improved view of the larynx. Aim The aim of the study was to compare the hemodynamic effect of Macintosh laryngoscope with GlideScope during intubation in adult cardiac surgery. Setting and design This was a prospective, randomized, comparative study conducted in Madinah Cardiac Center, Saudi Arabia. Materials and methods The study included 100 patients classified into two groups (n = 50), The patients were intubated either by Macintosh laryngoscope or by GlideScope. The following parameters were monitored: heart rate, mean arterial blood pressure, catecholamine level, intubation time, number of intubation trials, and the complications. Statistical analysis used Data were statistically described in terms of mean ΁ SD or frequencies. Measurements and main results The intubation time was longer in GlideScope than in Macintosh (P < 0.001), and the number of intubation trials was higher in GlideScope than in Macintosh (P < 0.001). The heart rate increased significantly in patients of the GlideScope group compared with the Macintosh group at first minute (P < 0.001), third minute (P < 0.001), and at fifth minute (P = 0.034). The mean arterial blood pressure increased significantly in patients of the GlideScope group compared with the Macintosh group at first minute (P < 0.001), third minute (P = 0.003), and at fifth minute (P = 0.029). The epinephrine level was higher with GlideScope at first and fifth minute (P = 0.032 and 0.036, respectively). The norepinephrine was higher in the GlideScope group at first and fifth minute (P = 0.043 and 0.033, respectively). The incidence of oral trauma and bleeding was higher with GlideScope than Macintosh (P = 0.003). Conclusion The intubation by GlideScope is associated with increased heart rate, blood pressure, catecholamine level, number of intubation trials, and oral complications compared with Macintosh laryngoscope.
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CASE REPORT
Abstracts of the Egyptian Cardio-Thoracic Anesthesia Society (ECTAS) Conference, 12-14 February 2015. El-Gouna, Hurgada, Egypt

January-April 2015, 9(1):14-15
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