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 <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

Effect of oral tizanidine on prolongation of intrathecal lidocaine

Objective: In order to prolong the duration of intrathecal lidocaine, various drugs are used along with it. Due to the promising effects of tizanidine on central nervous system, it can be assumed that tizanidine can have a positive effect on increasing the anesthesia duration too. Thus, we aimed to investigate the effect of oral tizanidine on the duration of lidocaine spinal anesthesia. Methods: This double blind clinical trial was conducted on 40 male patients waiting for elective leg surgery with the age range of 20-60 years in one of the educational hospitals of Kerman University of Medical Sciences, Iran. We used simple random sampling and our participants were assigned into 2 groups (placebo and oral tizanidine receivers). Spinal anesthesia with 1 mg/kg of hyperbaric lidocaine 5% was performed in both groups. In tizanidine group, patients received 4 mg of oral tizanidine one hour before spinal anesthesia. Sensory block was examined by pin prick test and all anesthetic duration including start block until reduction of sensory level was calculated at 2 lower dermatomes. Results: Findings showed that oral tizanidine compared to placebo can cause a 10-15 minute increase in patients’ lidocaine spinal anesthesia. Therefore, the average anesthesia time for tizanidine group increased meaningfully (P = 0.03). In addition, tizanidine can sedate patients during surgery (P = 0.00) or in recovery (P = 0.003). Conclusion: Based on the results, tizanidine increased the duration of lidocaine so oral tizanidine can be used to prolong the duration of lidocaine spinal anesthesia

Effect of dexmedetomidine infusion on hemodynamics and stress responses in pediatric cardiac surgery: A randomized trial

Background: Infants and children compared with adults have intensified stress responses that lead to increased morbidity and mortality. Stress control reduces the incidence of complications and improves recovery. In clinical and experimental studies, dexmedetomidine reduces the inflammatory and neuroendocrine responses. Objectives: This prospective randomized double-blinded clinical trial was conducted to assess the role of dexmedetomidine in reducing stress responses. Materials and Methods: According to convenient sampling method, 40 patients in two groups (case under treatment with dexmedetomidine and control, each including 20 patients) were selected from whom admitted for open heart surgery. Anesthe- sia was induced and maintained by fentanyl and midazolam. After central venous and arterial catheter insertion, patients were randomly allocated into one of two equal groups (n = 20 each). In the dexmedetomidine group, patients received an initial loading dose (0.5 μg/kg) during10 minutes immediately followed by a continuous infusion of 0.5 μg/kg. In the control group, normal saline solution with similar volume was infused. Results: Changes in heart rate, systolic and diastolic blood pressures and central venous pressure before administration of dexmedetomidine, in 10, 20 and 30 minutes after the operation, after skin incision, after sternotomy, after separation from the pump and at the end of procedure showed no significant difference between the two groups (P = 0.860, 0.067, 0.888 and 0.482, respectively). Changes in lactate, interleukin 6, tumor necrosis factor, C-reactive protein concentrations before administration of dexmedetomidine, after separation of pump and 24 hours after intensive care unit entrance showed no significant difference be- tween the two groups (P = 0.525, 0.767, 0.868 and 0.840, respectively). Conclusions: According to our findings, using dexmedetomidine as an adjuvant anesthetic medication with initial loading dose of 0.5 μg/kgand maintenance dose of 0.5 μg /kg in pediatric heart surgeries is a safe choice. However, further studies are needed to clarify the role of dexmedetomidine to reduce stress responses