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(a) Extravascular lung water index; (b) Intrathoracic blood volume index; (c) Global end diastolic volume index at different time intervals (T0-baseline before induction of anaesthesia, T1-after induction of anaesthesia, T2-30 min after coming off cardio pulmonary bypass, T3-at Intensive Care Unit (ICU) admission, T4-4 h after ICU, T5-8 h after ICU, T6-30 min postextubation, and T7-at 24 h after ICU admission) (P < 0.05 was considered significant, *indicate significant difference between two groups) c
Source publication
To compare the effects of propofol and nitroglycerine (NTG) on the efficacy of rewarming, extra volume added during cardiopulmonary bypass and extravascular lung water (EVLW) in patients undergoing on-pump coronary artery bypass grafting.
A prospective, randomized, blinded trial, twenty adult patients were randomly assigned to receive either NTG in...
Context in source publication
Context 1
... naso : Nasopharygeal temperature, T rectal : Rectal temperature, T foot : Foot temperature, Afterdrop ES: Afterdrop at the end of surgery, Afterdrop ICU: Afterdrop till 24 h of Intensive Care Unit admission, NTG: Nitroglycerine, CI: Confidence interval, CPB: Cardiopulmonary bypass, SD: Standard deviation less in the propofol group at 30 min after coming off CPB compared to NTG group (P -0.02). It remained comparable between both groups at all other time points [ Figure 1a PaO 2 /FiO 2 ratios were comparable between both the groups at all points. Higher value from baseline were seen after induction of anesthesia, 30 min after CPB and at ICU admission in the propofol group, but only after induction of anesthesia in NTG group [ Figure 2d]. ...
Citations
... offpump cardiopulmonary bypass grafting), lack of capacity to consent, and use of total intravenous anesthesia (TIVA) whilst on CPB. TIVA with propofol was excluded due to its potential beneficial vasodilating properties during CPB [14]. Based on our previous study we calculated our sample size to need over 59 patients to have a power value of 90% [15]. ...
... Baseline demographic data, total CPB time, total time to rewarm & total surgery time were comparable between both groups including Euroscore 2. This may also explain the comparable time to extubation found between both groups in the setting of a matching post-operative lactate trend. Our results did not replicate the previous positive findings from our earlier study or Ying-Hsuans retrospective review [14,15]. The mean dose of GTN administered in the low dose group was 25 micrograms compared to 1506 micrograms in the higher dose GTN group. ...
... One interesting study that showed promise by Kumar et al., looked at propofol vs GTN on the efficacy of rewarming along with extra volume added during CPB [14]. This study showed a benefit of propofol over GTN in reducing the afterdrop phenomenon, albeit the numbers were much smaller with only 10 patients in each arm. ...
Background:
Does Glyceryl trinitrate (GTN) administered during rewarming on cardiopulmonary bypass (CPB) impact: time to completion of rewarming prior to separation from CPB circuit, early post-op patient peripheral - core temperature gradient, time to maintenance of normothermia (core temperature > 36.5 °C) for minimum of 2 h in the initial post-op period, and plasma lactate concentrations initially post-CPB.
Methods:
Single centre prospective randomized trial conducted in the Mater Misericordiae University teaching hospital in Dublin Ireland.
Trial registration:
ISRCTN registry, ISRCTN10480871 , registered 16th of August 2017. 82 patients enrolled. Patients randomised to low dose GTN infusion (0.01 mcg/kg/min) or higher dose GTN infusion (0.5 mcg/kg/min) during rewarming on CPB.
Measurements and main results:
There was no significant difference between the treatment arms for the total time to being rewarmed, U = 759.0, p = 0.84. There were also no differences between the treatment arms for the time to achieve core temperature greater than 36.5 after two hours, U = 714.0, p = 0.52, the time to achieve plateau core skin temperature, U = 688.0, p = 0.37, and the post-intervention protamine lactate, U = 721.0, p = 0.56.
Conclusions:
Higher dose GTN infusion during rewarming on CPB does not improve peripheral-core temperature gradient post operatively and has no effect on post-operative lactate concentrations.
Objectives:
Comparison of effects of propofol and isosorbide dinitrate during rewarming on cardiopulmonary bypass in patients undergoing coronary artery bypasses grafting.
Methods:
It was randomized prospective clinical trial. One hundred and twenty patient (120) undergoing CABG surgery were included in this study. Group-I (Study group, n=60): in which only propofol infusion used during rewarming and Group-II (control Group, n=60) in which isosorbide dinitrate and propofol infusion combination was used during rewarming. The data was entered and analyzed through SPSS Version 19. Independent sample T-test and chi-square test were used for data analysis. P value of ≤ 0.05 was taken as significant.
Results:
Mean arterial pressures during rewarming were 63.41±3.61 mmHg in propofol group versus 60.80±4.86 mmHg in control group (p-value 0.001). Core temperature on weaning from cardiopulmonary bypass was 37.11±0.49 °C in propofol group and 37.00±0.18 °C in control group. After drop in core temperature was little more in propofol group (1.02±0.36 °C) versus 0.96±0.37 °C in control group but this difference was not statistically significant (p-value 0.41). Mean Ventilation time after surgery in propofol group was 4.65±0.65 hours versus 5.03±0.81 hours in control group (p-value 0.006).
Conclusion:
Propofol alone is capable of fulfilling the requirements of adequate rewarming during Cardiopulmonary bypass and can produce more hemodynamic stability and early post-operative recovery.
