The Effects of Mean Arterial Pressure during Cardiopulmonary Bypass on Clinical and Paraclinical Parameters during and after Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Intern, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 Epidemiologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Cardiovascular disease is one of the most common causes of death in today's world. Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) is considered as a treatment for ischemic heart diseases. One of the conflicting points during CPB is maintaining optimum mean blood pressure. This study aimed to examine the impact of two different ranges of mean arterial pressure during CPB on intra- and post-operative clinical and paraclinical variables.Methods: In this randomized clinical trial study, two groups of 54 patients undergoing CABG surgery with CPB were enrolled. During CPB, blood pressure was maintained at about 50-70 mmHg in one group and 70-90 mmHg in the other group by administration of ephedrine and nitroglycerin. The patients were studied for blood gas, urine output, pace maker and inotrope requirements, arrhythmia, blood urea nitrogen (BUN), creatinine (Cr), cognition before, during and after the surgery, and also duration of intensive care unit (ICU) stay and intubation.Findings: In this study, two groups of 54 patients were enrolled. Overall, 92 (85%) subjects were male and 16 (15%) were female. Mean age of patients was 61.3 ± 9.3 years. Results showed that mean values of bicarbonate (Hco3), BE, arterial pressure of carbon dioxide(PCO2), arterial pressure of oxygen (PO2), BUN, Cr, duration of ICU stay, urine output, duration of intubation, level of cognition, pace maker and inotrope requirements and incidence of arrhythmia had significant relationships with blood pressure before, during, and after surgery. Meanwhile, pH did not have any significant relationships with blood pressure Conclusion: Overall results showed that prognosis in patients with controlled blood pressure at about 70-90 mmHg during CABG surgery was better compared to the group with a blood pressure of 50-70 mmHg. However, more studies seem necessary.

Keywords

References

  1. Jahanbin F. Epidemiology and prevention of cardiovascular disease. Proceedings of the 12th Internationals Congeress of Cardiovascular Disease; 2000; Tehran, Iran.
  2. Woods SL, Froelicher ESS, Motzer SAU. Cardiac Nursing. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.
  3. Cook DJ. Changing temperature management for cardiopulmonary bypass. Anesth Analg 1999; 88(6): 1254-71.
  4. Galloway AC, Sharony R, Sahwartz CF, Saunders PC, Grossi EA, Colrin SB. Acquircd heart disease. In: Brunicardi C, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, et al., editors. Schwartzs Principles of Surgery. 8th ed. New York: McGraw Hill; 2006. p. 651-2.
  5. Hammon J W. Extracorporeal circulation. In: Cohn L, editor. Cardiac Surgery in the Adult. 3rd ed. McGraw-Hill: New York; 2007. p. 389-414.
  6. Albert MA, Halevy N, Antman EM. Preoperative evaluation for cardiac surgery. In: Cohn L, editor. Cardiac Surgery in the Adult. 3rd ed. New York: McGraw-Hill; 2007. p. 261-80.
  7. De SF. Optimization of the perfusion circuit and its possible impact on the inflammatory response. J Extra Corpor Technol 2007; 39(4): 285-8.
  8. De SF. Optimal versus suboptimal perfusion during cardiopulmonary bypass and the inflammatory response. Semin Cardiothorac Vasc Anesth 2009; 13(2): 113-7.
  9. Gold JP, Charlson ME, Williams-Russo P, Szatrowski TP, Peterson JC, Pirraglia PA, et al. Improvement of outcomes after coronary artery bypass. A randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg 1995; 110(5): 1302-11.
  10. Charlson ME, Peterson JC, Krieger KH, Hartman GS, Hollenberg JP, Briggs WM, et al. Improvement of outcomes after coronary artery bypass II: a randomized trial comparing intraoperative high versus customized mean arterial pressure. J Card Surg 2007; 22(6): 465-72.
  11. Alavi SM, Babaei T, Sadeghpour Tabaee A, Naghipur B, Sedighinejad A, Jerineshin H. Comparison of the effect of gelatin solution, ringer solution and voluven in the hemodynamic status of CABG patients during transfer to ICU and early post operation. Journal of surgery 2010; 18(3): 38-47.
  12. Santos FS, Velasco IT, Fraguas R, Jr. Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Int Psychogeriatr 2004; 16(2): 175-93.
  13. Topal AE, Eren MN. Predictors of atrial fibrillation occurrence after coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg 2011; 59(4): 254-60.
  14. Bahcivan M, Gulel O, Kolbakir F. The effect of preoperative circadian blood pressure pattern on early postoperative outcomes in patients with coronary artery bypass graft surgery. Anadolu Kardiyol Derg 2008; 8(5): 354-9.
  15. Sanders JS, Skipworth JR, Cooper JA, Brull DJ, Humphries SE, Mythen M, et al. Duration of preceding hypertension is associated with prolonged length of ICU stay. Int J Cardiol 2010. [Epub ahead of print].
Journal of Isfahan Medical School
Volume 29, Issue 169 - Serial Number 169
November and December 2012
Pages 2574-2583

Files

History

  • Receive Date: 26 November 2011
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics