Heparin- induced thrombocytopenia (HIT): a case report of CABG patient

Heparin- induced thrombocytopenia (HIT) is an antibody mediated adverse effect of heparin therapy which is classified into two subtypes, HITI which is non-immune, spontaneously reversible thrombocytopenia and; HITII which is an autoimmune-mediated adverse effect of heparin therapy. In this case report, we described a 65-year old male patient with HITII after coronary artery bypass grafting.Key words: Heparin- induced thrombocytopenia, Heparin- induced thrombosis, coronary artery bypass grafting

The Preconditioning Effect of Sevoflurane on Coronary Artery Bypass Surgery Patients

Background: One of the most important issues in the field of surgery is ischemic preconditioning (IPC) of the myocardium during the coronary artery bypass grafting (CABG). The current study attempted to reevaluate the issue to find a potential approach to diminish morbidity, inotrope administration, ischemia and possibly intensive care unit stay after CABG in adult patients.Materials and Methods: Through randomized single-blind clinical trial, all elective coronary bypass surgeries in 40 to 80 years-old patients enrolled the study. Atrioventricular (AV) block (mobitz2); complete heart block; left bundle branch block (LBBB); acute heart failure (ejection fraction (EF) <30%); re-exploration due to surgical complications and MI cases in the last 7 days were excluded. In all patients, induction (sufentanil, cis-atracurium and etomidate) and maintenance phase (sufentanil, midazolam, cis-atracurium) of anesthesia were done following the same protocol. After cross-clamp of aorta in intervention group, the patients received oxygen (2Lit/min) and sevoflurane (4%) during coronary bypass surgery. After rewarming of the patients, sevoflurane was discontinued. Main outcome measures were troponin 4, 8, 24, 48 hours after surgery with charting the electrocardiogram (ECG) changes, need for inotrope agents and hemodynamic indices during and after CABG in ICU.Results: 58 CABG candidates enrolled the current study: 29 in intervention group and 29 in control group. There were no statistical differences between the groups concerning hemodynamic issues, Central Venous Pressure (CVP), hematocrit (HCT), ECG changes, demands for inotrope, or ICU stay between the groups.Conclusion: No significant relationship between application of 4% sevoflurane and IPC was found in adult CABG patients. However, the effect of Sevoflurane on IPC might be dose-related.Keywords: Ischemic preconditioning (IPC); Sevoflurane; Coronary Artery Bypass Surgery (CABG

Neuroprotective Strategies in the Perioperative Period: A Systematic Review

Surgery and anesthetics may cause brain damage, and the resulting neurological defect can impair the patient's cognitive function. This disorder is one of the most common complications after surgery and causes disorders in several cognitive areas of the patient. The mechanism of this disorder is not fully understood, but Neuronal inflammation is one of the main causes of this disorder. The purpose of this systematic review study was to evaluate neuroprotective drug strategies for the treatment or prevention of surgical disorders associated with anesthesia. We searched the keywords "neuroprotective", "neuroprotection", "postoperative" and "perioperative" in the databases of web of science, Scopus, PubMed, science direct and Google Scholar with a 5-year time limit. At first, 492 articles were obtained and finally, after detailed survey based on exclusion and inclusion criteria, 31 studies were selected to extract data. Findings from studies show that medication and treatment strategies used in group of mice and rats under surgery with treatment can improve Neuronal inflammation and brain damage compared to mice and rats with surgery only and reduce the side effects of surgery and anesthetics

Frequency of cardiac involvement among patients with Ankylosing Spondylitis

Background and aims: Ankylosing spondylitis (AS) is an idiopathic chronic inflammatory disease mainly involves sacroiliac and axial joints; but it may also have extra-articular involvement. Accordingly, this study was designed to determine the frequency of cardiac involvement among patients with ankylosing spondylitis. Methods: This study was performed as a descriptive-analytical cross-sectional survey. In this study 50 consecutive patients with AS and 40 normal healthy subjects were enrolled and compared for cardiologic manifestations. Results: The frequency of cardiac involvement was similar between AS patients and normal subjects (P>0.05). However, there was significant difference between 2 groups in point of mitral valve prolapse and mitral regurgitation (P<0.05). Conclusions: Totally, according to the obtained results, it may be concluded that the frequency of cardiac involvement in AS patients and normal subjects were relatively similar

Management of Alveolar Proteinosis by Bronchopulmonary lavage under Extra Corporeal Membrane Oxygenation (ECMO)

The gold standard of treating Pulmonary Alveolar Proteinosis (PAP) is bronchopulmonary lavage (BPL). We describe a rare case of BPD for PAP, who underwent extracorporeal membrane oxygenation (ECMO) due to hypoventilation in the setting of one-lung ventilation. First, the clinical course of the patient is presented; furthermore, the biomolecular basis of PAP and new treatment approaches is discussed. &nbsp

Potential effect of coenzyme Q10 (Ubiquinone) on serum NGAL biomarker and kidney function following Coronary Artery Bypass Grafting surgery

Background: Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) surgery, and is associated with major adverse outcomes. Effect of preoperative administration of coenzyme Q10 was evaluated in order to realize that whether it could prevent the occurrence of AKI following elective CABG surgery. Materials and Methods: Two hundred and fifty patients who were candidate for elective CABG surgery between September 2017 and August 2018 were randomly assigned to intervention group (receiving coenzyme Q10, 300 mg BID for 2 days before surgery) and control group. Serum NGAL (neutrophil gelatinase-associated lipocalin) was measured at baseline, 6 and 24 hours after surgery. Serum creatinine (sCr) and urine output (UO) were also measured at baseline and after surgery. Results: Fifty patients completed the study. The total incidence of acute kidney injury was 32%. There were no significant differences in the incidence of AKI (p=0.07) between the two groups. Serum NGAL was shown no significant difference at 6 (p=0.13) and 24 (p=0.22) hours after surgery compared to the baseline level between the two groups, whereas, the significant difference in the hospitalization duration was shown between them (p=0.02). Conclusion: CoQ10 supplementation did not significantly decrease the incidence of AKI in patients undergoing elective CABG

The Effect of Bromelain Combined With Montelukast in Hospitalized COVID-19 Patients

Introduction: The activation of bradykinin B1 receptors on endothelial cells in the lung following inflammation is a major cause of the severity and mortality of COVID-19. It has already been shown that bromelain and montelukast as two anti-inflammatory agents can be effective in controlling this condition. Methods: Patients with the novel coronavirus (COVID-19) referred to Masih Daneshvari hospital in Tehran were included in the study after providing full explanations and obtaining written consent. All 40 patients with moderate symptoms were randomly divided into the placebo (n=20) and intervention (n=20) groups. In the sample group, a dose of 200 mg oral bromelain was given to patients every 8 hours and one tablet of montelukast 10 mg 1 hour before or after dinner for 5 days. In the control group, placebo capsules were administered exactly at the above intervals. The results were evaluated using a t test and SPSS21 software. Results: After treatment, the sample (bromelain and montelukast) group represented significant improvements in C-reactive protein (CRP), lactate dehydrogenase (LDH), and lymphocyte count (P<0.05), while the other factors did not have significant differences with the control group. Conclusion: Bromelain and montelukast can improve the condition of hospitalized COVID-19 patients by the positive effect on oxygen saturation, lymphocytes, serum levels of CRP, and LDH

Thiamine can decrease Lactate and Creatinine level after Coronary Artery Bypass Surgery in Patients with Mild Systolic Dysfunction

Introduction: During cardiopulmonary bypass, oxidative stress happens in the patient's cells due to blood contact with various levels of synthetic materials. It can activate inflammatory process and release factors such as IL-6, CRP, and Neutrophils witch may hurt different organs. In recent years, many efforts have been made to prevent this type of damage, however, no single treatment has been proposed to reduce this risk. Antioxidant substances such as Thiamine is important in cell defense against free oxygen radicals. Regarding this issue, in this study, the effect of thiamine on lactate levels in patients undergoing coronary artery bypass graft surgery has been investigated.Materials and methods: In this study, 140 patients from 25 to 65 years old with mild systolic dysfunction (EF = 45-55%) who were candidates for elective CABG surgery in two groups: control and purpose (patients receiving Thiamine) were examined. All of these patients were anesthetized in an identical manner, and were subjected to a heart-lung pump. Serum lactate levels were measured before, during and 6, 12, 18, and 24 hours after surgery. All data collected in a questionnaire were recorded and evaluated using spss statistical software.Results: Study groups showed no significant differences regarding demographics and underlying diseases. Serum lactate was significantly lower in thiamine group during the first 24 hours after surgery (except before operation and 2 hours later) (p &lt;0.05).Creatinine level in two groups before surgery was not significantly different ,However, it was significantly lower in case group 24 hours after surgery(1.54±0.14 vs. 1.24±0.19; p: 0.001).Also, dose of Inotropes in  patients who received thiamine, was significantly lower than the control group (p= 0.001). Extubation was longer in control group (15.4±4.9 vs. 13.15±4.1; p=0.003) while ICU stay was not different.Conclusion: It seems that thiamine administration before cardiopulmonary bypass, in patient with decreased left ventricular function, can decrease serum lactate as tissue perfusion marker and also improve kidney function

Comparison of Different Ventilation Strategies during Cardiopulmonary Bypass in Smoker Patients Under Cardiac Surgery

Background: Control of pulmonary ventilation during surgery, especially heart surgery, is very important. Therefore, in this study, we will compare different ventilation strategies during cardiopulmonary bypass in smokers undergoing cardiac surgery. Methods: A total of 42 patients who had a clinical indication for CABG were included in this study. Patients were randomly divided into two groups.  All patients were operated on by the same surgeon and cardiac anesthesia team in the same condition. The patient data includes age, sex, height, weight, and spirometry indices (FEV1, FVC, FEV1 / FVC, MMEF, PEF, PaO2, PaCO2, PaO2 / fio2, PaO2 / fio2, and Pent. T)  were recorded prospectively for each patient. Results: Examines the spirometry indices of patients in the two groups in both pre-procedure and off-pump time, do not show significant changes (P<0.005). Conclusion: The use of different ventilation strategies in smokers undergoing CABG surgery could not cause significant changes in patients' respiratory parameters