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   2016| January-April  | Volume 10 | Issue 1  
    Online since June 1, 2016

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Monitoring the correlation between passive leg-raising maneuver and fluid challenge in pediatric cardiac surgery patients using impedance cardiography
Heba AA Labib, Rania M Hussien, Yasser A Salem
January-April 2016, 10(1):17-22
Aim The aim of the study was to highlight the effectiveness of passive leg-raising maneuver as a predictor of fluid responsiveness in pediatric patients following cardiac surgery and to determine the parameter that we can depend on to assess its responsiveness. Patients and methods This prospective randomized study was performed in the ICU. Forty pediatric patients aged 2-7 years with a noncyanotic cardiac defect scheduled for elective corrective cardiac surgery under cardiopulmonary bypass (CPB) support were included if they needed fluid challenge (FC) in the early postoperative period (10 ml/kg normal saline infusion). Hemodynamic parameters [heart rate, mean blood pressure, stroke volume (SV), and cardiac index (CI)] were assessed at baseline, after passive leg raising (PLR), at baseline again, and after FC. Statistical analysis A comparison of pre-PLR and post-PLR hemodynamic parameters and those before and after FC was made using the paired Student's t-test, whereas a comparison after passive leg raising (PLR) and FC was made using the unpaired Student's t-test. The hemodynamic parameters after PLR and its relation to the responses to fluid administration were analyzed using diagnostic validity tests and the χ2 -test. Results The increase in SV and CI with PLR is significantly correlated with the response to fluid administration. An increase in CI by 10% or more due to PLR predicted preload-dependent status with a sensitivity of 65% and a specificity of 75%, whereas an increase in SV by more than 10% due to PLR predicted preload-dependent status with a sensitivity of 42.1% and a specificity of 85.7%. Conclusion The PLR maneuver is a reliable noninvasive method that can predict volume responsiveness in post-cardiac-surgery pediatric patients. Both SV and CI can be used as predictors of fluid responsiveness, although CI is a more accurate.
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Experience with cardiac surgery in a private tertiary hospital in Chennai, India
Oyebola O Adekola, Ezekiel O Ogunleye, Juriel G Kurien, Akinsanya Olusegun-Joseph, Olufunmilayo O Ajayi, Olugbenga O Ojo, Sanjay Cherian
January-April 2016, 10(1):6-11
Background Major perioperative complications are not uncommon during cardiac surgery, which has been attributed to an increase in patients scheduled for complex and urgent cardiac surgeries on account of a surge of patients at the extremes of age. Patients and methods This was a cohort study of patients anesthetized for open heart surgery from March 2012 to May 2012 at the Frontier Lifeline Hospital, Chennai, India. Primary outcome measures were the pattern of presentation and complications following cardiac surgery. Secondary outcome measure was the 30-day perioperative mortality associated with cardiac surgery. Results A total of 291 patients underwent cardiac surgery. Their mean age was 34.71 ΁ 26.25 years (range 8.4 months to 81 years). Of them, 63.57% were adults and 66.32% were male. The most common indication for cardiac surgery was coronary artery disease [135 (46.39%) patients], followed by septal defect [60 (20.62%)] and valvular defect [40 (13.75%)]. In patients with coronary artery disease, triple-vessel disease occurred in 39.26% and double-vessel disease in 32.59%. Three patients underwent coronary artery bypass grafting plus mitral or aortic valve replacement, whereas off-pump coronary artery bypass grafting was performed in three (2.22%) patients. Sixty-three complications were observed in 291 patients (21.64%); the most common complication was significant pleural effusion in 13 patients (4.47%), followed by deep sternal wound infection in 10 (3.44%) and respiratory failure in seven patients (2.41%). Thirty days' perioperative mortality was seen in 17 patients (5.84%). Conclusion We have demonstrated that major complications are not uncommon after cardiac surgery. However; prompt and appropriate intervention reduces mortality.
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Higher incidence of emergence agitation in children with genetic intronic variant GABRγ2 rs2279020 after sevoflurane anesthesia
Zeinab Y Bayoumy, Horea F Ahmad, Heba Nabil Baz
January-April 2016, 10(1):1-5
Emergence agitation (EA) is very common in Preschool children who receive Sevoflurane anesthesia. The GABA receptors are the target effect site of Sevoflurane. The aim of this study Is to investigate if GABRγ2 Genetic variant (or Single nucleotide polymorphism SNP) rs211037 and an intronic nucleotide number rs2279020 polymorphism from A to G, is associated with EA after Sevoflurane anesthesia in Preschool children. Patients and Methods This study included 60 pre-school children, ASA I, of both sexes who underwent lower abdominal surgery, anesthetized by Sevoflurane and caudal blockade. At emergence, children were assessed for EA every 5 min, in PACU by Watcha scale1: (0: Asleep, 1: calm, 2: crying, can be consoled, 3: crying, cannot be consoled, or 4: agitated and thrashing). Children were divided into 2 groups. Gr.I: Non-agitated children; scored (0, 1 or 2) Gr.2: Agitated children; scored (3 or 4). GABA receptor gene polymorphisms rs211037 and intronic rs2279020 were genotyped by PCR-RFLP. Results GABRγ2 rs211037 stratified the cases into wild homozygous CC in (65%) and Heterozygous CT in (35%) of children, none of the cases was homozygous mutant (TT). The two groups showed insignificant EA between them. The intronic polymorphism rs2279020, however, was heterozygous AG in 73.3% of the cases; it was associated with EA in 54.50% of children versus 9 % in AA and 0.0% in GG Introns, (P < 0.001). Conclusion There was high incidence of EA in children with genetic intronic variant GABRγ2 (SNP) rs2279020 (A/G) after Sevoflurane anesthesia.
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Addition of dexamethasone to magnesium decreases atrial fibrillation following coronary artery bypass grafting surgery
Hoda Shokri, Ihab Ali, Ahmed Hassouna
January-April 2016, 10(1):12-16
Objective Atrial fibrillation (AF) is a frequent complication that occurs within the first 5 days after cardiac surgery with a reported incidence of 20-40%. It might lead to significant morbidity, such as stroke and myocardial infarction. This prospective study aims to assess the potential benefit of adding a standard dose of dexamethasone to intravenous magnesium (Mg) in the case of AF after coronary artery bypass grafting (CABG). Patients and methods This was a prospective, randomized, parallel group study conducted in Ain Shams University Hospital. One hundred patients scheduled for elective primary isolated CABG were included. All patients had a preoperative sinus rhythm. Patients in the dexamethasone plus magnesium (DMg) group (50 patients) received two doses of intravenous dexamethasone (6 mg each) along with two doses of Mg supplementation (2 g each) within the first postoperative day. Patients in the Mg-only group (50 patients) received two doses of Mg supplementation (2 g each) at the similar time as patients in the DMg group. Continuous ECG recording was carried out for the first 72 h for all patients. Incidence of postoperative complications caused by dexamethasone was recorded. Measurements and main results All patients (50 in each group) completed the study. There was no significant difference between the two study groups with regard to demographic data, preoperative comorbidities, and surgical factors. The incidence of postoperative AF was significantly lower in the DMg group (P < 0.05) compared with the Mg-only group. There was no significant difference between the study groups regarding duration of postoperative ICU stay and extubation time. There was no significant difference between the study groups regarding incidence of chest infection (P = 0.7), sternal wound infection (P = 0.5), and urinary tract infection (P = 0.6). Conclusion Addition of dexamethasone (12 mg) to MgSO 4 (2 g) seems to decrease the incidence of new-onset AF in primary isolated elective CABG surgery without an increased incidence of complications.
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Correlation between passive leg raising manoeuvre and fluid challenge in paediatric cardiac surgery patients by the use of impedance cardiography
Ali Jamshid
January-April 2016, 10(1):23-24
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