Somalia Mukherjee

Abstract

Background: The study aimed to determine the prevalence of carotid artery stenosis, it’s severity and relation with peri-operative stroke in neurologically asymptomatic patients undergoing CABG for coronary artery disease (CAD) in a tertiary care hospital. It also evaluates the relationship of hemodynamic alterations with the prevalence of stroke. It is a cross sectional study with prospective observations. Materials and Methods: 97 neurologically asymptomatic patients with CAD in NYHA classification I, II and III scheduled for Off Pump CABG in our cardiac surgery operation theatre. Colour doppler ultrasound was performed in all patients prior to induction to determine the presence of carotid artery stenosis. Based on parameters measured in ultrasound, CAS was classified as per the Society of Radiologists criteria. Prevalence of carotid artery stenosis was assessed. Results: The prevalence of carotid artery stenosis in our study population was 40.2%. The risk factors associated with CAS in our study were BMI >25kg/m2, smoking, left main coronary artery involvement, left ventricular systolic dysfunction (EF Conclusions: This study suggested relatively wide prevalence (40.2%) of carotid artery disease in neurologically asymptomatic patients undergoing CABG for coronary artery disease in the elective setting. It demonstrated the importance of subjecting these patients to evaluation by doppler ultrasound of the carotid vessels in the operating room immediately before induction of anaesthesia and the subsequent planning of anaesthetic management as well as surgical approach.   Keywords: Carotid artery stenosis, Carotid doppler ultrasound, Coronary artery off-pump bypass grafting, Coronary artery disease, Neurological dysfunction.

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Abstract

Background & Aims: Atrial fibrillation (AF) occurs in almost 30% of patients undergoing coronary artery bypass grafting (CABG). Around 80% of these patients have decreased levels of total and ionized serum magnesium postoperatively. The association between magnesium deficiency and post CABG AF is still undetermined. Therefore, a large variety of prophylactic strategies have been assessed including perioperative magnesium administration. However, the efficacy is still questionable. The aim of this study was to find out any correlation of serum magnesium levels with the incidence of post-operative atrial fibrillation in patients undergoing off-pump CABG and whether magnesium supplementation modifies the incidence. Materials and Methods: One hundred fifty patients undergoing CABG were selected and divided into treatment and control groups. Perioperative serum magnesium assays were done, and patients were monitored in the postoperative period for occurrence of Atrial Fibrillation. Results: The risk of post CABG atrial fibrillation was more among females, obese patients, patients with EF < 50 xss=removed xss=removed> Conclusion: The proportion of patients with post-operative atrial fibrillation among cases (6.7%) was lower than that of controls (14.7%) which may indicate an important role of magnesium in prevention of AF following cardiac surgeries. The results however didn’t reach a statistical significance which could be due to sample size, the duration and design of the study, and the period of post-operative AF monitoring.   Keywords: Atrial fibrillation, Coronary artery bypass grafting, Magnesium sulphate.

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