OBJECTIVE: Increasingly used Off Pump Coronary Artery Bypass Grafting (OPCABG) has significantly reduced the oxidative stress and decreased the inflammatory response associated with the use of Cardiopulmonary by Pass (CPB). However, OPCABG is associated with significant oxidative stress and its associated complications. This present study is a prospective, randomized, double blind investigating the effects of N-acetylcysteine (NAC), a potent anti-oxidant on oxidative stress in patients undergoing OPCABG. METHODS: Fifty patients undergoing elective OPCABG were randomized into two groups. Group A (n=25), the control group received 200ml of Normal saline immediately following induction, whereas Group B (n=25), the study group received 150mg/kg of NAC in 200ml of Normal saline at the corresponding time. At the end of surgery, all the patients were shifted to intensive care unit (ICU) and were extubated at the earliest possible time. Malondialdehyde (MDA), a marker of free radical injury and Glutathione (GSH) Levels were assayed from the 2 blood samples obtained (First sample immediately following induction and the second immediately after shifting to ICU). RESULTS: Demographic profile, pre-incision clinical and biochemical values were comparable in both the groups. At the end of surgery, MDA levels were significantly raised in control group (p<0.001) whereas its levels were maintained in study group (p<0.569). GSH levels were significantly decreased in control group (p<0.001) whereas its levels were significantly increased in study group (p<0.001). CONCLUSION: These results revealed that OPCABG was associated with significant oxidative response and the administration of N-Acetylcysteine attenuates this stress response by replenishing the Glutathione stores.

Background: Postpartum hemorrhage (PPH) accounts for 25% to 33% of obstetric deaths every year. Anemia is a cause and consequence of PPH. Despite intense efforts to prevent anemia, many Indian women labour with low hemoglobin levels. Tranexamic acid (TXA), an antifibrinolytic, have been demonstrated to reduce blood loss and transfusion requirements in various surgeries including cesarean section. Objectives were to study the efficacy of TXA in effectively reducing blood loss in Indian women following vaginal delivery.Methods: This randomized, double-blind, placebo-controlled study was conducted on 200 patients scheduled for vaginal delivery. In addition to oxytocin 10 units, group T received TXA 15 mg/kg and group P received normal saline administered over 5 minutes. Estimated blood loss, Hemoglobin deficit, need for additional uterotonics, need for blood transfusion, incidence of PPH and adverse events were noted.Results: The fall in hemoglobin was significantly higher in group P (p<0.00001). Estimated 24 hour blood loss was significantly higher by a mean blood volume of 86.99 ml in group P compared to group T (p<0.00001). The incidence of PPH was lower in group T (2.8% versus 11.3%). There were no significant difference in the need for supplementary uterotonics (9.9% versus 15.5%) and the incidence of blood transfusion (2.8% versus 8.5%). No adverse maternal and fetal outcomes were noted.Conclusions: To reduce blood loss following vaginal delivery, TXA may be safely recommended as standard adjunct to Oxytocin for regular management of third stage of labour, especially in developing countries like India.

OBJECTIVE:Postoperative lung injury is one of the most frequent complications of cardiac surgery. Increasingly used Off Pump Coronary Artery Bypass Grafting (OPCABG) has significantly reduced the oxidative stress and the inflammatory response associated with the use of cardiopulmonary bypass (CPB). However, OPCABG is also associated with significant oxidative stress and its related complications. The present study is a prospective, randomized, double blind investigating the effects of N-acetylcysteine (NAC), a potent anti-oxidant on pulmonary functions in patients undergoing OPCABG. METHODS: Fifty patients undergoing elective OPCABG were randomized into two groups. Group A (n=25), the control group received 200ml of Normal saline immediately following induction whereas Group B (n=25), the study group received 150mg/kg of NAC in 200ml of Normal saline at the same time. Pulmonary Capillary Wedge Pressure (PCWP), Pulmonary Artery Pressure (PAP), Dynamic lung compliance (C Dyn), Static lung compliance (C Stat), Alveolar -arterial oxygen gradient (A-a Do2) were measured immediately following induction, after admission into ICU, and then 4 th hourly till extubation. Malondialdehyde (MDA) and Glutathione (GSH) levels were assayed once immediately following induction and again immediately after shifting to ICU. RESULTS: Demographic profile, pre-incision clinical and biochemical values were comparable in both the groups. PCWP, PAP-Diastole were lower and C Dyn and C Stat were significantly higher in study group when compared to control group. No difference in PAP-Systole was found. Both the groups had increased A-a Do2, but the increase was significantly lower in the study group. At the end of surgery, MDA levels were significantly raised in control group (p<0.001) whereas its levels were maintained in study group (p<0.569). GSH levels were significantly decreased in control group (p<0.001) whereas its levels were significantly increased in study group (p<0.001). CONCLUSION: OPCABG was associated with significant oxidative response but the administration of NAC attenuates this stress response by replenishing the GSH stores. NAC improves pulmonary function in terms of increased compliance and increased systemic oxygenation.

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