Better understanding of the pathophysiology of myocardial injury has led to the development of multiple modifications and new strategies for myocardial protection. New drugs and techniques are always being investigated to add to the already proven techniques applied for myocardial protection.

Background Left internal mammary artery (IMA) graft is the most promising arterial conduit for coronary artery bypass grafting. Stellate ganglion block (SGB) induces sympathetic blockade and is used to prevent or control spasm of the internal mammary artery. The purpose of this study was to investigate the effect of left SGB on left IMA blood flow rate. Patients and methods A total of 170 patients aged between 65 and 70 years, with American Association of Anesthesiologists physical status II and III, and scheduled for elective coronary artery bypass grafting, were randomly allocated to either a SGB group or a verapamil-nitroglycerine group. In the SGB group, the patients received SGB using 8 ml of bupivacaine 0.25%. In the verapamil-nitroglycerine group, the patients received intraluminal injection of the harvested IMA graft with a solution, containing verapamil 5 mg, nitroglycerine 2.5 mg, heparin 500 U, 8.4% NAHCO₃ 0.2 ml, and ringer solution 40 ml, throughout its whole length using a small syringe, and with a low dose of intravenous nicardipine infusion started after harvesting (5 mg nicardipine in 100 ml saline at a rate of 0.5 mg or 10 ml/h). IMA blood flow rate (primary outcome), abnormal ECG changes, ICU length of stay, intra-aortic balloon usage, pre–postoperative pulse rate and blood pressure, incidence of atrial fibrillation, radio-femoral arterial pressure difference, pre–postoperative ejection fraction, need for re-exploration, and mortality rate were observed. Results This prospective study showed a significant increase of IMA blood flow rate (P<0.001) and nonsignificant decrease in mortality rate in the SGB group compared with the verapamil-nifedipine group. There was no significant difference between the two groups regarding ICU length of stay, re-exploration, intra-aortic balloon usage, preoperative and postoperative mean pulse rate, preoperative and postoperative mean blood pressure, and preoperative and postoperative ejection fractions between study groups. The incidence of atrial fibrillation (P=0.030) and abnormal ECG changes (P=0.043) was significantly lower in SGB group. Radio-femoral pressure difference was significantly lower in SGB group at 20 and 40 min after cardiopulmonary bypass. Conclusion The results of this study showed that SGB prevents IMA spasm, increases its blood flow rate, and decreases incidence of atrial fibrillations compared with intraluminal injection of verapamil and nitroglycerine combined with intravenous nicardipine.

Context Atrial fibrillation is the most frequent arrhythmia following cardiac surgery. Many risk factors for this problem have been studied. Aims The objective was to investigate the relation between perioperative hyperglycemia and postoperative atrial fibrillation (POAF) after coronary artery bypass grafting. Settings and design The study was a retrospective observational study that took place at Benha University Hospital, which is a tertiary referral center. Patients and methods The study was conducted on 100 patients who were admitted for coronary artery bypass grafting. Patients were divided into two groups: group A included 50 patients who developed POAF and group B included 50 patients who did not. Statistical analysis Data were imported into Statistical Package for the Social Sciences (SPSS version 20.0) software for analysis. Qualitative data represented as number and percentage and tested by the χ²-test. Quantitative data were represented by mean±SD and tested by t-test or Mann–Whitney. Results The authors have found that a history of diabetes mellitus, mean postoperative blood sugar (BS), and maximum postoperative BS levels were more significant (P<0.05) in group A. The mean BS cutoff level that predicted the occurrence of POAF was 193.7 mg/dl. The authors also have found that postoperative drainage volume was higher in group A than group B, with P less than 0.001. Conclusions The authors believe that a history of diabetes mellitus, postoperative BS levels, and postoperative drainage volume were significant risk factors for the occurrence of POAF.

Objective The present study aimed to assess the hemostatic effects of fresh whole blood (FWB) transfusion on bleeding and blood product transfusion in patients on clopidogrel undergoing emergency coronary artery bypass grafting surgery (CABG). Design A randomized study was conducted. Setting The study was conducted at a cardiac center. Patients and methods The study included 124 patients undergoing CABG surgery. The patients were divided into two groups: FWB group patients received two to six units of FWB after weaning off cardiopulmonary bypass and in the cardiac surgery ICU. Control group patients received blood products (packed red blood cells, platelets, fresh frozen plasma, or cryoprecipitate) after weaning off cardiopulmonary bypass and after surgery in cardiac surgery ICU. Total number of the transfused FWB, platelets, packed red blood cell, fresh frozen plasma, and cryoprecipitate (intraoperative and postoperative transfusion), bleeding time, and platelet aggregation function were measured. Moreover, the thorax closure time and amount of blood losses, re-exploration, pulmonary edema, and postoperative mechanical ventilation were monitored. Results FWB significantly decreased the blood loss and blood product transfusion compared with the control group (P=0.001 and 0.001, respectively). The bleeding time and platelet aggregation function were better in the FWB group compared with the control group (P=0.020 and 0.034, respectively). Moreover, the thorax closure time, cardiac tamponade, re-exploration, pulmonary edema, and postoperative mechanical ventilation decreased significantly in the FWB group compared with the control group (P<0.05). Conclusion FWB decreased the blood loss, blood product transfusion, cardiac tamponade, and re-exploration in patients on preoperative clopidogrel undergoing emergency CABG.