Background:Anesthesia induction is often accompanied by a period of hemodynamic instability, which could be deleterious in patients with coronary artery disease (CAD) and left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery. The aim of this study was to compare the hemodynamic responses to propofol, etomidate, and diazepam following anesthesia induction, laryngoscopy and intubation in CABG surgery patients with low ejection fraction (EF).Methods:A double-blind randomized, clinical study was performed on 150 patients with CAD and left ventricular dysfunction (EF≤35%) scheduled for elective CABG surgery with Cardiopulmonary bypass (CPB). Patients were randomly allocated to three groups A, B, and C. These patients received propofol, etomidate or diazepam at induction of anesthesia, respectively. Hemodynamic variables (systolic and diastolic blood pressure [SBP, DBP], mean arterial pressure [MAP] and heart rate [HR]) were measured and recorded at baseline, immediately before laryngoscopy and tracheal intubation and one and three minutes after intubation.Result:One minute after induction and before laryngoscopy, there was a statistically significant decrease from the baseline in SBP, DBP and MAP in all three groups, but these variables in each hemodynamic parameters in diazepam group were less than other two groups (p<0.001). Moreover, the mean HR decreased in patients receiving propofol and etomidate one minute after induction and before laryngoscopy, but did not decreased in the diazepam group (p=0.005).Conclusion:The present study showed that in patients undergoing CABG surgery with low EF, diazepam is more favorable in terms of hemodynamic stability compared to propofol and etomidate and this drug can be used safely for induction of anesthesia in patients with impaired ventricular function.
It seems that perioperative intravenous NAC therapy can be effectively used to reduce inflammation and the incidence of POAF after CABG surgery. The clinical trial registration number: IRCT2015040921669N1.
Background:Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the Intensive Care Unit (ICU). The aim of this analysis is to determine potential association between zinc supplementation with the occurrence of VAP in adult mechanically ventilated trauma patients.Subjects and Methods:This secondary analysis of a prospective observational study was carried out over a period of 1 year in ICUs of one teaching hospital in Iran. A total of 186 adults mechanically ventilated trauma patients, who required at least 48 h of MV and received zinc sulfate supplement (n = 82) or not (n = 104) during their ICU stay, were monitored for the occurrence of VAP until their discharge from the ICU or death.Results:Forty-one of 186 patients developed VAP, 29.09 days after admission (95% confidence interval [CI]: 26.27–31.9). The overall incidence of VAP was 18.82 cases per 1000 days of intubation (95% CI: 13.86–25.57). Patients who received zinc sulfate supplement have smaller hazard of progression to VAP than others (hazard ratio: 0.318 [95% CI: 0.138–0.732]; P < 0.0001).Conclusion:The findings show that zinc supplementation may be associated with a significant reduction in the occurrence of VAP in adult mechanically ventilated trauma patients. Further well-designed randomized clinical trials to confirm the efficacy of this potential preventive modality are warranted.
IntroductionAcute post-operative pain remains a troublesome complication of
cardiothoracic surgeries. Several randomized controlled trials have examined
the efficacy of dexmedetomidine as a single or as an adjuvant agent before,
during and after surgery. However, no evidence-based conclusion has been
reached regarding the advantages of dexmedetomidine over the other
analgesics.ObjectiveTo review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy
pain.MethodsMedline, SCOPUS, Web of Science, and Cochrane databases were used to search
for randomized controlled trials that investigated the analgesia effect of
dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The
outcomes were postoperative pain intensity or incidence, postoperative
analgesia duration, and the number of postoperative analgesic
requirements.ResultsFrom 1789 citations, 12 trials including 804 subjects met the inclusion
criteria. Most studies showed that pain score was significantly lower in the
dexmedetomidine group up to 24 hours after surgery. Two studies reported the
significant lower postoperative analgesia requirements and one study
reported the significant lower incidence of acute pain after surgery in
dexmedetomidine group. Ten studies found that the total consumption of
narcotics was significantly lower in the dexmedetomidine group. The most
reported complications of dexmedetomidine were nausea/vomiting, bradycardia
and hypotension.ConclusionDexmedetomidine can be used as a safe and efficient analgesic agent for
reducing the postoperative pain and analgesic requirements up to 24 hours
after cardiothoracic surgeries. However, further well-designed trials are
needed to find the optimal dosage, route, time, and duration of
dexmedetomidine administration.
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