BNP, TnI and Lactic Acid variations in Warm Blood Cardioplegia vs Cold Crystalloid Cardioplegia in Coronary Artery Bypass Grafting (CABG)

Introduction: Myocardial protection is one of the key points during cardiac surgery. Inadequate myocardial protection in cross-clamping period is an issue of concern in cardiac surgery.  Cardioplegic solutions improve the tolerance of ischemia and reperfusion by preserving myocardial energy reserves, preventing osmotic, electrolyte imbalances and acidosis. Warm blood cardioplegia (WBC) has had a profound impact, especially in coronary artery bypass surgery and there have been many studies that compared it with Cold crystalloid cardioplegia (CCC). A good myocardial protection will be reflected especially on patients outcome, on postoperative ICU strategy, morbidity and mortality as well. Brain Natriuretic Peptide (BNP), Troponin I (TnI) and Lactic Acid LA) are very significant biomarkers that reflects an adequate myocardial and organ perfusion/protection. The purpose of this study is to determine if warm blood cardioplegia offers any advantages in comparison with CCC in Coronary Artery Bypass Grafting (CABG) based primary on variations of BNP, TnI and Lactic Acid. Patients and method: 60 patients with coronary artery disease (CAD) that will have Coronary Artery Bypass Surgery (CABG), were retrospectively randomized in two groups of 30 patients with different techniques of myocardial protection: group A had CCC, and group B had warm blood cardioplegia (WBC), according to Calafiore [1] protocols). Intraoperative and postoperative variables were used to assess primary outcomes. Results: This study found benefits of warm blood cardioplegia in clinical outcome after CABG Keywords:Myocardial protection, Cardiac surgery, Cardiopulmonary Bypass, Calafiore, Cardioplegia, Coronary Artery Bypass Grafting (CABG), Brain Natriuretic Peptide (BNP), Troponin I (TnI) and Lactic Acid LA) DOI: 10.7176/ALST/95-02 Publication date: November 30th 202

Patient with Wolff-Parkinson-White Syndrome undergoing Non-Cardiac Surgery. Perioperative Management

Background: Perioperative management of patients with preexcitation may become quite challenging, especially if there is no time for adequate preoperative investigation and clinical optimization, as in emergencies, or even worse, in undiagnosed cases. It is possible that the poorly controlled or unknown underlying electrophysiological abnormality will become unmasked during anesthesia and surgery, giving rise to potentially life-threatening arrhythmias. In the literature, pre-excitation syndromes have been mainly approached from the view of the disease (i.e., presentation, diagnosis, treatment), while anesthetic data are scarce. This case report aims to focus on the perioperative management of patients with WpW. Conclusion; Managing such cases provides an opportunity to revisit important considerations on Wolff-Parkinson-White syndrome avoiding neuromuscular blockers may make a difference in avoiding arrhythmias when laryngeal mask airway / general anesthesia is required in patients with Wolff-Parkinson-White syndrome. sympathetic stimulation should be avoided as it may shorten the refractory period of ap and alleviate life-threatening arrhythmias. Keywords: WpW, arrhythmias, bundle of Kent, anesthesia DOI: 10.7176/ALST/95-03 Publication date: November 30th 2022