Journal of

Introduction: Corticosteroids decrease side effects after noncardiac elective surgery. The aim of this study was to determine the prophylactic effects of IV dexamethasone (6mg×2) in preventing side ef­fects after cardiac surgery.

Methods and Materials: In a randomized, double blinded, placebo-controlled study 184 ASA physical status I or Il patients ranging 40-82 undergoing coronary revascularization surgery were enrolled in Imam Khomeini Hospital, medial sciences university of Tehran.
Dexamethasone (6mg/mL) or saline (1mL) was administered after the just before surgery and a second dose of the same study drug was given on the morning after surgery.  The patients were assessed at 24 and 48h intervals after surgery as well as at the time of hospital discharge, to determine the incidence and severity of postoperative side effects.

Results: Dexamethasone significantly reduced the incidences of nausea (P=0.034) and vomiting on the first postoperative day (P=0.005). In addition, dexamethasone significantly improves appetite on the first postoperative day (P=0.005). The corticosteroid decreased the incidences of atrial fibrillation AF (P=0.018) in the postoperative period. However, the corticosteroid failed to decrease the incidences postoperative pain.

Conclusion: dexamethasone (12 mg in divided doses) is suggested in reducing nausea and vomiting, decreases of atrial fibrillation and improving appetite after cardiac surgery.

Background & Aim : Symptoms associated with acute discomfort, e.g., headache eye, nose, or throat irritation dry and itchy skin, which are known as Sick Building Syndrome (SBS) are well reported amongst people who work in hospital environment especially in the X- ray department. The aim of this study was to determine the prevalence of the symptoms and to identify work related factors in hospital environment.

Materials and Methods : A questionnaire survey has been done from 219 hospital personnel who worked in the university hospitals (medical X-ray technologists, physiotherapists and office staff) as the exposed group and 219 personnel of the same occupations from private health care units and offices as the control group about if they experienced any of the mentioned symptoms in the last eight weeks. A total of 215 and 216 the questionnaire were accepted from each group respectively and included in analyses.

Results: From data provided by this work, 6 symptoms (headache, sorethroat, sinusitis, dermatitis,nasalaids and sore eyes)  have significant relationship between exposed and control groups. One symptom (catarrh) had significant difference among physiotherapists (P< 0.05), but with no significant difference between hospital and non-hospital environment. In addition, there was a relationship between incidence of dermatitis and history of skin allergy (P< 0.05).

Conclusion: The results from this preliminary work are similar with the studies, which have been done by others. These results also suggest that there is a link between incidence of SBS and hospital based chemical agents.

Background and Aim: Discontinuing aspirin use in patients before coronary artery bypass grafting (CABG) has focused on bleeding risks. The aim of this study was to determind the effect of aspirin use on overall mortality with this procedure.

Materials and Methods: In a retrospective review was under taken of 2,252 consecutive isolated coronary artery bypass grafting (CABG) procedures performed between July 1995 and May 3003 in Tehran, Shriati hospital. Patients who had isolated CABG operations and received aspirin were analyzed and compared to nonusers undergoing similar bypass procedures during the same period. Aspirin use was defined by identification of ingestion within 7 days before the operation.

Results: CABG patients using preoperative aspirin were less likely to experience in hospital hemorrhage compared to nonusers (P=0.0001). Significant difference was seen for transfusion of blood products, and need for reexploration for hemorrhage between patients who did and did not receive aspirin (P=0.0001).
Mortality in multivariate (odds ratio [OR] =0.12, 95%confidence interval [0.05, 0.28] analysis was less to patients using aspirin compared to nonusers (p=0.0001).

Conclusions : Preoperative aspirin use appears to be associated with a decreased risk of mortality in CABG patients with significant increase in hemorrhage, blood product requirements, or related morbidities.

Background and Aim: Females were reported to have significantly lower hematocrit (Hct), which might be the cause of increased need for blood transfusion. The goal of this study is to determine risk factors affecting blood transfusion in patients undergoing coronary artery bypass graft procedure related to gender

Materials and Methods: A cross sectional review of 500 (306 males and 194 females) ASA physical status I or Il patients undergoing bypass procedures with saphenous vein graft performed over a one year period were included in this study. The conducting of anesthesia was standardized. For each patient, we recorded the gender, age, body weight, height, body surface area (BSA), and duration of surgery. Hematocrit levels prior to surgery and the end of surgery were recorded. Packed red blood cell (PRBC) administration and use of fresh frozen plasma (FFP) and platelets were noted. Differences between the data for female and male patients were evaluated using Student's t-test, Chi-square test and using regression analysis.

Results: Approximately 57.2 % (111) female and only 39.9% (121) male patients received PRBCs. On average, females received 1. 6 units of PRBCs intraoperatively and 2. 6 units of PRBCs during the entire hospital stay, while the males received 1.1 units and 1.8 units for similar periods (P=0.0001). When females and males were compared within the same subgroups for age, body surface area (BSA), duration of surgery, and preoperative Hct, etc. ...had a significant correlation with age, postoperative Hct and BSA in females but had a significant correlation with preoperative Hct, preoperative PRBC and duration of surgery in males (P<0.05). Multiple logistic regression analysis showed that the probability of a patient receiving or not receiving PRBC transfusion is significantly influenced by preoperative Hct, postoperative Hct, duration of surgery, preoperative PRBC mass, and gender.

Discussion and Conclusion: Gender is an independent essential determinant of blood transfusion in CABG patients, and may interact with BSA, preoperative Hct, duration of surgery and other factors in determining the probability of transfusion.

Background and Aim: Excessive Bleeding continues to play a key role and an important cause of morbidity and mortality after cardiopulmonary bypass (CPB). The goal of this study was to determine the differences in bleeding and transfusion between OPCAB and on -pump CABG patients.

Materials and Methods: In a randomized, double blinded prospective study 300 patient's undergoing coronary revascularization surgery were enrolled, 150 CABG patients were compared with 150 OPCAB patients. The patients were assessed during the first 72 hours to determine the postoperative side effects. The 2 groups were compared using the chi-square test or fisher's exact test and the rank sum test.

Results: CABG patients received more intraoperative red blood cells (P<0.0001), more albumin and more fresh- frozen plasma (P<0.0001). Postoperatively, CABG patients were more likely to receive more platelets (29.3% ν 70.7 %, P<0.007). During the operative and the initial 4-hour postoperative period OPCAB patients exhibited greater blood loss (P<0.0001) however, at 12,24and 72 hours postoperatively, CABG patients exhibited greater blood loss. There were4 death in CABG patients (P<0.05)

Conclusion: Despite not reversing the heparin at the end of the OPCAB surgery, OPCAB surgery was associated with an overall reduction in platelets, fresh- frozen plasma, Albumin and transfusion requirements.