Comparison of inhaled iloprost and nitric oxide in patients with pulmonary hypertension during weaning from cardiopulmonary bypass in cardiac surgery: a prospective randomized trial.

OBJECTIVE: The objective of this study was to compare the efficacy of inhaled iloprost and nitric oxide (iNO) in reducing pulmonary hypertension (PHT) during cardiac surgery immediately after weaning from cardiopulmonary bypass (CPB). DESIGN: A prospective randomized study. SETTING: A single-center university hospital. PARTICIPANTS: Forty-six patients with PHT (mean pulmonary artery pressure (mPAP) > or = 26 mmHg preoperatively at rest, after anesthesia induction, and at the end of CPB) scheduled to undergo cardiac surgery were enrolled. INTERVENTIONS: Patients were randomly allocated to receive iloprost (group A, n = 23) or iNO (group B, n = 23) during weaning from CPB. MEASUREMENTS AND MAIN RESULTS: Heart rate, mean arterial pressure, central venous pressure, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure, and left atrial pressure were recorded continuously. Iloprost and iNO were administered immediately after the end of CPB before heparin reversal. Both substances caused significant reductions in mean PAP (mPAP) and pulmonary vascular resistance (PVR) and significant increases in cardiac output 30 minutes after administration (p < 0.0001). However, in a direct comparison, iloprost caused significantly greater reductions in PVR (p = 0.013) and mPAP (p = 0.0006) and a significantly greater increase in cardiac output (p = 0.002) compared with iNO. CONCLUSIONS: PHT after weaning from CPB was significantly reduced by the selective pulmonary vasodilators iNO and iloprost. However, in a direct comparison of the 2 substances, iloprost was found to be significantly more effective.

Effectiveness and safety of internal rectilinear biphasic versus monophasic defibrillation in patients undergoing cardiac surgery.

BACKGROUND: Recently it has been shown that biphasic external shocks are more effective in the treatment of ventricular fibrillation (VF) compared with monophasic external shocks in terms of number of defibrillation attempts and maximal energy used for termination of VF. Biphasic defibrillators apply different biphasic impulse forms, depending on technology. To the authors' knowledge, there are no existing data concerning the effects of rectilinear biphasic internal shocks in patients undergoing cardiac surgery. The purpose of this study was to compare monophasic with rectilinear biphasic internal shock waveforms for termination of VF in patients undergoing cardiac surgery. METHODS: One hundred thirty-four patients scheduled for elective cardiac surgery were prospectively randomized either to monophasic (group A) or biphasic (group B) internal defibrillation. Defibrillation was started with 7 J and increased stepwise to 30 J in each group until successful termination of VF after aortic declamping. The number of defibrillations, as well as the cumulative and maximal energy for termination of VF, were determined. Preoperatively, intraoperatively, and postoperatively troponin T, total creatine phosphokinase (CPK), and CPK- MB isoenzymes were measured. RESULTS: In 64 patients (47%) VF occurred. The groups consisted of 32 patients each. The number of defibrillations (1.3 +/- 0.6 v 1.9+/- 1.2; p = 0.013), maximal energy per patient (7.9 +/- 2.5 v 11.6 +/- 7.32; p = 0.006), and cumulative energy (10.1 +/-6.1 v 21.3 +/- 24.1; p = 0.016) for successful termination of VF were significantly reduced in group B. Troponin T, CPK, and CPK-MB did not differ between groups. CONCLUSIONS: Results of this study indicate that rectilinear biphasic internal defibrillation is more effective in the treatment of VF during cardiac surgery than is monophasic defibrillation. However, no significant difference in myocardial damage could be detected between groups.

Massive postoperative rhabdomyolysis following combined CABG/abdominal aortic replacement: a possible association with HMG-CoA reductase inhibitors.

OBJECTIVE: The beneficial effects of the treatment of hyperlipidemia in the secondary prevention of ischemic heart disease are well established. Pravastatin is a 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitor often prescribed for the treatment of hypercholesterolemia. Occasional side effects include increased creatine kinase levels and myalgias worsened by exertion, rarely presenting with severe myopathy and rhabdomyolysis resulting in myoglobinuria and renal failure. PATIENTS AND METHODS: We report on a case of a 68-year-old male patient who developed rhabdomyolysis, severe myoglobinuria, and acute renal failure following uneventful coronary bypass grafting surgery (CABG) combined with infrarenal replacement of the abdominal aorta. The patient presented with numerous risk factors for development of rhabdomyolysis following surgical intervention. We underscore important contributory factors and discuss differential diagnostic considerations e.g., malignant hyperthermia and neuroleptic malignant syndrome in such patients. CONCLUSIONS: Considering the high risk of perioperative mortality in patients that routinely take fat lowering substances, we suggest to discontinue the intake prior to surgical interventions.