Does Off-pump Coronary Artery Bypass Reduce the Prevalence ofAtrial Fibrillation?

INTRODUCTION: To examine whether or not off-pump CABG (Coronary Artery Bypass Reduce) reduces the incidence of AF after cardiac surgery. METHODS: The study was carried out in 939 consecutive coronary artery disease patients with sinus rhythm from which 383 patients underwent off-pump CABG, and 556 patients were operated through on-pump CABG. All patients were monitored postoperatively during intensive care unit (ICU) stay. Then, the incidence and predictive risk factors of post operative AF (POAF) in two groups were determined and compared with each other. RESULTS: Overall, the mean age of the patients was 56.0±12.8 years with 234 patients (24.9%) being older than 65 years. POAF developed in 38 patients (9.9%) of the off-pump and in 93 patients (16.7%) of the on-pump CABG. There was significant difference between two groups when considering the incidence of POAF (P=0.002). Among preoperative risk factors, age>65 years had a significant association with the incidence of AF in both groups. This study also showed that most of the POAF cases converted to sinus rhythm after treatment. Moreover, these finding demonstrated that conversion to sinus rhythm is significantly more probable in off-pump group (P=0.006). CONCLUSION: A reduced prevalence of POAF could be observed in patients with off-pump as compared with on-pump techniques. Furthermore, conversion to sinus rhythm in off-pump group was significantly more probable than on-pump group.

Postoperative Atrial Fibrillation following Open Cardiac Surgery: Predisposing Factors and Complications.

INTRODUCTION: New-onset postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that has substantial effects on outcomes. The aim of this study is to analyze the risk factors in the pre, intra, and postoperative periods, and evaluate its impact on patients' outcome. METHODS: In this prospective study, between March 2007 and February 2011, a total of 1254 patients with preoperative sinus rhythm who underwent open cardiac surgery were included of which 177 (13.6%) had developed POAF. Many clinical variables that are associated with the development of POAF, were evaluated. RESULTS: The study population consisted of 1254 patients that 864 (68.9%) were male and 390 (31.1%) female, and average age was 55.1±15.7 years. POAF occurred in 171 (13.6%) of patients and most of them (68.4%) developed within the first two days after surgery. Multivariate logistic regression analysis was used to identify the following risk factors of POAF: Preoperative risk factors: age>50, smoking, Left ventricular hypertrophy, renal dysfunction, intraoperative risk factors: intraoperative inotrope use, valve surgery, atrial septal defect (ASD) surgery, bicaval cannulation, concomitant cardiac venting of pulmonary and aorta, longer cardiopulmonary time, longer cross-clamp time, postoperative use of inotropic agent after termination of cardiopulmonary bypass. CONCLUSION: POAF is the most common arrhythmia after cardiac surgery and not only concerted effort should be performed to identify and to reduce the risk factors, but also effective treatment is necessary to prevent mortality and morbidity.

Hemodynamic Changes following Anesthesia Induction and LMA Insertion with Propofol, Etomidate, and Propofol + Etomidate.

INTRODUCTION: LMA is a simple supra-laryngeal device which is used to establish and maintain airway. Despite the common use of the LMA, there are no optimal methods for induction of anesthesia that can guarantee a proper insertion. The purpose of this study is comparing three methods of induction of anesthesia (Propofol, Etomidate, Propofol+Etomidate) in the hemodynamic stability after LMA insertion in elective surgeries. METHODS: A total of 90 patients with ASA classes I and II undergoing elective surgeries were randomly allocated into one of the following three groups. Before anesthesia induction, all patients were premedicated. Anesthesia induction methods included: Group P (propofol 2.5 mg/kg), Group E (etomidate 0.3 mg/kg) and Group P+E (propofol 1 mg/kg plus etomidate 0.2 mg/kg). Heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were measured before induction and 30 seconds after induction. Apnea time is recorded in all patients. Number of attempts to laryngeal mask insertion, ease of placement, were compared in three groups. RESULTS: There was no significant difference between demographic data and BIS, SaO2, Etco2 associated diseases, in three group (P>0.5).There is significant difference in hemodynamic (Systolic, diastolic and mean blood pressures) changes between group 1 in comparison with group 2 and group 3. HR was significantly lower in group 1 than group 2 (P=0.16). There was significant difference in the number of attempts and ease of LMA insertion between group 2 in comparison with group 3 and group 1. The duration of apnea in group 2 was a (8.67± 6) min, where as it was (18.10±6.25) min in group 1 and (12.03±6.4) min group 3. CONCLUSION: Etomidate plus propofol is an effective and alternative to propofol and etomidate for facilitating LMA insertion with the added advantage of lack of cardio-vascular depression.

Prerequisites for electronic learning: Iranian postgraduate nursing students' points of view.

BACKGROUND: Nursing education is mostly conducted through electronic educational programs. We aimed at assessing the Iranian postgraduate nursing students' skills and attitudes regarding the electronic education. MATERIALS AND METHODS: Ninety-seven postgraduate nursing students were surveyed using questionnaires assessing their individual-social and educational characteristics, electronic education skills, and attitudes toward the electronic education. RESULTS: Scores of the students' skills in using computer and the Internet were significantly associated with gender and the number of hours working with computer and the Internet at home and work. CONCLUSION: Prerequisites for performing electronic education programs are present at moderate levels in Iran.

Intravascular catheter colonization and related bloodstream infection in the heart surgery intensive care unit.

OBJECTIVE: To study the incidence of catheter tip colonization, catheter-related infections, their risk factors, and to compare these data with other studies. METHODS: Since 2006, we have had a through program for the insertion and care of all catheters used at cardiac surgical intensive care unit SICU, Tabriz University of Medical Sciences, Tabriz, Iran, between May 15, 2006 and September 15, 2007. We studied prospectively 183 catheters in 150 patients in relation to insertion data and catheter characteristics, catheterization time and microbiological cultures. These catheters were in place for >48 hours over a 16 months period. Risk factors were analyzed by multivariate analysis. RESULTS: The analysis included 115 central venous catheter CVCs, 65 arterial catheters ACs, and 3 pulmonary artery catheters PACs inserted in 150 patients. The median time of catheter placement was 4 days. The incidence of positive tip culture was 9.8% and 10 microorganism isolated from 18 colonized catheters. Thirteen Gram-negative bacilli, 4 Gram-positive cocci, and one yeast were isolated. From multivariant analysis, >6 days of catheterization, and insertion site were the variables associated with significantly increased risk of catheter colonization. CONCLUSION: Gram-negative bacilli and Gram-positive cocci are the most common microorganisms colonizing CVC and AC from cardiac SICU patients. Duration of catheterization and catheter insertion site were independent risk factors of catheter related infection.