Using Music for the Prevention of Delirium in Patients After Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial.

OBJECTIVE: The aim was to evaluate the effect of music on preventing delirium after coronary artery bypass grafting, to analyze vital signs and blood gas parameters, and to determine risk factors affecting delirium. DESIGN: A randomized clinical trial. SETTING: A single-center, tertiary hospital. PARTICIPANTS: In total, 200 patients who underwent coronary artery bypass grafting surgery from April 2020 to April 2021. INTERVENTIONS: A one-hour session of new-age music was administered twice a day postoperatively for 7 days using a headphone. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit before and after each session. Vital signs and blood gas parameters were compared to evaluate the effect of music. All assessments were conducted blindly by a different researcher. MEASUREMENTS AND MAIN RESULTS: Twelve participants who were delirium-positive were in the control group, and there were 3 in the case group, which suggested a statistically significant effect of music in preventing delirium (p = 0.016). The mean age of patients was 64.7 ± 7.9 years old in the control group and 62.2 ± 7.5 years old in the case group. There was a significant difference among the control and case groups in terms of the surgery time; surgery time in the control group was significantly lower than in the case group (242.4 ± 42.3 v 261.6 ± 48.9, respectively; p = 0.03 < 0.05). Blood pressure and heart rate in the case group were lower, similar to the respiratory rate and venous blood gas parameters; Blood pressure differences were not statistically significant (p > 0.05); CONCLUSION: Relaxation music, including bird, water, and wind, significantly prevents delirium after coronary artery bypass grafting.

Sleep Quality after Coronary Artery Bypass Graft Surgery: Comparing Pulsatile and Nonpulsatile Pump Flow.

Poor postoperative sleep quality is a common problem in patients undergoing coronary artery bypass graft surgery (CABG). The purpose of this study was to compare the effect of pulsatile and nonpulsatile pump flow on sleep quality of these patients. In this clinical trial, 52 patients undergoing on pump CABG surgery with the roller pump were randomly divided into two equal groups of 26 patients: group 1 using pulsatile pump flow and group 2 nonpulsatile pump flow while the heart was arrested. Sleep score of both groups was evaluated by Pittsburgh Sleep Quality Index questionnaire 2 days before operation and 1 month after operation, and they were compared with each other. Analysis was performed with SPSS software version 22 (SPSS for Windows Inc., Chicago, IL) using the independent t-test, chi-square test, and Fisher exact test. Both groups were the same in demographic characteristics and risk factors such as age, gender, diabetes mellitus, hypertension, hyperlipidemia, smoking, body mass index, and preoperative ejection fraction. Operation data showed no difference between two groups considering cardiopulmonary bypass time and cardiac arrest time. Preoperative sleep quality score of both groups had no significant difference (p = .84). One month postoperative sleep quality score of the pulsatile group was significantly better than that of the nonpulsatile group (p = .04). Using pulsatile flow cardiopulmonary bypass can effectively decrease postoperative sleep disorders in comparison to nonpulsatile flow.

Preventive Use of Ascorbic Acid For Atrial Fibrillation After Coronary Artery Bypass Graft Surgery.

BACKGROUND: Atrial fibrillation is one of the most frequent complications and a major risk of morbidity and mortality after cardiac surgery. Antioxidants such as vitamin C are used for prevention of this arrhythmia. Different results of studies have been reported, but most of them have shown efficiency of vitamin C in prophylaxis of postoperative AF. We tried to examine this efficacy with larger sample size. METHODS: Three hundred and fourteen on pump coronary artery bypass graft surgery alone. Patients were divided into two groups: The intervention group received vitamin C (N = 160) and the control group did not receive any (N = 154). Intervention group was administered two grams of vitamin C intravenously (IV) 24 hours preoperatively, 500 mg every 12 hours IV for 48 hours in ICU, and 500 mg every 12 hours PO for 48 hours in ward. Continuous monitoring in ICU and three times a day ECG was used for AF detection. The two groups were compared. RESULTS: The two groups were matched in terms of age, sex, LA size, ejection fraction, functional class, and TSH level. Of the patients, 244 were male. Mean age was 62 years (40-84 years) in both groups. M/F ratio was four in both groups. Functional class and ejection fraction were the same in both groups. There was no mean TSH level difference. AF occurrence in vitamin C group was 7.6 % and in control group was 7.8 %. There was no difference in ICU or hospital stay. CONCLUSIONS: Prophylactic use of vitamin C does not further reduce postoperative atrial fibrillation in on pump CABG patients.

Does topical tranexamic acid reduce postcoronary artery bypass graft bleeding?

BACKGROUND: Postoperative bleeding is a common problem in cardiac surgery. We tried to evaluate the effect of topical tranexamic acid (TA) on reducing postoperative bleeding of patients undergoing on-pump coronary artery bypass graft (CABG) surgery. MATERIALS AND METHODS: One hundred and twenty-six isolated primary CABG patients were included in this clinical trial. They were divided blindly into two groups; Group 1, patients receiving 1 g TA diluted in 100 ml normal saline poured into mediastinal cavity before closing the chest and Group 2, patients receiving 100 ml normal saline at the end of operation. First 24 and 48 h chest tube drainage, hemoglobin decrease and packed RBC transfusion needs were compared. RESULTS: Both groups were the same in baseline characteristics including gender, age, body mass index, ejection fraction, clamp time, bypass time, and operation length. During the first 24 h postoperatively, mean chest tube drainage in intervention group was 567 ml compared to 564 ml in control group (P = 0.89). Mean total chest tube drainage was 780 ml in intervention group and 715 ml in control group (P = 0.27). There was no significant difference in both mean hemoglobin decrease (P = 0.26) and packed RBC transfusion (P = 0.7). Topical application of 1 g TA diluted in 100 ml normal saline does not reduce postoperative bleeding of isolated on-pump CABG surgery. CONCLUSION: We do not recommend topical usage of 1 g TA diluted in 100 ml normal saline for decreasing blood loss in on-pump CABG patients.

A comparative study of stored arterial versus venous blood collected using the acute normovolemic hemodilution method in coronary artery bypass grafting patients in Iran.

BACKGROUND: In the present study, arterial and venous blood was collected from patients who were candidates for elective coronary artery bypass grafting (CABG); the blood was stored for 28 days and cellular, biomechanical, and hematological changes in blood were compared to determine whether stored arterial blood is superior to stored venous blood. METHODS: The present follow-up comparative study included 60 patients >18 years of age, with hemoglobin >14 mg/dl and ejection fraction >40% who were candidates for CABG. After induction of anesthesia, 250 ml of arterial or venous blood was drawn from patients (arterial blood group and venous blood group). Laboratory blood samples were taken at specified times from the collected blood and re-injected into the patients after CABG. RESULTS: Significant differences were observed in pH, partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), bicarbonate (HCO3), and glucose values at several time points between the groups. Other parameters such as urea and creatinine did not show any significant differences between the groups. CONCLUSIONS: Twenty-eight days of storage can have a negative effect on some of the cellular, biochemical, and hematological components of arterial and venous blood; however, the quality of stored arterial blood and venous blood does not differ significantly.

Comparison of the effect of 1:1 and 1:2 frequencies of intra-aortic balloon pump on hemodynamics of the patients undergoing coronary artery bypass graft surgery.

BACKGROUND: Some patients require intra-aortic balloon pump (IABP) after coronary artery bypass graft (CABG) surgery. IABP can be adjusted to different frequencies such as 1:1, 1:2, or 1:3. In this study, we tried to compare the effect of 1:1 and 1:2 frequencies of IABP on hemodynamic status of the patients after CABG surgery. METHODS: In this experimental study, all patients using IABP after CABG surgery were entered the study as pretest and posttest groups. The study could not be blinded because of the clearness of posttest group for the same echocardiographist. The pretest group included patients using a 1:1 frequency of IABP device. The posttest group included patients in the pretest group who were exposed to a 1:2 frequency for 20 minutes. In both groups, on the moderate dose of inotropic support, hemodynamic parameters of patients including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume (SV), and velocity time integral (VTI) in the aorta during systole were measured. Both groups were compared using Wilcoxon signed rank test. SPSS software was used for analysis and P < 0.05 was considered to be statistically significant. RESULTS: Twelve patients were entered into the study. Three patients were excluded because of open chest and instability of vital signs. Nine patients completed the study. 3 patients were men and 6 were women. The mean age was 58.32 ± 13.18 years. MAP in 1:1 frequency was significantly higher than 1:2 (P = 0.043); however, there was no significant difference between 1:1 and 1:2 in other hemodynamic parameters, namely CO, CI, SV, HR, and VTI. CONCLUSION: In patients on moderate dose of inotropes, IABP frequencies of 1:1 and 1:2 have the same effect on hemodynamic parameters such as CI, SBP, DBP, HR, and left ventricular outflow tract (LVOT) VTI; meanwhile, MAP remains higher in 1:1 frequency.

Rare post-operative complications of large mediastinal tumor resection.

BACKGROUND: There are some reports in the literature, which suggest that cardiac tamponade drainage may transiently affect systolic function and also cause acute respiratory distress syndrome (ARDS). We did not find any reports of acute ventricular failure and ARDS secondary to mediastinal tumor resection without tamponade. CASE REPORT: Here we report a 48-year-old woman presenting with massive pericardial effusion without tamponade in whom tumor was resected through median sternotomy using cardiopulmonary bypass. ARDS and acute heart failure were two rare complications that happened at the end of the operation secondary to a sudden decompression of the heart from tumor pressure. CONCLUSION: ARDS and acute heart failure are two rare complications, which can happen after large mediastinal tumor resection.

Giant esophageal squamous papilloma: a case report.

Esophageal papilloma is a rare disorder that may cause hypopharyngeal symptoms. This patient was a 56-year-old man who presented with cough and choking symptoms. After the initial negative laryngoscopy, a fiberoptic endoscopy revealed a mass originating from the hypopharyngeal area, which was resected surgically and found to be non-malignant.