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ABSTRACT: INTRODUCTION: Nowadays, many patients undergo coronary artery bypass grafting (CABG) with a cardiopulmonary bypass (CPB); while a number of therapeutic agents have been used to suppress its related inflammatory process. Magnesium sulfate (MgSO4) solution has been used as an anti-inflammatory agent. Among the cardiac biomarkers, N-terminal pro brain natriuretic peptide (NT Pro-BNP) is one of the most widely recognized. We performed this study to assess the effect of MgSO4 solution on NT Pro-BNP levels in patients undergoing CABG with CPB. MATERIALS AND METHODS: In a double-blind clinical trial, after IRB approval for ethical considerations, during a 12-month period, 88 adult patients aged 40-70 years qualified for the study after inclusion and exclusion criteria were considered. After random allocation of the patients between the two groups, anesthesia, surgical procedure, cardiopulmonary bypass (CPB) methods, and postoperative care were made as similar as possible; however, one group received a MgSO4 infusion (15 mg/kg/h) and the other group saline (placebo). Pre- and post-operative levels of NT Pro-BNP were assessed using an electrochemical luminescence immunoassay in an Elecsys 2010 (Roche, Indianapolis, IN, USA). The results were compared using a Student's t-test. A P value less than 5 % was considered significant. RESULTS: The MgSO4 group had shorter postoperative mechanical ventilation, lower postoperative morphine requirements and lower postoperative pain scores. Also, 24 h postoperative NT Pro-BNP levels were significantly lower in the MgSO4 group. CONCLUSION: Administration of MgSO4 in elective CABG with CPB can decrease the postoperative NT Pro-BNP levels; also, it decreases their time of postoperative mechanical ventilation.
Journal of Anesthesia 05/2013; · 0.83 Impact Factor
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Hepatitis Monthly 11/2012; 12(11):e8437. · 2.19 Impact Factor
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ABSTRACT: Repeated implantation failure (RIF) is a worldwide health problem that imposes a great deal of cost on patients and health care system. Vitamin D(3) has been proposed to have positive impact on the process of implantation. The present study was performed to compare the effect of 1,25-dihydroxy vitamin D(3) (1,25(OH)(2)D(3)) on cytokine production by endometrial cells of women with RIF and healthy fertile controls. Whole endometrial cells (WECs) and endometrial stromal cells (ESCs) from RIF and normal fertile women were treated with 1,25(OH)(2)D(3). The levels of IL-10, TGF-β, IFNγ, Il-6, IL-8 and IL-17 in culture supernatants were assayed by ELISA. Also, ability of the cells from both groups to produce 1,25(OH)(2)D(3) was evaluated and compared. 1,25(OH)(2)D(3) down-regulated cytokine production in WECs from both groups except for IL-8 which was upraised. Similar trends were also observed in ESCs except up-regulation of TGF-β in RIF group. Endometrial cells of both groups had comparable capacity to produce 1,25(OH)(2)D(3). Based on the minimal differential immunoregulatory effect of vitamin D(3) on endometrial cells from RIF and control women, it may be suggested that circulating levels of maternal vitamin D(3) be the subject of further investigation.
Gynecological Endocrinology 05/2012; 28(11):906-11. · 1.58 Impact Factor
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ABSTRACT: The aim of this study was to clarify the efficacy of perioperative glucose-insulin-potassium (GIK) infusion on preoperative and postoperative N-terminal (NT)-pro-brain natriuretic peptide (BNP) concentrations in patients with a low ejection fraction undergoing isolated on-pump coronary artery bypass graft (CABG) surgery.
A double-blind, randomized, controlled study.
Modarres Hospital, Tehran, Islamic Republic of Iran.
Sixty-six patients with a low ejection fraction who required coronary artery surgery were selected.
Patients were allocated to a GIK (n = 36) or a control (n = 30) group. The GIK group received GIK solution (500 mL of dextrose in water (DW) 10% + 40 U of regular insulin + 40 mEq of KCl, and 2 g of MgSO(4)) at a rate of 1 mL/kg/h for 10 hours preoperatively and until the removal of the aortic cross-clamp. The control group received half saline solution as placebo with an equivalent infusion rate during the same interval.
Serum NT-proBNP levels were measured before starting the GIK, at the time of anesthesia induction, and 24 hours after surgery. The primary outcome measures were preoperative and postoperative NT-proBNP level. The amount of elevation in postoperative NT-proBNP concentrations was less prominent in the GIK group than in the control group (2,601 ± 1,799 pg/mL v 4,732 ± 4,127 pg/mL; p = 0.02). The patients in the GIK group were extubated sooner (495 ± 92 minutes) than the control group (774 ± 224 minutes; p = 0.002). The overall extubation time was 606 ± 177 minutes. Delayed requirement for mechanical ventilation was significantly more in the controls compared with the GIK group (45.8% v 13.9%, p = 0.004).
GIK is of value in the reduction of post-cardiac surgery NT-proBNP elevation. Thus, its infusion should have a protective effect in patients with low ejection fraction undergoing CABG surgery. Further studies may prove GIK infusion benefits in high-risk CABG surgery patients optimize outcome.
Journal of cardiothoracic and vascular anesthesia 01/2012; 26(4):631-6. · 1.06 Impact Factor
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ABSTRACT: A number of elective coronary artery bypass graft (CABG) surgery patients have impaired underlying left ventricular function (poor ejection fraction). This study was performed to compare the effect of postoperative oral carvedilol versus metoprolol on left ventricular ejection fraction (LVEF) after CABG compared with metoprolol. In a double-blind clinical trial, 60 patients with coronary artery disease, aged 35 to 65 years, who had an ejection fraction of 15% to 35% were included. Either carvedilol or metoprolol was administered the day after CABG. The patients were evaluated by the same cardiologist 14 days before and 2 and 6 months after elective CABG. The results demonstrated better improvements in LVEF in the carvedilol group. No difference regarding postoperative arrhythmias or mortality was detected. The results suggest that carvedilol may exert more of an improved myocardial effect than metoprolol for the low ejection fraction patients undergoing CABG in the early postoperative months.
Journal of perianesthesia nursing: official journal of the American Society of PeriAnesthesia Nurses / American Society of PeriAnesthesia Nurses 12/2011; 26(6):384-7.
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ABSTRACT: Background: Repeated Implantation Failure (RIF) is one of the most intricate obstacles in assisted reproduction. The cytokine and chemokine composition of uterine cavity seem to play important roles in the implantation process. Objective: To compare the cytokine profile in the endometrium of normal fertile women and those with repeated implantation failure. Methods: After enzymatic digestion of endometrial tissues, whole endometrial cells and endometrial stromal cells from RIF and normal fertile women were cultivated and stimulated for cytokine secretion. The levels of IL-10, TGF-β, IFN-γ, IL-6, IL-8 and IL-17 in culture supernatants of the two groups were assayed by ELISA and compared together. Results: Endometrial stromal cells and whole endometrial cells of normal fertile women produced higher levels of IL-6, IL-8 and TGF-β compared to RIF group, although this difference was statistically significant only in endometrial stromal cells (p=0.005, 0.002 and 0.001, respectively). In addition, endometrial stromal cells of normal fertile women produced lower levels of IL-10 in comparison with RIF group (p=0.005). Conclusion: Disturbances in cytokine production at the feto-maternal interface could be a cause of implantation failure. A pro-inflammatory cytokine milieu seems to be pivotal for successful implantation.
Iranian journal of immunology: IJI 12/2011; 8(4):201-8.
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ABSTRACT: Chronic opium exposure leads to altered response to opioid compounds. The aim of this study was to assess the behavioral effects of opium tolerance on the analgesic effects of intrathecal lidocaine in rats.
Twenty-four adult male Sprague Dawley rats with intrathecal (IT) catheters were divided into 3 groups of 8. The first group was morphine tolerant and received IT lidocaine (ML). Rats in the second group were not morphine tolerant and received IT lidocaine (L), while the third group consisted of not morphine tolerant rats that received IT placebo. Tail flick test was done and maximal possible antinociceptive effects (MPAE) were compared using analysis of variance (ANOVA).
While percent of MPAE significantly increased in the L group, it had a significant reduction in the ML group (P < 0.001).
After intrathecal lidocaine administration, a hyperalgesic response was seen in morphine tolerant rats and an analgesic response was seen in the lidocaine group.
Journal of research in medical sciences 10/2011; 16(10):1361-5. · 0.46 Impact Factor
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ABSTRACT: Throat pain is a common postoperative complaint. In this study, we aimed to determine its incidence of throat pain after rhinoplasty by general anesthesia (GA) or conscious sedation (CS).
We evaluated throat pain in postanesthesia care unit, 4, 12 and 24 hours after surgery using a numerical rating scale (NRS) in a clinical trial. A total number of 252 consecutive females aging over 18 years undergoing GA or CS for elective rhinoplasty entered the study after implementing inclusion and exclusion criteria. A logistic regression model was used to predict having throat pain.
The incidence of throat pain after CS and GA in postanesthesia care unit, 4, 12 and 24 hours after rhinoplasty were 34.9% vs. 34.9% (P = 0.99), 27.0% vs. 33.3% (P = 0.27), 14.3% vs. 22.2% (P = 0.10), 10.3% vs. 15.9% (P = 0.19), respectively. The odds ratio for throat pain was statistically significant for nausea/vomiting in postanesthesia care unit (OR = 11.1, 95% CI: 5.7-21.8; P < 0.0001).
Method of anesthesia had no independent role in predicting throat pain. Although larynx of subjects undergoing general anesthesia is manipulated by tracheal intubation, sedation has its specific risks for promoting throat pain after surgery. Therefore, neither CS nor GA is superior in terms of throat pain.
International journal of preventive medicine 10/2011; 2(4):275-9.
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ABSTRACT: The fluorinated hydrocarbons that are used for anesthesia are derived from ether. Although they have many benefits, there are several side effects of these drugs, including untoward hepatic effects. Whether the use of halothane gas can be revitalized is unknown. Introducing nanocarriers inside the halothane molecule can increase its benefits as an anesthetic in the lungs and cardiovascular system and prevent exposure to the liver. The findings of new fields, such as cancer therapy, and anesthetic agents, such as propofol, can improve the quality of the drug using nanomedicine.
Hepatitis Monthly 07/2011; 11(7):511-2. · 2.19 Impact Factor
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ABSTRACT: Prolonged mechanical ventilation is an important recognized complication occurring during cardiovascular surgery procedures. This study was done to assess the perioperative risk factors related to postoperative pulmonary complications and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass.
It was a retrospective study on 5,497 patients, including 31 patients with prolonged ventilatory support and 5,466 patients without it; from the latter group, 350 patients with normal condition (extubated in 6-8 hours without any complication) were selected randomly. Possible perioperative risk factors were compared between the two groups using a binary logistic regression model.
Among the 5,497 women undergoing coronary artery bypass graft (CABG), 31 women needed prolonged mechanical ventilation (PMV), and 15 underwent tracheostomy. After logistic regression, 7 factors were determined as being independent perioperative risk factors for PMV.
Age ≥70 years old, left ventricular ejection fraction (LVEF) ≤30%, preexisting respiratory or renal disease, emergency or re-do operation and use of preoperative inotropic agents are the main risk factors determined in this study on women undergoing CABG.
Saudi journal of anaesthesia. 04/2011; 5(2):167-9.
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ABSTRACT: Sodium thiopental is known to have a number of cardiovascular effects, but injection into the cardiopulmonary bypass reservoir has not been studied. The effect of sodium thiopental on mean arterial blood pressure during cardiopulmonary bypass was assessed in 150 patients undergoing elective coronary artery bypass grafting. Sodium thiopental 3 mg · kg(-1) was administered via the cardiopulmonary bypass reservoir. Mean arterial pressure was recorded just before drug administration and at 15-sec intervals up to 120 sec afterwards. Compared to the baseline value, mean arterial pressure was significantly higher at 30, 45, 60, and 75 sec after drug administration, and it was significantly lower at 90, 105, and 120 sec. Sodium thiopental, in addition to its effects on myocardial tissue, acts initially as a potent vasopressor, and shortly after, as a potent vasodilator.
Asian cardiovascular & thoracic annals 01/2011; 19(3-4):213-6.
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ABSTRACT: Halothane was introduced as an anesthetic in the 1950s and was considered a revolutionary agent in the field of anesthesia. Soon after, halothane-induced hepatitis became a concern, leading to the development of less toxic gases that induced a lower incidence of side effects. Two types of halothane-related hepatotoxicity have been described: type 1, or mild hepatitis, is associated with elevated transaminase levels and self-limiting symptoms, and type 2, or severe hepatotoxicity, is associated with acute fatal liver failure and is fatal in most cases. Hepatotoxicity is most likely to be immune-related, based on much evidence. Free radicals that are produced by the metabolism of halothane in the liver can modify cellular proteins and introduce neo-antigens to the immune system. Sensitization to these neo-antigens induces a more severe response after multiple exposures; most cases of type 2 hepatitis occur after repeated contact. New halogenated anesthetics such as enflurane, sevoflurane, and desflurane, are not metabolized in the liver, causing few cases of sensitization. Compared with halothane, these anesthetics are expensive. As a result, replacement of halothane with new halogenated anesthetics requires a precise cost-benefit analysis, especially in developing countries that have low health care budgets.
Hepatitis Monthly 01/2011; 11(1):3-6. · 2.19 Impact Factor
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ABSTRACT: airway management is one of the greatest concerns of anesthesiologists and difficult intubation, well known as the anesthesiologist's nightmare, is an event not easy to predict before induction of anesthesia. The aim of this study was to assess the relationship between history of snoring and the Cormack and Lehane grading score.
in a descriptive-analytical study, 120 candidates for elective surgery were selected and allocated in the two groups (snoring and snoring free groups, respectively). The history of night time snoring was taken from the patient's wife/husband. After induction of anesthesia, each patient was assessed regarding the Cormack and Lehane grading under direct laryngoscopy.
the difference between the two groups regarding Cormack and Lehane grading system was statistically significant.
the findings of this study demonstrated a relationship between the presence of snoring and increased number of Cormack & Lehane grading score.
Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists. 12/2010; 48(4):172-3.
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ABSTRACT: There are a wide range of analgesic methods used for postoperative pain control in children undergoing elective adenotonsillectomy and there are many cases in which the postoperative analgesic modalities have not been fully successful to treat pain effectively. The acute postoperative analgesic effects of peritonsillar bupivacaine infiltration compared with rectal acetaminophen suppositories in elective adenotonsillectomy have been compared here. The methods employed were a single blind randomized clinical trail where 110 cases were selected to enter the study. After induction of anesthesia and intubation, and just before start of the procedure, the 1st group received 30 mg/kg of acetaminophen rectally; while, the 2nd group received 1 mg/kg peritonsillar bupivacaine infiltration around the tonsils. Throat pain at rest, after swallowing, after taking fluid and after soft food and also, parents' and nurses satisfaction regarding patient analgesia were compared. The results stated that there was no difference between the two groups regarding throat pain at rest, after swallowing, after taking fluid and after soft food and also, parents' and nurses' satisfaction. We concluded that when considering the feasibility of rectal acetaminophen, the results of the study suggest it superior due to minimal risks compared with local peritonsillar administration of bupivacaine for elective adenotonsillectomy of children.
Archives of Oto-Rhino-Laryngology 12/2010; 268(4):581-4. · 1.29 Impact Factor
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ABSTRACT: Postoperative blood drainage is a great concern for health care providers when monitoring patients after cardiac surgery. In this study, the effect of intravenous magnesium sulfate infusion on postoperative bleeding in patients undergoing elective coronary artery bypass graft (CABG) surgeries was assessed. In a double-blind, randomized placebo-controlled clinical trial, 140 patients scheduled for elective CABG were randomly assigned into two groups; one group receiving intravenous magnesium sulfate and one receiving placebo. All the cases were similar regarding anesthesia and surgery. The magnesium group had less postoperative bleeding (465 ± 130 mL vs 680 ± 190 mL in the placebo group; P = .00) and less packed cell use (2.1 ± 0.6 packs vs 3.2 ± 0.8 packs in the placebo group; P < .05) as compared with placebo. The results demonstrated significantly less postoperative bleeding and packed cell use in the group receiving intravenous magnesium sulfate infusion during elective CABG surgery.
Journal of perianesthesia nursing: official journal of the American Society of PeriAnesthesia Nurses / American Society of PeriAnesthesia Nurses 10/2010; 25(5):290-5.
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Anesthesia and analgesia 08/2010; 111(2):584. · 3.08 Impact Factor
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ABSTRACT: A 4-month-old boy was admitted to our hospital following an unsuccessful attempt at interventional repair of aortic coarctation via the right carotid artery, which seemed to have given rise to the formation and growth of a cervical mass overlying the entry site. Despite the initial anticipation of difficulty during intubation due to the pressure effect of the mass, anesthesia progressed uneventfully, the mass, which was a hematoma, was evacuated, and the coarctation was repaired. The patient was discharged after the operation. At three weeks' follow-up, there was no significant lesion in the neck and transthoracic echocardiography demonstrated no residual coarctation.
The journal of Tehran Heart Center. 01/2010; 5(1):39-41.
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ABSTRACT: A 17-year-old, 55 kg girl was referred to the endocrinology department of a university hospital to determine the etiology of suspected Cushing's syndrome. The patient was treated with oral ketoconazole for 3 days, but a rapid and severe elevation in her liver function test results led to selection of IV etomidate as a therapeutic option. This approach led to decreasing levels of serum cortisol, and the patient was able to tolerate surgical adrenalectomy.
Anesthesia and analgesia 02/2009; 108(1):238-9. · 3.08 Impact Factor
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ABSTRACT: Difficult airway management is a dilemma for any anesthesiologist. Although practice guidelines and algorithms may help in such situations, the anesthesiologist's judgment and vigilance remain the primary means to save lives. In the following case, we encountered an acutely enlarging thyroid mass that was compromising the airway. This huge neck mass precluded tracheostomy under local anesthesia, and the patient could breathe only in the sitting position. Therefore, there were few safe strategies for airway management for general anesthesia. We reiterate the role of awake fiberoptic intubation in such circumstances.
Anesthesia and analgesia 12/2008; 107(5):1627-9. · 3.08 Impact Factor
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ABSTRACT: Regional anesthesia is an alternative to general anesthesia in selected surgical settings. Paravertebral block as a regional anesthesia technique was compared with general anesthesia for elective breast surgeries regarding postoperative pain.
Sixty patients scheduled for breast surgery were randomized to two groups of 30 patients each: general anesthesia (control group) and paravertebral block (study group). Postoperative pain, the primary outcome variable of the study, was assessed by a numeric rating scale at 1, 3, and 6 hours during the postoperative period. Total amount of morphine and hospital stay were also recorded. Student's t-test and ANOVA were used to compare results. A p value less than 0.05 was considered statistically significant.
The paravertebral group was found to have better postoperative pain relief (p=0.0000), reduced need for morphine (p=0.0000), and a shorter hospital stay (p=0.0000) compared with the general anesthesia group.
The study suggests paravertebral block as a suitable alternative to general anesthesia in selected breast surgical patients regarding postoperative pain reduction.
Medical science monitor: international medical journal of experimental and clinical research 11/2007; 13(10):CR464-7. · 1.70 Impact Factor
