Background: Intravenous drug abuse (IVDA) is a global health care problem that has tremendous socio-economic implications. Vascular complications following IVDA are not uncommon and may have serious consequences. At the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, there has been a steady increase in the number of cases with vascular complications of IVDA in the recent years. Objectives: The present study was undertaken to evaluate our surgical strategy for the management of various vascular complications following IVDA. Materials and Methods: Over the last 5 years, a total of 45 patients presented at the NICVD with various complications of IVDA. Thirty seven patients presented at the emergency department with bleeding from ruptured aneurysm or with impending aneurysm rupture. The remaining 8 patients presented at the vascular outpatient with deep venous thrombosis, superficial thrombophlebitis and chronic venous insufficiency. After resuscitation when necessary, excision of aneurysm was done either with simple ligation of the artery (Group A) or with restoration of arterial continuity (Group B). Outcome in the two groups were compared against the following parameters; acute limb ischemia, chronic limb ischemia, wound infection and lymphorrhoea. Results: There was no in-hospital mortality in this series. Both ligation and restoration of arterial continuity following aneurysmectomy were effective in treating the bleeding aneurysm. However, statistically significant differences were seen between the two groups in terms of acute and chronic limb ischemia. Restoration of arterial continuity was more effective in preventing acute and chronic limb ischemia. Conclusions: In Bangladesh, the incidence of IVDA with vascular complications is increasing at an alarming rate. In patients presenting with arterial pseudoaneurysms, surgical management should be aimed at restoration of arterial continuity whenever feasible. Key words: Intravenous drug abuse, Vascular complication, Aneurysm. DOI: 10.3329/cardio.v3i1.6426Cardiovasc. j. 2010; 3(1): 45-49

Introduction: Arrhythmias are not uncommon after Coronary Artery Bypass Graft (CABG) surgery. There is increasing evidence that Magnesium, the important intracellular cation plays a crucial role in preventing and terminating cardiac arrhythmias. Objectives: The aim of this study was to establish the role of peroperative use of intravenous Magnesium in reducing the incidence of per and postoperative arrhythmias in CABG surgery. Materials and methods: A total sixty (Group-I 30 and Group-II 30) patients of both sexes and different ages undergoing conventional CABG surgery under general anesthesia in CMH Dhaka from January 2009 to December 2011 were selected randomly. After induction, Group-I received 2 gm of Magnesium in 100 ml normal saline intravenously over a period of 30 minutes and Group-II received no Magnesium. Parameters recorded per and postoperatively were- aortic cross clamp time, Cardio Pulmonary Bypass (CPB) time, total surgery time, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and blood sample were collected on arrival to Cardiac Intensive Care Unit (CICU) and after 6, 12, and 24 hours. Results were expressed as mean ± SD (Standard Deviation) or in frequencies (percentage) as applicable. The results were analyzed by Student’s ‘t’ test. Results: Magnesium levels were significantly (p<0.05) low in Group-II patients than that of Group-I. In Group-II patients, the fluctuations of HR, SBP and DBP were significantly (p<0.05) more than that of Group-I. In Group-I patients incidence of arrhythmias were significantly (p<0.05) less than that of Group-II. Conclusion: Low serum Magnesium levels are a frequent finding after conventional CABG surgery. This acute loss of Magnesium has been suggested as an etiology of many per and postoperative arrhythmias. This study revealed that peroperative administration of Magnesium provided a significant reduction in arrhythmias per and postoperatively. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18739 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 105-114