The Effects of Vitamin D3 in Pediatric Patients Undergoing Congenital Heart Surgery

Background: To investigate the effects of vitamin D3 on the surgical outcome of pediatric patients undergoing cardiac surgery for congenital heart conditions. Materials and Methods: Ninety pediatric cardiac surgery patients referred for preoperative evaluation were enrolled. Patients with insufficient vitamin D3 levels received intramuscular vitamin D3 (300,000 IU) three days before the surgery and those with final vitamin D3 level of ≥30 ng/dl were included and divided into 3 groups (Group A: abnormal Vit D levels, no Vit D treatment; Group B: abnormal Vit D levels, Vit D treatment up to normal serum Vit D levels before surgery; Group C: normal baseline Vit D levels, no supplemental Vit D treatment). Interleukin 1, 6, 10, tumor necrosis factor-alpha, vital signs, and arterial blood gas parameters were measured before the surgery and at 6 and 24 hours after cardiopulmonary bypass. Data on total hospital stay, reoperation rates, and inotropes scores were retrieved. Additionally, postoperative measures including hemodynamic factors, blood pressure, heart rate, cardiac output, electrocardiography changes, chest-tube drainage, and ventilation-related factors (i.e. respiratory rate, arterial blood gas, respiratory resistance, intubation time, …) were recorded. Results: We observed a significant increase in post cardiopulmonary bypass levels of IL-10 and IL-6 in all groups (p<0.002) regardless of vitamin D treatment status; however, no significant difference was seen in levels of IL-1 and TNF-alpha. Groups B had more patients with critical levels of VIS scores compared to groups A and C (p<0.002). Furthermore, no differences in hemodynamic and metabolic parameters were observed. Conclusion: No significant difference in the rates of postoperative parameters in patients with normal and those with deficient levels of vitamin D3 was observed

The Effect of Oral Triiodothyronine in Outcome of Pediatric Congenital Cardiac Surgery

Background: Cardiac surgery especially in small children is associated with a marked decrease in thyroid hormone levels consistent with the phenomenon referred to as Sick Euthyroid Syndrome (SES). The purpose of the present study was to determine if oral triiodothyronine could reduce the length of ICU stay, vasoactive inotropic score (VIS), and promote ejection fraction in infants and children undergoing cardiac surgery with CPB. Materials and Methods: In a double-blind clinical trial, one hundred and twenty children aged 6 to 60 months and scheduled for different types of cardiac surgery with CPB, were randomized into two groups to receive either 2 mcg/Kg triiodothyronine (trial group) or 5% dextrose water (placebo group), immediately after anesthesia and 24 hours after surgery. The perioperative serum thyroid hormone levels and hemodynamic variables were determined. The intubation time, ICU stay length, ICU inotropic use, and cardiac ejection fraction was recorded. Results: The basic demographic data were comparable in two groups. No significant side effects or adverse reactions were seen due to hormone therapy. Intubation time, ICU stay, and VIS values were significantly shorter between the two groups. Conclusion: In children undergoing cardiac surgery with CPB, perioperative oral small-dose triiodothyronine therapy could improve clinical indices of perioperative care

Red Cell Distribution Width as a Predictor of Outcome in Cyanotic Congenital Cardiac Surgery

Background: Red blood cell distribution width (RDW) is a vital marker associated with various clinical states. In the present study, we aimed to determine the associations between RDW changes and adverse effects caused by pediatric cardiac surgery. Materials and Methods: In the present research, we retrospectively analyzed 100 pediatric patients enrolled in this study who were candidates for cardiac surgery. RDW was determined pre-and postoperatively and at the time of discharge from the hospital. Intubation time, duration of intensive care unit (ICU) stay and hospital stay, cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, vasoactive inotropic score (VIS), and mortality rate were determined as well. Results: Intubation time, duration of hospital stay, CPB time, ACC time, VIS, and mortality rate were significantly higher in the patients with higher RDW rates. Conclusion: This study demonstrated that RDW could be used as an essential indicator in predicting both morbidity and mortality caused by pediatric congenital heart surgery

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

Effect of combined Conventional Ultrafiltration and Modified Ultrafiltration on Serum Interleukin-6 and TNF-α Levels in Pediatric Cardiac Surgery Patients

AbstractBackground: Water retention occurs in most of the congenital heart surgery patients, especially in pediatrics. Ultrafiltration excretes water, electrolytes, many free radicals and inflammatory mediators. The aim of this study was to investigate the effect of modified ultrafiltration (MUF) on the serum levels of TNF-α and IL-6 in pediatrics patients undergoing congenital heart surgeries.Methods and Materials: A total of 91 pediatric congenital heart disease patients candidate for total correction were selected and divided randomly in two groups: CUF (Conventional Ultrafiltration) and CUF+MUF; 40 patients were allocated to CUF group and 51 patients to CUF+MUF group. Serum levels of TNF-α and IL-6 were assessed before CPB and 6 hours after the end of the operation in ICU. Postoperative levels of TNF-α and IL-6 were compared between the two groups.Results: In the MUF+CUF group, the preoperative and postoperative TNF-α levels were 2.5±5.6 and 1.4±3.0 respectively. However, IL-6 serum levels before and after operation were 4.8±8.9 and 41±56. In the CUF only group, the TNF-α level before and after surgery was 3.1±6.2 and 1.0±0.44; respectively; similarly, IL-6 serum levels were 3.3±8.2 and 34.8±37.7.Conclusion: MUF in congenital heart surgery could filtrate excess water and elevate hematocrit but does not have a definitive role in reducing TNF-α and IL-6 serum levels.Keywords: MUF, TNF-α, IL-6, CUF, cardiopulmonary bypas

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

Introducing a Method for Safe Air Evacuation from Oxygenator in Cardiac Surgery Operating Rooms during COVID-19 Pandemic

Covid-19 pandemic provides new perspectives and possibly permanent changes in some existing guidelines and safety principles. Evacuated air from the exhaust reservoir and oxygenator, after close contact with the patient’s blood added contaminated secretions, drain into the operating room, a potential source for contamination. There are two air exhaust ways from the oxygenator in cardiopulmonary bypass (CPB) circuit; which might be the potential carrier of the Covid-19 virus and resulting contamination. In the current design, these two exhausts are connected to one antibacterial and antiviral filter and then they will attach to the ventilator's exhaust port with a three-way connector, in such a way that the contaminated air will be vented outside the operating room. It is recommended to use antibacterial and antiviral filters in the passage way of the contaminated air coming from Reservoir and Oxygenator exhaust, to be directly guided outside the operating room. In this article, this design is fully described

Effect of Prophylactic Vasopressin on Hemodynamic Parameters after Coronary Artery Bypass Graft Surgery

Background: As common complications of Coronary artery bypass grafting (CABG), low vascular resistance and hypotension could be life threatening . The aim of present study was to investigate the effect of low-dose vasopressin on hemodynamics in CABG patients.Material &amp;Methods: In this randomized double-blinded clinical trial, 80 patients undergoing selective CABG were randomly divided into two equal case and control groups (n=40). Case group was received vasopressin 0.03 IU/min 30 minute before the end of cardio-pulmonary bypass (CPB) until one hour after that. Control group was received normal saline in the same manner. Dopamine requirement, ICU stay, heart rate (HR), mean arterial blood pressure (MAP), central venues pressure (CVP) and atrial blood acidity (PH) were recorded and compared between groups  in 5 phases ( 0,30,60,90,120 min) after separation of CPB.Results: There was no significant difference between two groups in number of patients with severe hypotension (11 vs. 12 patients in case and control group respectively). CVP was corrected and then dopamine administration was compared in both group. In vasopressin and placebo group, 3 vs 11 patients need to dopamine administration immediately after separation from CPB (p= 0.018) and 4 vs 12 patients later in ICU (p=0.024) respectively. The mean needed dose of dopamine in vasopressin and placebo group immediately after separation from CPB were 7.63±3.42 vs 9.21±2.08 µg/kg/min (p=0.031) and later in ICU were 7.42±2.02 vs 8.66±4.08 µg/kg/min (p=0.045) respectively, which was significantly lower in vasopressin group in comparison with placebo group.Conclusion: Based on our results low-dose vasopressin administration significantly reduced the mean needed dose of required dopamine, 24 hours urinary output, Duration of mechanical ventilation and patient’s heart rate