Objective: To compare the hemodynamic effects of Atracurium versus Cisatracurium in Cardiac Patients Undergoing coronary artery bypass graft Surgery. Study Design: Randomized controlled trial. Place and Duration of Study: The study was conducted at Armed Forces Institute of Rawalpindi, a tertiary care hospital, after seeking hospital ethics committee permission, from Apr 2019 to Oct 2019. Methodology: A total of 200 consecutive patients were randomized into two equal groups, group-A and group-C (100 in each group). Group-A patients were induced with 0.5mg/kg of Atracurium, followed by infusion @ 10μg/kg/min whereas group C patients received Cisatracurium @ 0.2mg/kg at induction, followed by infusion @ 2μg/kg/min during the maintainence phase. Systolic blood pressure, diastolic blood pressure, Mean arterial pressure and heart rate were noted at different intervals of both groups. Decrease in systolic blood pressure of >20% from baseline or a value <90 mmHg was considered as hypotension. Results: The mean age of patients was 57.5 ± 6.75 years and 56.52 ± 4.46 years in group A and group C respectively. Systolic and diastolic blood pressure was better maintained with cisatracurium than atracurium. Also Mean arterial pressure remained more stable with cisatracurium (p<0.05), but after opening of sternum and before going on cardiopulmonary bypass, the difference was insignificant in both groups (p>0.05). Heart rate remained more steady with cisatracurium (p<0.05) but had insignificant difference before going on cardiopulmonary bypass (p>0.05). Conclusion: Cisatracurium found to be more suitable drug in maintaining the stable hemodynamics and preventing fluctuations in pressure in cardiac patients undergoing on-pump bypass surgery.

Objective: To determine the effect of NAC in prevention of post-operative atrial fibrillation in patients undergoing CABG. Study Design: Quasi experimental study. Place and Duration of Study: Adult Cardiac Intensive Care Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC&NIHD) Rawalpindi during 6 months. Methodology: 146 patients of both gender undergoing elective CABG were included in the study, having age between 30-70 years. However, any patient with history of arrhythmia including AF, thyroid dysfunction, ejection fraction less than 25%, any valvular lesion, dilated left atrium, dilated left ventricle, dilated right atrium, dilated right ventricle or having right atrial tear during surgery were excluded from the study. By using non-probability consecutive sampling, patients were divided into two groups by using envelope method. One group was given standard treatment (control group) while other group was named as NAC group (experimental group). Data analysis was performed using SPSS version-23. Descriptive statistics were reported as Mean±SD. Categorical variables were reported as frequency and percentage. Chi square test and T-test was used to determine association between different variables. Results: A total of 146 patients with mean age 55.27±7.3 yrs. 127(87%) were male and 19(13%) were females. 28(19.2%) patients had atrial fibrillation while 11(7.5%) patients had ventricular premature contractions (VPC). There was no statistically significant difference between ages (p=0.784), gender (p=0.461), AF (p=0.207) and VPC (p=0.347). Out of 73 (50%) patients from each group; the mean age of NAC group was 55.41±7.3 yrs and of control group was 55.08±7.1 yrs (p=0.784). Gender wise distribution of NAC group had 8(11%) females and 65(89%) males while in control group 11(15%) females and 62(85%) were males. AF was found to be 11(15%) and 17(23.3%) in NAC and control group respectively. In NAC group, VPC was 4 (5.5%) and in control group it was 66 (90.4%). Conclusion: This study shows that NAC decreases the frequency of post-operative atrial fibrillation and ventricular premature contractions, but the decrease is statistically insignificant in Pakistani population. However, keeping in view other beneficial effects of NAC, we would recommend more studies on this subject in Pakistani population.

Objective: To compare two techniques of activated clotting time (ACT) measurement by two different devices to evaluate the correlation and agreement between these techniques at different points of time during cardiac surgery. Study Design: Comparative Cross-sectional Study. Study settings: Cardiac Anesthesia Department, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi Pakistan, from Feb 2022 to Apr 2022. Methodology: 100 patients undergoing CABG surgery on pump were included by non-probability consecutive sampling technique. Two devices operating on different techniques of measurement were used to measure ACT at four different points of time during surgery. Same sample was used to measure ACT from both devices. Data was collected and analysed by SPSS V.20.0. Pearson's chi square test and paired sample t-test were applied to measure the significance. Linear regression analysis was done to find correlation and Bland Altman plot was used for checking agreement between ACT values from both devices.p-value less than 0.05 was considered significant. Results: Out of 100, male patients were 79 and female patients were 21. Their mean age was 54.18±11.91 years and mean weight was 79.06±18.49 kg. Moderate positive correlation was found with Pearson r value of 0.55. There was poor agreement between the ACTs measured by two devices. On average Hem R measures ACT 63.54±50.83 seconds higher than Hem JSP. Average mean and median values for Hem R group are 400.03±59.39 sec and 397.75sec respectively and for Hem JSP group are 336.49±44.63 sec and 340.5 sec respectively. Conclusion: There is moderate positive correlation but poor agreement between the values of ACT measured by Hem R and Hem JSP due to different techniques of measurement so these should not be used interchangeably.

Objective: To determine the frequency of post-operative pulmonary complications after (coronary artery bypass grafting)CABG surgery and to compare the respiratory complications of post COVID and comparison group Study Design: Analytical Cross- sectional study Study Place and Duration: Study was conducted in Adult Intensive Care Unit, Armed Forces Institute of Cardiology,Rawalpindi Pakistan, from Sep 2021 to Mar 2022. Methodology: 40 patients were selected, and divided into two groups using Non-Probability consecutive sampling. Group-A had history of COVID-19 infection and Group-B was a comparison group and had no history of COVID-19 infection. Patients presenting for elective On-Pump (coronary artery bypass grafting) CABG surgery and known history of COVID-19 were included in our study. Patients of age ranging 30 to 70 years irrespective of gender were included in the study. Any patient who had cardiopulmonary bypass time of more than 120 min, respiratory illness like asthma or Chronic Obstructive Pulmonary Disease (COPD), history of smoking, or requiring post-operative re-ventilation due to cardiac or neurological complication, were excluded from the study. After patients were received from Operation theatre, they were monitored for the respiratory complications and both groups were compared. Results: A total of 40 patients were included in this study having mean age 57.9±7.62 years. Most of the patient population was male 31(77.5%) and only 09(22.5%) were female patients. Study population was equally divided into two groups i.e.20(50%) in comparison group and 20(50%) in post COVID-19 group. There was no significant difference in age (p=0.714), ventilation time (p=0.068), gender (p=1.000), and re-ventilation (p=0.451) of both groups. While Intensive Care Unit stay(p=<0.0001) and non-invasive ventilation (NIV) were found to be significant (p=0.007).

Objective: To find out the association of CHA2DS2-VASc score with postoperative atrial fibrillation in cardiac surgery patients. Study Design: Analytical Cross-Sectional study. Place and Duration of Study: Cardiothoracic Anaesthesia and Adult Cardiac Critical Care department, Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFIC/NIHD), Rawalpindi Pakistan, from Feb 2022 to Apr 2022. Methodology: After IERB approval, 186 adult patients of POAF with the prevalence of 9.7%undergoing CABG surgery were included in the study. Their demographic data and CHA2DS2-VASc score, originally used to find the risk of stroke in patients with atrial fibrillation, was calculated pre-operatively. They were followed for 48 hours postoperatively for any episode of post op atrial fibrillation (POAF). Data including pre op drugs, type of surgery, number of grafts, inotropic support and POAF timing after surgery was recorded and analysed by SPSS v 21.0. Results: Incidence of POAF in our study patients was 17.2 %( n=32). Mean time of onset of POAF was 24.75±16.05 hours.Patients who developed POAF had higher CHA2DS2-VASc score 3.06±1.21 compared with those who did not develop POAF 2.61±0.97. This association was statistically significant (p-value=0.023). Among the variables of CHA2DS2-VASc score, age had significant association with POAF (p-value= 0.001). No difference was found between on pump vs off pump surgery in terms of POAF (p-value=0.539). Conclusion: This study found that CHA2DS2-VASc score has significant association with POAF after CABG surgery. It is a simple and easy scoring system which can be calculated in preoperative period. Patients at increased risk of POAF can be identified and given prophylactic treatment to reduce morbidity and mortality.