Context Postinduction hypotension is a modifiable risk that can be prevented by adjusting the technique for induction of anesthesia. Therefore, volume loading could prevent postinduction hypotension in fluid responder patients. Aims To compare the hemodynamic profile of patients who received volume loading before induction of general anesthesia in patients with CAD undergoing CABG. Settings and design A randomized, controlled, double-blinded trial. Methods and material Patients were randomly divided into two groups; control group were receive nothing before induction, while patients in volume loading group received volume loading of 8 ml/kg Ringer acetate over 10 min. The primary outcome was the incidence of postinduction hypotension from start of induction of anesthesia till 15-minutes after intubation. The two groups were compared according to the following: Incidence of postinduction hypertension, bradycardia, and tachycardia in addition to mean arterial blood pressure, heart rate, stroke volume variation and cardiac index recordings. Results Fifty patient were included in this study. Patients in volume loading group received on average 771±289 ml of acetated ringer before induction of anesthesia to have their SVV below 13%. The incidence of postinduction hypotension was higher in the control group (13/25) compared to volume loading group (5/25) after induction of anesthesia (P<001). Conclusions Volume loading in fluid responder patients undergoing CABG effectively reduced the incidence of hypotension in the first 15 min postinduction period.
Metformin is a commonly used first-line oral hypoglycemic agent for type 2 diabetes. Metformin associated lactic acidosis (MALA) is an extremely rare event with an estimated incidence of 0.03–0.06 per 1000 patient-years and a mortality rate of up to 50%.We report successful perioperative management of a 63-year-old man who developed MALA during his postoperative period following off-pump coronary artery bypass graft (OPCABG) surgery. MALA is a rare complication associated with metformin and is a diagnosis of exclusion. It should be considered during the perioperative period if there is suspicion of metformin accumulation. It is associated with a high mortality rate; hence, prompt recognition.
Background Myocardial injury can occur during reperfusion of the heart during open heart surgery when the myocardium has been subjected to global ischemic cardioplegic arrest. The most common cardiac biomarker, cardiac troponin I (cTnI), can be used to assess the clinical prognosis of patients undergoing cardiac surgery. Anaesthetic medications have been linked to preventing ischaemia and reperfusion injury to the heart. Methods Eighty one children scheduled for open heart surgery were randomly divided into 3 groups Control group (C) (n=27): Isoflurane 1.2MAC was used to maintain anaesthesia Ketamine-dexmedetomidine group (n=27) KD Following the establishment of anaesthesia, dexmedetomidine (1 ug/kg) was administered over 10 minutes, followed by ketamine (2 mg/kg). maintenance throughout the operation was accomplished by administering ketamine (1 mg/kg/hr) and dexmedetomidine (0.5u g/kg/hr) while keeping variations in the mean arterial blood pressure to within 25% of the baseline. Fentanyl-midazolam group: (n=27) FM: Fentanyl (3 ug/kg) and midazolam (100 ug/kg over 2 to 3 minutes) were used to induce anaesthesia, and midazolam (1 ug/kg/min) and fentanyl (2u g/kg/h) were used to maintain anaesthesia during the procedure. a baseline sample for troponin was taken (T0), and measurements were made at declamping, 1hr, 6hrs, 12hrs, and 24hrs after declamping. heart rate (HR) and mean arterial pressure (MBP) readings taken at baseline, induction, at skin incision, 15, 30 min, post bypass at15, 30, 45, 60 min, duration of CPB and number of patients required inotropic support and nitroglycerine. extubation time and ICU stay were also recorded. Results Troponin level was significantly lower in the KD group at declamping, 1, 6, 12, and 24 hr after declamping compared to FM and C group (P<0.001). Extubation time was significantly lower in KD and FM groups compared to C group (P value <0.001) and was insignificantly different between KD and FM groups. ICU stay was significantly lower in the KD group compared to FM and C groups (P value <0.001). Conclusion By detecting the least increase in troponin I in paediatric patients undergoing elective congenital open heart surgery, the combination of ketamine and dexmeditomidine exerts great potential for cardiac protection and improving post-operative recovery compared to midazolam and fentanyl or the control group
