A study of the efficacy of furosemide as a prophylaxis of acute renal failure in coronary artery bypass grafting patients: A clinical trial

BACKGROUND: Renal failure is a frequent event after coronary artery bypass grafting (CABG). Hemodynamic alterations during surgery as well as the underlying disease are the predisposing factors. We aimed to study intermittent furosemide therapy in the prevention of renal failure in patients undergoing CABG. METHODS: In a single-blind randomized controlled trial, 123 elective CABG patients, 18-75 years, entered the study. Clearance of creatinine, urea and water were measured. Patients were randomly assigned into three groups: furosemide in prime (0.3-0.4 mg/kg); intermittent furosemide during CABG (0.2 mg/kg, if there was a decrease in urinary excretion) and control (no furosemide). RESULTS: There was a significant change in serum urea, sodium and fluid balance in �intermittent furosemide� group; other variables did not change significantly before or after the operation. Post-operative fluid balance was significantly higher in �intermittent furosemide� group (2573 ± 205 ml) compared to control (1574 ± 155 ml) (P < 0.010); also, fluid balance was higher in �intermittent furosemide� group (2573 ± 205 ml) compared to �furosemide in prime� group (1935 ± 169 ml) (P < 0.010). CONCLUSION: The study demonstrated no benefit from intermittent furosemide in elective CABG compared to furosemide in prime volume or even placebo. © 2015, Isfahan University of Medical Sciences(IUMS). All rights reserved

Effect of low-dose Dopamine on lactate level in patients undergoing coronary bypass surgery

Background: The aim of this study was to study the effect of low-dose Dopamine on the blood lactate levels as a sign of visceral perfusion in coronary artery bypass graft surgery (CABG) patients. Methods: In a double-blinded, randomized clinical trial, 100 adult patients - who were candidated for elective isolated CABG surgery - were divided equally into two groups of low-dose Dopamine group (2 μg / kg / min) and control group (n=50 in each). Lactate levels, arterial blood gas analyses, blood pressure, and heart rate were recorded intraoperatively at four time points: before the induction of anesthesia; 15 minutes after the beginning of cardiopulmonary bypass (CPB); during CPB at rewarming to 34°C; and 15 minutes after separation from CPB. These biochemical and hemodynamic parameters were compared in these four time points between the two study groups. Results: Arterial blood gas and hemodynamic parameters were similar between the two groups during surgery (p values > 0.05). There were no significant differences between the lactate levels in the Dopamine and control groups at the beginning of CPB (3.1 ± 2.5 vs. 2.6 ± 2.0 mg/dl; p value = 0.453), at the time of rewarming (3.1 ± 2.5 vs. 2.6 ± 2.0 mg/dl; p value = 0.510), and after CPB (3.1 ± 2.5 vs. 2.6 ± 2.0 mg/dl; p value = 0.551) - respectively. Conclusions: The use of low-dose Dopamine did not decrease lactate levels in our CABG patients using CPB

Comparison of bispectral index monitoring with the critical-care pain observation tool in the pain assessment of intubated adult patients after cardiac surgery

Background: Detecting pain is crucial in sedated and mechanically ventilated patients, as they are unable to communicate verbally. Objectives: This study aimed to compare Bispectral index (BIS) monitoring with the Critical-care pain observation tool (CPOT) and vital signs for pain assessment during painful procedures in intubated adult patients after cardiac surgery. Materials and Methods: Seventy consecutive patients who underwent cardiac surgery (coronary artery bypass graft or valvular surgery) were enrolled in the study. Pain evaluations were performed early after the operation in the intubated and sedated patients by using BIS and CPOT, and also checking the vital signs. The pain assessments were done at three different times: 1) baseline (immediately before any painful procedure, including tracheal suctioning or changing the patient�s position), 2) during any painful procedure, and 3) five minutes after the procedure (recovery time). Results: The mean values for CPOT, BIS, and mean arterial pressure (MAP) scores were significantly different at different times; they were increased during suctioning or changing position, and decreased five minutes after these procedures (CPOT: 3.98 � 1.65 versus 1.31 � 1.07, respectively (P � 0.0001); BIS: 84.94 � 10.52 versus 63.48 � 12.17, respectively (P � 0.0001); MAP: 92.88 � 15.37 versus 89.77 � 14.72, respectively (P = 0.003)). Change in heart rate (HR) was not significant over time (95.68 � 16.78 versus 93.61 � 16.56, respectively; P = 0.34). CPOT scores were significantly positively correlated with BIS at baseline, during painful stimulation, and at recovery time, but were not correlated with HR or MAP, except at baseline. BIS scores were significantly correlated with MAP but not with HR. Conclusions: It appears that BIS monitoring can be used for pain assessment along with the CPOT tool in intubated patients, and it is much more sensitive than monitoring of hemodynamic changes. BIS monitoring can be used more efficiently in intubated patients under deep sedation in the ICU. � 2016, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). All rights reserved

Frequency of reoperation due to bleeding and its related factors after adult cardiac surgeries

Background: Reoperation due to bleeding in adult cardiac surgeries is an important postoperative complication that increases mortality and morbidity. Studying the risk factors and outcomes of reoperation in these patients is imperative. Methods: The present descriptive (cross-sectional) study performed a 3-month assessment of patients that underwent elective cardiac surgeries (coronary or valve surgeries or both). The inclusion criterion was being an adult undergoing elective cardiac surgeries on cardiopulmonary bypass (coronary or valve surgeries or both), and the exclusion criteria consisted of congenital heart diseases, cardiac surgeries without cardiopulmonary bypass, emergency cardiac surgeries, aneurysm and aortic dissection surgeries, known causes of bleeding due to acquired or congenital diseases, and redo cardiac surgeries. Results: Of 740 patients studied, 55 (7.43) patients returned to the operating room due to bleeding. Of these 55 patients, 74.5 had bleeding due to surgical operations, 23.6 due to tamponade, and 1.8 due to coagulation disorders. Apropos risk factors, there was a significant relationship between the international normalized ratio (INR) and bleeding after cardiac surgeries leading to reoperation (P = 0.05). Conclusions: In this study, 7.43 of the patients returned to the operating room because of bleeding, which is an acceptable percentage according to the literature. There was a significant relationship between preoperative INR and postoperative bleeding resulting in reoperation. © 2020, Iranian Heart Association. All rights reserved