The Cardioprotective Effects of N acetylcysteine as an Additive to the Blood Cardioplegia During Coronary Artery Bypass Grafting

Abstract: Introduction: During coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB), the role of cardioplegic solution which results in cardiac arrest, is critical. This study was planned to evaluate the clinical impacts of N acetylcysteine (NAC) enriched cold-blood cardioplegia on early reperfusion injury in patients with ischaemic heart disease undergoing CABG. Methods: In a randomized double blind clinical trial, seventy patients undergoing elective CABG surgery with CPB were studied. They all underwent similar methods of preoperative medication, anaesthesia and cardiac surgery. Patients were randomly divided into the case group (cardioplegia plus 50 mg/kg NAC) and the control group (cardioplegia with the equal volume of normal saline). The incidence of arrhythmias, usage of DC-shock, pacemaker and inotropic agents during and twenty four hours after surgery, EF five days after surgery and ICU staying and hospitalization periods in the two groups were compared. Results: There were no statistically significant differences between the two groups according to demographic features, EF before surgery, CPB or aorta clamping times, intraoperative DC shock and pacemaker requirements and postoperative inotropic necessity (p >0.05). Two groups showed significant differences in regard to the incidence of arrhythmias (5.7% vs. 22.9%), the inotropic requirement (14.3% vs. 34.3%) during surgery, EF five days after surgery (51.4% vs. 45%) and the mean EF changes postoperatively in comparison with the preoperative period (0.88 vs. -2.28) (p <0.05). Conclusion: Addition of N-acetylcysteine to cardioplegic solution can reduce some of the clinical complications during and after surgery and has positive effects on the postoperative ejection fraction. Keywords: Coronary artery bypass grafting, N acetylcysteine, Cardiac surgery, Cardioplegi

Septic Thrombophlebitis of the Cephalic Vein Caused by a Peripherally Inserted Venous Catheter

Septic thrombophlebitis of a vein is a rare but life-threatening complication of an intravascular (IV) catheter placed percutaneously in the veins. Most published clinical experiences with IV catheters, mainly in the outpatient settings, have reported very low rates of catheter-related bloodstream infection compared to rates with central venous catheters placed in a subclavian or internal jugular vein. Most of the complications reported with IV catheters have been non-infectious, particularly sterile phlebitis or thrombosis. We report a case of cephalic vein suppurative thrombophlebitis from an intravascular catheter and offer guidelines for diagnosis and management of this complication.&#13; Key words: Septic thrombophlebitis, Intravascular catheter, Suppurative thrombophlebiti