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 and Aim: Stroke is an important cause of morbidity and mortality in patients undergoing coronary artery bypass (CABG) surgery. There are various mechanisms that can cause prioperative strokes in patients undergoing CABG other than Carotid Artery disease. The goal of this study is to evaluate whether the presence of stenosis internal carotid artery (ICA) influences prioperative stroke and mortality rates in patients subjected to Coronary Artery Bypass Grafting. 

Materials and Methods: After institutional ethical committee review and approval, a retrospective review was undertaken of 1978 bypass procedures with saphenous vein graft performed over a period of four years is conducted. All those who had valve replacement or non-CABG procedure were excluded from this study. Carotid duplex ultrasonography scans were performed as part of preoperative evaluation of these patients. Ultrasound imaging measurement and velocity criteria were taken in to consideration in the estimation of degree of the carotid arteries. The stenosis of ICA was classified as non significant stenosis when there was<60% narrowing of the arterial lumen, and significant stenosis when there was 60%-99% narrowing of the arterial lumen.

Results: prioperative stroke rates were 0.8 %, 46.8% and 90%for groups A, B, and C, respectively. Group A results varied significantly from group's B (P=0.0001) and C (P=0.0001). Statistically significant difference was noted between groups B and C (p=0.0001    ). Prioperative mortality rates for groups A, B, and C, were 1.0 %, 16.7 % and 70 % respectively. The mortality rate for group A was lower than for groups B (P=0.0001) and C (P=0.0001).

Conclusion: The presence of an ICA occlusion increases the morbidity and mortality in patients undergoing CABG.

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.