Background:There have been many concerns about alteration in hemodynamic parameters within and shortly after endotracheal intubation (ETI) in patients scheduled for elective coronary artery bypass grafting (CABG).Objectives:We compared the attenuation effect of magnesium sulfate and lidocaine on hemodynamic responses after ETI, in patients undergoing CABG.Patients and Methods:In this randomized controlled trial 150 patients undergoing elective CABG were enrolled. Included patients were randomly allocated to three groups and received lidocaine (1.5 mg/kg), magnesium sulfate (50 mg/kg within five minute), or normal saline, 90 seconds before ETI. Baseline hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded immediately before anesthesia induction, before intubation, immediately after intubation, and at second and fifth minutes after intubation.Results:The baseline hemodynamic variables had no deference among the three groups. HR between intubation and five minute after intubation was significantly lower in two groups received lidocaine or magnesium sulfate in comparison with placebo group. Lidocaine induced more than 20% decrease in HR and MAP immediately after intubation; hence, lidocaine group showed significant MAP reduction in comparison with the two other groups.Conclusions:Lidocaine induced hemodynamic instability but premedication of magnesium sulfate maintained hemodynamic stability after intubation. Therefore, in patients undergoing CABG who received high-dose intravenous analgesic for general anesthesia, the administration of magnesium sulfate might result in maintaining hemodynamic stability after ETI in comparison with lidocaine.

Introduction: This study aimed to evaluate the effects of high positive-end expiratory pressure (PEEP) and low tidal volume (TV) and recruitment maneuver, on postoperative pulmonary complications (PPCs) after coronary artery bypass grafting (CABG) surgery. Methods: This study is a randomized double blind clinical trial on 64 patients who were undergoing CABG surgery, and were randomly divided into two groups of conventional ventilation (C-Vent) with TV of 9 mL/kg and PEEP=0 cm H2O, and lung protective ventilation (P-Vent), with 6 mL/kg TV and PEEP=10 cm H2O with recruitment maneuver every 30 minutes. Measures of PPCs and modified clinical pulmonary infection score (mCPIS), were assessed for the first 24 hours of postoperative time in order to evaluate the pulmonary complications. Results: P-Vent with 31 patients and C-Vent with 30 patients, participated in the stage of data analysis. Demographic, and preoperative laboratory results showed no significant difference between two groups. During surgery, cardiovascular complications were higher in P-Vent group (P = 0.61) but pulmonary complications were higher in C-Vent group (P = 0.26). Extubation time was not significantly different between two groups, and also components of arterial blood gases (ABG) of 24 hours after surgery showed no significant difference between the two groups. Pathologic changes in the chest X-ray (CXR) of 24 hours after surgery, were lower in P-Vent group, but the difference was not significant (P = 0.22). The PPC criteria was less positive in P-Vent (2 patients) vs 9 patients in C-Vent group (P = 0.02) and mCPIS score was significantly lower in P-Vent group (1.2 ± 1.4) than C-Vent group (2 ± 1.6) (P = 0.048). Conclusion: Lung protective strategy during and after cardiac surgery, reduces the postoperative mCPIS in patients undergoing open heart surgery for CABG.

Introduction: To compare the effects of oral clonidine and tramadol on shivering caused by spinal anesthesia in patients undergoing transurethral lithotripsy (TUL). Methods: The present study is a triple-blind clinical trial conducted on 80 elective urologic surgical candidates during 2016-2017 at Tehran Hasheminejad Hospital in Iran. Using the Balanced Block Randomization method, the patients were randomly assigned into two groups (40 patients per group) 90 minutes before performing spinal anesthesia. The first group (group C) received 150 µg of oral clonidine and the second group (group T) received 50 mg of oral tramadol. Body temperature, core body temperature, heart rate, diastolic blood pressure and shivering were recorded for the patients at different time periods, and entered in the SPSS22 software program. The above variables were then statistically analyzed using independent sample T-tests chi-squared tests and Repeated Measure ANOVA. Results: The results of this study indicated that there was a significant statistical difference (P<0.05) between the clonidine and tramadol treatment groups with regards to some variables, such as average body temperature and average core temperature, at different time periods. However, for other variables, such as heart rate, systolic blood pressure, diastolic blood pressure and shivering, there were no significant statistical differences between the two treatment groups (P>0.05). Conclusion: Clonidine and tramadol treatment groups were only significantly different in terms of body temperature and core temperature. Therefore, it is recommended that other precise randomized clinical trials be performed to ensure the accuracy of the results of this study.

Background & Objective: The present study aimed to assess the supportive role of open lung ventilation on respiratory mechanics, the rate of oxygenation, inflammatory biomarkers, and probable liver or renal injuries following coronary artery bypass grafting surgery. Materials & Methods:This randomized double-blinded clinical trial study was conducted on 64 candidates for coronary artery bypass surgery using a cardiopulmonary pump. The patients were randomly categorized into the Positive endexpiratory pressure (PEEP) group (n = 32) or Zero End Expiratory Pressure (ZEEP) group (n = 32).Results: Interleukin-6 levels were similar between the PEEP and ZEEP groups before surgery (p = 0.18) and were significantly higher in the ZEEP group after pump insertion (p = 0.005). On the contrary, the levels of Interleukin-6 were significantly higher in the PEEP group after extubation (p = 0.001). The Between-group analysis also showed a significant difference between the levels of interleukin-6 in the ZEEP and PEEP groups, representing a greater increase in the PEEP group (p < 0.001). There was no difference in certain hemodynamic parameters, including heart rate, mean blood pressure, mean CO2 pressure (PCO2), mean concentration of HCO3, and base excess. The mean arterial O2 saturation was higher overall in the PEEP group compared to the ZEEP group. The mean PaO2/FiO2 was significantly higher in the PEEP than in the ZEEP group (p < 0.001). Conclusion:Supportive ventilation technique leads to better oxygenation and better lung expansion, as well as lowering inflammatory biomarkers, after coronary artery bypass surgery.