This study was undertaken to evaluate the effects of alpha-tocopherol and ascorbic acid on markers of myocardial reperfusion injury and myocardial contractile function after coronary artery surgery. Forty-eight patients were divided into 4 groups; 300 mg/day alpha-tocopherol was given orally to the patients in group I for 14 days. In groups II and III, 4g of ascorbic acid was administered intravenously prior to induction and in the cardioplegic solution, respectively. Group IV was the control group. Blood samples were taken to determine the concentrations of creatine phosphokinase MB isoenzyme, malondialdehyde, uric acid, ascorbic acid and alpha-tocopherol in the perioperative period. Left ventricular functions were determined by means of MUGA scans and echocardiography preoperatively and on the 3rd and 7th days, postoperatively. The changes in serum creatine phosphokinase MB and malondialdehyde were significantly lower in study groups. when compared with the control group. We observed no significant changes in ventricular function, requirement for (+) inotropic agents and the incidence of ventricular arrhythmias among the groups, postoperatively. Biochemical findings are consistent with the free radical hypothesis. But we could not confirm these data with hemodynamic findings. This is probably due to the population of low-risk elective coronary surgery patients in this study.
Psychiatric disturbances due to cardiopulmonary bypass, especially postoperative delirium syndrome, are among the immediate complications of open-heart surgery. In a series of 32 male and 18 female patients the prevalence of such disorders was investigated and search was made for possible risk factors for their occurrence. Psychiatric, neurologic and electroencephalographic evaluation was made pre- and postoperatively, in addition to haemodynamic, echocardiographic, angiographic and regional cerebral blood flow studies. Nine of the 50 patients had significantly reduced perfusion of certain cerebral lobes in single photon emission computed tomography, and in six of them the psychiatric tests indicated postoperative delirium; three of these six also had moderate electroencephalographic changes. The cerebral hypoperfusion persisted on day 15 in four patients, while psychiatric tests were negative. The study showed possible risk factors to be patient age, long aortic cross-clamp time, high-dose inotropic support and excessive transfusion of blood or blood products.
Low-dose postoperative beta-adrenergic blockade is valuable for patients who receive these medications before off-pump coronary artery bypass grafting procedures and may be beneficial against AF in all patients.
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