Comparison of different doses of tranexamic acid on post-operative bleeding in patients of CABG surgery

To compare three different dosing schedules of tranexamic acid to achieve good hemostasis intraoperatively and in post-operative period. Randomized controlled trials. Anaesthesia department, Armed Forces Institute of Cardiology/ National Institute of Heart Diseases [June 2011 to Jan 2013] A total of 128 patients, due for coronary artery bypass grafting were included in this study after informed consent. The patients were randomly divided into four groups. Group A, being the control group, did not receive tranexamic acid during the operation, whereas the remaining three groups received tranexamic acid just after the reversal of heparin with protamine sulphate. Group B received low dose, group C received medium dose and group D received high dose of tranexamic acid both as bolus and followed by infusion. Six patients, 4 from group B and 2 from group D were dropped out due to incomplete data or some complication. The blood loss at 6 hours and 24 hours after surgery were noted along with amount and type of transfusions needed and clinical outcomes. The total cardio-pulmonary bypass time, aortic cross-clamp time and chest closure time were also noted. Haemoglobin levels, coagulation profile and activated clotting time were noted and compared pre and post operatively. All the 4 groups were comparable with respect to age, weight, gender and personal history. Average 1eeding in group A was similar to group B after six hours [p = 0.755] and 24 hours [p = 0.343] but significantly higher as compared to group C [p < 0.001] and group D [p <0.001]. Group B also had more blood in chest drain as compared to group C [p <0.001] and group D [p <0.001]. Group C and group D had almost similar amount of blood loss after 6 hours [p = 0.916] as well as after 24 hours [p = 0.834]. This study showed that tranexamic acid, when given at a loading dose of 20 mg/kg or greater and followed by a maintenance infusion of 15 mg/kg/hr or greater, significantly reduced the amount of blood loss, both intra-operatively and post- operatively, in patients undergoing on-pump coronary artery bypass grafting

Reduction in platelet count in post CABG patients with or without IABP- an experience at AFIC/NIHD Rawalpindi

To study the reduction in platelet count in patients after coronary artery bypass grafting having IABP placed peri operatively with and without IABP placed. Descriptive Study. Armed Forces Institute of Cardiology/National Institute of Heart Diseases [AFIC/NIHD] from Jan 2012 to Dec 2013. All cases with intra-aortic balloon pump [IABP] placed peri operatively [coronary artery bypass grafting, CABG] during this time period were examined in detail. Only those patients who had a platelet count of 150,000 or more pre operatively were included in the study. Patients taking medicines pre operatively that lead to decrease in platelet count were excluded. Platelet counts of each patient were analyzed till the third post-operative day. One hundred and fifty patients were divided into two equal groups, group A without IABP and group B with IABP. Patients without IABP [group A] pre operatively had mean platelet count of 223.57 +/- 83.02, on first post op day the mean platelet count was 171.0 +/- 59.0 which was 76.48% of preoperative level, on second post op day the mean platelet count was 168.1 +/- 59.4 which was 75.20% of preoperative level and on third post op day the mean platelet count was 167.5 +/- 60.0 which was 74.95% of pre-operative level. Patients with IABP [group B], pre operatively had mean platelet count of 205.32 +/- 50.257, on first post op day the mean platelet count of 152.71 +/- 43.77 which was 74.37% of preoperative level, on second post op day the mean platelet count was 112.11 +/- 42.571 which was 54.60% of preoperative level and on third post op day the platelet count was 90.87 +/- 41.538 which was 44.25% of preoperative level. There was significant reduction in platelet count from the pre-operative level in both the groups. Reduction in platelet count in post CABG patients is similar in both the groups i.e. in whom IABP is and those patients who are not treated with IABP

relationship of skin to epidural space depth with different physical parameters in obstetric patients

The objective of the study was to find out the correlation between the skin to epidural space depth and different physical parameters like age, height, parity, weight and Body mass index in obstetric patients. Prospective non-probability purposive correlational study. This study was conducted in Department of Anaesthesia and Intensive care, Combined Military Hospital, Quetta, over duration of one year from may 2005 to April 2006. This was prospective correlational study and total of 100 obstetric patients belonging to ASA-I and II class were included. All patients received epidural anaesthesia with 16/18G Tuohy's needle and an epidural catheter was passed at the level of L3-L4/L4-L5 interspace. The skin-to-epidural space depth was marked on the Tuohy's needle with a marker and was subsequently measured with a scale. This study was conducted on parturients undergoing Caesarean section having ages between 18-40 years with mean 27.27 + SD 4.90 years, weight between 44-92 kg with mean 62.73 + SD 9.37 kg, height 142-166 cm with mean 153 + SD 5 cm, parity between primigravida to gravida 9 with mean 2.43 + SD 2.24 and body mass index of 19-38 kg/m2 with mean 27 + SD 4 kg/m2. The skin-to-epidural space depth ranging between 31 mm to 78 mm with mean of 41.59 + SD 6.49 mm was noted. Pearson correlation coefficient for the relation of skin to epidural space depth with patient's age was r=0.317 [p=0.001], with weight was r=0.618 [p=0.0001], with height was r= -0.004 [p=0.966], with body mass index was r=0.623 [p=0.0001] and with patient's parity was r=0.210 [p=0.028]. It was concluded that the skin-to-epidural space depth had statistically significant strong correlation with weight and body mass index but statistically significant weak correlation with age and parity, and statistically insignificant correlation with height