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Showing 5 results for Coronary Artery Bypass Grafting
Sh Shahbazy, M Falahat,
Volume 12, Issue 46 (9-2005)
Volume 12, Issue 46 (9-2005)
Abstract
Propofol’s unique pharmacokinetic profile offers advantages for rapid emergence in patients after coronary artery bypass graft surgery. However, concern for negative inotropic properties potentially limits its usage in these patients. The present study was undertaken to compare the hemodynamic effects of anesthesia, with propofol base versus morphine base, on usage of inotrope during weaning off cardiopulmonary bypass. This study was conducted on 60 patients with A.S.A II, III, EF>35% without history of recent myocardial infarction. We randomized 60 patients undergoing CABG surgery to receive either a propofol-based (propofol 50 μ g/kg/min+ fentanyl 0.1 μ g/kg/min as infusion) or morphine-based (morphine 0.3-0.4 mg/kg+Midazolam 0.1-0.15 mg/kg as bolus) anesthesia during pump. Either group underwent general anesthesia similarly (midazolam 0.1-0.15 mg/kg, Morphine 0.3-0.4 mg/kg, thiopental 3-4 mg/kg and pancuronium bromide 0.15 mg/kg) and it was maintained with halothane 0.5% O2+N2O (50%/50%). The requirement to inotrope was assessed by mean arterial blood pressure(BP) and central venous pressure(CVP). If CVP was more than 14 mmHg and mean BP was less than 80 mmHg we started infusion of epinephrine 0.02 μ g/kg/min that was increased to 0.5 μ g/kg/min. Thirty-seven of the patients required inotrope, out of whom, 24 patients received morphine-based anesthesia and 13 patients received propofol anesthesia(P<0.05). The result of this trial suggests that a morphine-based anesthesia requires additional inotrope support during weaning off CPB in contrast to a propofol-based anesthesia.
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Volume 22, Issue 132 (6-2015)
Volume 22, Issue 132 (6-2015)
Abstract
Background: In many clinical trials and medical studies, the
survival and longitudinal data are collected simultaneously. When these two
outcomes are measured from each subject and the survival variable depends on a
longitudinal biomarker, using joint modelling of survival and longitudinal
outcomes is a proper choice for analyzing the available data.
Methods: In this retrospective archival study, 84 patients with coronary
artery bypass surgery admitted in the intensive care unit of Jamaran Hospital
in Tehran were randomly selected during 2001-2008. We defined the survival
event as the 25% decline in GFR from baseline and the repeated measurements of
urinary output from ICU admission to time of event as the longitudinal
biomarker.
Results: The study showed that older age (HR=1.112), male sex
(HR= 4.307), and number of bypassed grafts (HR=1.874) were
significant effective factors on reducing the amount of GFR and risk stage of
acute kidney injury event.
Conclusion: In this study, it was concluded that decreasing urinary
output can be considered as an informative medical biomarker for acute kidney
injury. Moreover, joint modeling of longitudinal and survival data which
considers the relationship between these two outcomes, is an efficient approach
for analyzing these kinds of datasets.
Behnam Askari, Hamid Mehdizadeh, Safa Koomasi,
Volume 25, Issue 11 (2-2019)
Volume 25, Issue 11 (2-2019)
Abstract
Background: Cardiovascular diseases are the leading cause of mortality in Iran and in the world. There is a controversy about risk factors and causes of mortality following Coronary Artery Bypass Graft (CABG) surgery and the purpose of this study is to determine these factors.
Methods: In the retrospective case-control study, from March 2010 to July 2016 preoperative and intraoperative clinical data's of CABG patients were obtained and analyzed. Case group included 36 patients who died during the 30 days after operation and control group included 144 patients who had not died after surgery.
Results: The mortality rate during this interval was 1.29% (36/2774). Old age, female sex, three vessel disease, chronic obstructive pulmonary disease, left main involvement, mitral valve regurgitation, emergency surgery, preoperative critical condition, low hemoglobin level, high white blood cell count, peripheral vascular disease, high aortic cross clamping time, pulmonary hypertension, high cardiopulmonary bypass time, intra-aortic balloon pump placement and use of inotrope and pacemaker had a significant relationship with mortality.
Conclusion: Emergency surgery has a high mortality in the patients with preoperative critically ill conditions, especially in older women with multiple comorbidities. Preoperative precise assessment and correcting factors such as anemia, controlling inflammatory and pulmonary diseases, and reducing the duration of surgery is recommended to reduce mortality after surgery.
Fakhreddin Mahdavi, Tahere Bagherpoor, Nematollah Nemati,
Volume 29, Issue 3 (5-2022)
Volume 29, Issue 3 (5-2022)
Abstract
Background & Aims: An increasing number of elderly individuals are now undergoing coronary artery bypass surgery. Elderly patients, compared with patients of a younger age group, present for surgery with a greater burden of risk factors and reduced functional levels. Short‐term outcomes are hence poorer in them. But symptom relief occurs in most survivors and is accompanied by excellent rates of long‐term survival and a good quality of life. Therefore, an individualised risk–benefit profile must be carefully constructed by clinicians, taking into account several different factors and not just age alone. This review summarises the current concepts of coronary artery bypass surgery from the perspective of the very old. This, unfortunately, is not an easy question to answer. Risk–benefit profiles are individualised, and each elderly patient must be assessed on his or her own merit. There are no universally accepted standards for selection or rejection of patients for surgery. An elderly person with few background illnesses and a good expected quality and length of life would probably stand to benefit from CABG. On the other hand, an octogenarian with several comorbidities and an expected suboptimal quality of life after surgery would probably be best managed conservatively. The greatest risk, however, is in the critically ill elderly patient for whom the CABG operation may be the best of several high‐risk options. Due to the effect of cardiac rehabilitation in the secondary prevention of cardiovascular diseases and accidents on the one hand and the high direct and indirect treatment costs imposed on insurance organizations due to drug and surgical interventions on the other hand is covered. Giving a cardiac rehabilitation program due to its high clinical benefits, including reducing blood pressure risk factors and blood lipid profile and increasing the functional capacity of vascular transplant patients, reducing per capita drug use, reducing mortality and increasing life expectancy for the benefit of patients and society It is also in the interest of insurance companies. Therefore, the researcher seeks to answer the question of whether eight weeks of cardiac rehabilitation affect hemodynamic parameters and blood lipid profile in male patients 55 to 70 years of age with CABG coronary artery bypass graft surgery.
Methods: For the present quasi-experimental study, which was performed with a pre-test-post-test design, among male patients with an age range of 55 to 70 years, coronary artery bypass graft referring to Sari Heart Center (120 people), 40 people were selected as volunteers and Were randomly divided into control and experimental groups. The research variables were measured 24 hours before and 48 hours after the exercises. Also, the experimental group performed rehabilitation exercises for 8 weeks, 3 sessions per week and each session for 45-60 minutes. Research variables were assessed using a heart rate monitor, hand barometer and blood sampling. Finally, descriptive statistics (mean and standard deviation) and Shapirovilk and independent t-tests were used using SPSS software at a significance level of p <0.05 for statistical analysis of data.
Results: Before comparing the results of the two groups, the data were analyzed using Shapiro-Wilk test to determine the normal distribution, which showed that the data distribution is normal. Also, according to the assumption of equality of variances based on Levin test, the first row of t-test table was used, which showed that 8 weeks of cardiac rehabilitation has a significant effect on hemodynamic parameters and blood lipid profile of coronary artery bypass graft surgery patients.
Conclusion: The results of this study showed that eight weeks of cardiovascular rehabilitation has an effect on hemodynamic parameters and blood lipid profile in men 55 to 70 years old by bypass surgery. Coronary artery surgery for the elderly is now safer than ever before, owing to modern surgical techniques and pharmacological breakthroughs. Despite magnified perioperative and postoperative dangers, symptom relief occurs in most patients. Long‐term survival and quality of life are also preserved or enhanced in the majority. Clinicians must understand the normal physiological changes associated with ageing in order to construct a risk–benefit analysis that is specifically tailored to each patient. This analysis should take into account a patient's life expectancy and quality of life both before and after a procedure, and not just age alone. Discrepancies between chronological age and biological age must be dealt with. Further, the physician is expected to anticipate end‐of‐life issues and the potential need for rehabilitation or nursing home placement in the early postoperative period. Most important among all is that these issues must be discussed with the patients and their families. Hence, it is up to the patient and the clinician to explore the potential benefits of an improved quality of living with the attendant risks of the procedure versus alternative treatment. Advanced age alone should not be a deterrent for coronary artery bypass surgery if it has been determined that these benefits outweigh the potential risk. In this study, the findings showed that due to the high prevalence of cardiovascular disease in the country and the high per capita consumption of drugs and its high costs and the high importance of cardiovascular rehabilitation in reducing cardiovascular risk factors and secondary prevention and reduction Re-stroke in heart patients, including coronary artery bypass grafting, more attention to the issue of cardiac rehabilitation and the establishment of clinics and centers in this regard is necessary. It is hoped that using the results of this study, a clear view on the importance of the impact of these programs on officials and experts to pay more attention to these programs. However, lack of access to all members of society, lack of control over hereditary and psychological characteristics and lack of control over the economic and social conditions of the subjects are some of the limitations of the present study that may affect the results of the study.
Mohammadjavad Mehrabanian, Mehdi Dehghani Firoozabadi, Kaveh Hosseini, Mehdi Mehrani, Soheil Mansourian, Babak Kavand, Mehdi Rahab, Sahar Kianmehr, Mehrdad Malekshoar, Ashkan Taghizadeh Imani, Afarin Zamani, Behrang Nooralishahi,
Volume 31, Issue 1 (3-2024)
Volume 31, Issue 1 (3-2024)
Abstract
Bakcground & Aims: Advancements in coronary artery disease treatment via Coronary Artery Bypass Grafting (CABG) have been substantial, yet post-operative pain management remains a significant challenge. Pregabalin, known for its unique mechanism of action, has gained attention for its potential in reducing post-CABG pain. The complexity of post-CABG pain involves multiple factors, including surgical incision sites and chest wall trauma, which, if poorly managed, can lead to various complications, emphasizing the importance of effective pain management (1-5). This systematic review aims to evaluate the efficacy of Pregabalin in this context. Advancements in coronary artery disease treatment via Coronary Artery Bypass Grafting (CABG) have been substantial and revolutionized the treatment landscape of coronary artery diseases. Despite its widespread adoption and procedural success, effective postoperative pain management post-CABG remains a formidable clinical challenge (1). The complexity of post-CABG pain involves multiple factors, including surgical incision sites and chest wall trauma (2, 3). The etiology of this pain is complex, involving nociceptive and neuropathic components, originating from various anatomical regions affected during surgery. Inadequate pain control can disrupt essential postoperative activities like coughing and deep breathing, increasing the risk of pulmonary complications, and can adversely affect the cardiovascular system, leading to hypertension and tachycardia, further burdening the heart and grafts. Post-CABG pain is typically acute and occasionally chronic, influencing immediate recovery and potentially impacting long-term rehabilitation and patient well-being (4). Additionally, the psychological impact of unmanaged pain can contribute to prolonged hospital stays, delayed mobilization, and diminished overall patient experience (5).
Over the years, various pharmacological and non-pharmacological methods have been employed for managing post-CABG pain. These include opioids, non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetics, and adjunctive therapies. However, each modality comes with its limitations and potential side effects (4). In this context, Pregabalin, primarily used for neuropathic pain, has attracted attention for its potential role in managing postoperative pain due to its unique mechanism of action, which involves binding to the α2δ subunit of voltage-gated calcium channels in the central nervous system, modulating the release of several neurotransmitters (6-8). This systematic review aims to evaluate the efficacy of Pregabalin in the management of post-CABG pain, considering the variability in results which might be attributed to differences in methodologies, patient populations, and pain management protocols across different studies.
Methods: A systematic search in Scopus, Google scholar, researchgate, Trip database, cochrane and science direct databases were made using the appropriate search phrase. Relevant published or conferenced clinical trials with the effect of using preoperative usual doses of pregabalin (75-150 mg) on pain reduction after CABG surgery with or without the use of a cardiopulmonary bypass pump were selected.
Results: In the studies found in the systematic review, there was a high heterogeneity in methodology and results, so meta-analysis was avoided due to the difference in methods. Nine randomized clinical trial studies in full, and two abstracts of randomized clinical trials were included in the review. In most studies, pregabalin was started at a dose of 150 mg one or two hours before the operation and was continued at a dose of 75 mg twice a day for different periods (from 2 to 14 days after the operation). First 24 Hours Post-Surgery: Pre-medication with Pregabalin did not significantly affect intraoperative and immediate postoperative fentanyl requirements, nor did it influence the duration of intubation (17-23). However, its primary goal, pain reduction post-surgery, yielded mixed results. While five studies reported significant pain reduction compared to placebo (18, 20, 23-25), four others found no significant difference (17, 19, 22, 24). Reduction in Postoperative Analgesics Usage: Varied outcomes were reported regarding the impact of pre-medication on postoperative analgesic consumption. Some studies observed a significant reduction in morphine usage among patients who received Pregabalin (18, 23, 26), while others reported no significant differences (17, 19, 22, 24).
Hospital Stay Duration: Regarding the length of hospital and ICU stays, the majority of studies reported no significant differences between the Pregabalin and control groups (17, 19, 20, 24, 27). This outcome indicates that while Pregabalin may aid in pain management, its effect on reducing the length of hospitalization, particularly in ICU settings, is not conclusively established. 3-6 Months Postoperative outcomes: An intriguing aspect of Pregabalin’s impact is its long-term benefits post-surgery. Studies pointed out improvements in patient satisfaction, quality of life, and reductions in neuropathic pain over a 3-6 month period post-surgery (19, 21, 23, 26, 27). These findings are significant as they suggest that Pregabalin may contribute to better long-term recovery and patient well-being after CABG. However, only a single study did not observe a significant long-term benefit, highlighting the heterogeneity in patient responses and the multifactorial nature of postoperative pain and recovery (20).
Conclusion: The synthesis of evidence from various studies reveals a notable heterogeneity in the therapeutic efficacy of Pregabalin. This variability in pain alleviation and analgesic requirements post-CABG potentially is due to diverse methodological approaches, patient demographics, and the varying pain management protocols adopted across different healthcare settings. Our review of the current literature indicates that Pregabalin, with its argueable efficacy in ameliorating pain during the initial 24 hours post-surgery and in reducing subsequent analgesic consumption, demonstrates promising outcomes in enhancing patient satisfaction, quality of life, and in the diminution of pain across a 3-6 month postoperative timeframe. However, these observations underscore the necessity for individualized therapeutic strategies. The decision to incorporate Pregabalin into the pain management regimen should be judiciously calibrated, taking into account the patient's unique clinical profile and specific perioperative circumstances.
Over the years, various pharmacological and non-pharmacological methods have been employed for managing post-CABG pain. These include opioids, non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetics, and adjunctive therapies. However, each modality comes with its limitations and potential side effects (4). In this context, Pregabalin, primarily used for neuropathic pain, has attracted attention for its potential role in managing postoperative pain due to its unique mechanism of action, which involves binding to the α2δ subunit of voltage-gated calcium channels in the central nervous system, modulating the release of several neurotransmitters (6-8). This systematic review aims to evaluate the efficacy of Pregabalin in the management of post-CABG pain, considering the variability in results which might be attributed to differences in methodologies, patient populations, and pain management protocols across different studies.
Methods: A systematic search in Scopus, Google scholar, researchgate, Trip database, cochrane and science direct databases were made using the appropriate search phrase. Relevant published or conferenced clinical trials with the effect of using preoperative usual doses of pregabalin (75-150 mg) on pain reduction after CABG surgery with or without the use of a cardiopulmonary bypass pump were selected.
Results: In the studies found in the systematic review, there was a high heterogeneity in methodology and results, so meta-analysis was avoided due to the difference in methods. Nine randomized clinical trial studies in full, and two abstracts of randomized clinical trials were included in the review. In most studies, pregabalin was started at a dose of 150 mg one or two hours before the operation and was continued at a dose of 75 mg twice a day for different periods (from 2 to 14 days after the operation). First 24 Hours Post-Surgery: Pre-medication with Pregabalin did not significantly affect intraoperative and immediate postoperative fentanyl requirements, nor did it influence the duration of intubation (17-23). However, its primary goal, pain reduction post-surgery, yielded mixed results. While five studies reported significant pain reduction compared to placebo (18, 20, 23-25), four others found no significant difference (17, 19, 22, 24). Reduction in Postoperative Analgesics Usage: Varied outcomes were reported regarding the impact of pre-medication on postoperative analgesic consumption. Some studies observed a significant reduction in morphine usage among patients who received Pregabalin (18, 23, 26), while others reported no significant differences (17, 19, 22, 24).
Hospital Stay Duration: Regarding the length of hospital and ICU stays, the majority of studies reported no significant differences between the Pregabalin and control groups (17, 19, 20, 24, 27). This outcome indicates that while Pregabalin may aid in pain management, its effect on reducing the length of hospitalization, particularly in ICU settings, is not conclusively established. 3-6 Months Postoperative outcomes: An intriguing aspect of Pregabalin’s impact is its long-term benefits post-surgery. Studies pointed out improvements in patient satisfaction, quality of life, and reductions in neuropathic pain over a 3-6 month period post-surgery (19, 21, 23, 26, 27). These findings are significant as they suggest that Pregabalin may contribute to better long-term recovery and patient well-being after CABG. However, only a single study did not observe a significant long-term benefit, highlighting the heterogeneity in patient responses and the multifactorial nature of postoperative pain and recovery (20).
Conclusion: The synthesis of evidence from various studies reveals a notable heterogeneity in the therapeutic efficacy of Pregabalin. This variability in pain alleviation and analgesic requirements post-CABG potentially is due to diverse methodological approaches, patient demographics, and the varying pain management protocols adopted across different healthcare settings. Our review of the current literature indicates that Pregabalin, with its argueable efficacy in ameliorating pain during the initial 24 hours post-surgery and in reducing subsequent analgesic consumption, demonstrates promising outcomes in enhancing patient satisfaction, quality of life, and in the diminution of pain across a 3-6 month postoperative timeframe. However, these observations underscore the necessity for individualized therapeutic strategies. The decision to incorporate Pregabalin into the pain management regimen should be judiciously calibrated, taking into account the patient's unique clinical profile and specific perioperative circumstances.
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