European Journal of Cardiovascular Medicine

Research Article Open Access

To Study the Hemodynamic Effects of Intravenous Magnesium Sulfate and Fentanyl Citrate in Surgical Procedures under General Anaesthesia

Dr. Sabih Ahmad

Pages 45 - 49

Abstract

Background: General anaesthesia is associated with various hemodynamic responses such as tachycardia, hypertension, and fluctuations in blood pressure during laryngoscopy, intubation, and surgical stimulation. Maintenance of stable hemodynamic parameters is an essential goal for anaesthesiologists during operative procedures. Intravenous fentanyl citrate is widely used as an opioid analgesic for attenuation of sympathetic responses, whereas magnesium sulfate has emerged as an adjuvant drug due to its analgesic, antiarrhythmic, and sympatholytic properties. This article aims To investigate and contrast the hemodynamic impacts of intravenous Magnesium sulfate versus Fentanyl citrate during surgical procedures conducted under general anesthesia. The effects on heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, oxygen saturation, and perioperative complications are discussed. The study also evaluates the efficacy of magnesium sulfate as an alternative or adjunct to fentanyl in achieving hemodynamic stability. Methods: This prospective randomized study was carried out at our hospital, involving 120 ASA (American Society of Anesthesiologists) grade I or II patients, encompassing both genders and aged between 18 and 46 years. The participants were scheduled for elective surgeries, meeting the specified inclusion and exclusion criteria, and necessitating general anesthesia with endotracheal intubation. The subjects were randomly assigned to two groups, each consisting of 30 individuals. The F Group received Fentanyl citrate as the study drug, while the M Group received Magnesium sulfate. Results: In this prospective randomized study involving 120 ASA grade I or II patients, scheduled for elective surgeries requiring general anesthesia with endotracheal intubation, a comparison was made between two study groups—F Group, administered Fentanyl citrate, and M Group, administered Magnesium sulfate. The pulse rate in the F Group approached baseline values at 5 minutes post-intubation, while the M Group exhibited this trend at 10 minutes post-intubation. Significant differences were noted in hemodynamic parameters between the groups after the administration of study drugs. Notably, 5 minutes after the study drug, the M Group showed a significant fall in systolic blood pressure (1.39%), contrasting with the insignificant change in the F Group (0.03%). Conclusion: Magnesium sulfate demonstrates comparable intraoperative hemodynamic stability to Fentanyl citrate, though it does not exhibit superiority in this regard. Both substances contribute to maintaining stable hemodynamics during surgery, suggesting that Magnesium sulfate can be a viable alternative to Fentanyl citrate in providing intraoperative cardiovascular stability.

Research Article Open Access

To evaluate role of gabapentin as a pre-emptive analgesic in patients undergoing modified radical mastectomy

Dr. Sabih Ahmad

Pages 41 - 44

Abstract

Background: Pre-emptive analgesia involves the introduction of an analgesic regimen before the onset of noxious stimuli, with the goal of preventing sensitization of the nervous system to subsequent stimuli that could amplify pain. The present study assessed the role of gabapentin as a pre-emptive analgesic in modified radical mastectomy. Materials & Methods: 80 female patients of ASA grade I and II of carcinoma breast posted for modified radical mastectomy under general anesthesia were divided into 2 groups. Each group comprised of 40 patients. Group I patients received tab. 600 mg Gabapentin orally before surgery and group II did not receive any drug before surgery. Parameters such as sedation score, VAS and side effects was recorded. Results: The mean age in group I was 46.4 years and in group II was 48.2 years. The mean weight in group I was 52.8 kgs and 53.1 kgs in group II. Duration of surgery was 1.9 hours in group I and 2.8 hours in group II. Duration of post- op analgesia was 5.1 hours in group I and 1.9 hours in group II. The difference was significant (P< 0.05). The mean VAS score in group I was 5.4 and in group II was 6.7. The mean sedation score in group I was 1.7 and in group II was 0.5. Common side effects was nausea/ vomiting seen in 7 in group I and 3 in group II, pruritis 1 in group I, urinary retention in 1 in group I and 2 in group II, headache 3 in group I and 2 in group II, constipation 1 in group I. The difference was significant (P< 0.05). Conclusion: Gabapentin prolongs postoperative analgesia as compare to control group. Preoperative gabapentin is effective as a pre-emptive analgesic in MRM, reducing postoperative pain and opioid consumption with minimal side effects.

Research Article Open Access

Comparison of Hybrid and Norwood Strategies in Hypoplastic Left Heart Syndrome

Pages 31 - 40

Abstract

Current surgical palliation for neonates with single ventricle physiology includes Norwood-based and Hybrid-based surgical strategies. When transplantation is not available, clinicians must choose between these two strategies with distinctly different learning curves and risk profiles. The Norwood strategy has evolved over several decades while the rising popularity of the Hybrid strategy is a much more recent addition to our therapeutic options. Based upon the premise that avoiding cardio pulmonary bypass in the neonatal period and deferral of aortic arch reconstruction until a second stage procedure have an important influence on outcomes, the Hybrid strategy has compelling theoretical advantages and disadvantages in comparison to the Norwood strategy. The purpose of this review is to summarise the currently available data to support – or refute – the theoretical advantages of the Hybrid strategy within the context of the Norwood strategy.

Research Article Open Access

The Antiplatelet Journey Thus Far: Focus On New Oral P2Y12 Inhibitors

Pages 21 - 30

Abstract

Platelets are pivotal in the pathophysiology of acute coronary syndromes; the leading cause of death worldwide. The use of antiplatelet agents in the treatment of acute coronary syndromes has reduced morbidity and mortality substantially. Thus, aspirin has been a cornerstone in the treatment of acute coronary syndromes for years. However, during the last decade the P2Y12 inhibitor clopidogrel has accompanied aspirin to further improve clinical outcomes. P2Y12 inhibitors are antiplatelet agents preventing the binding of adenosine diphosphate to P2Y12 receptors on the platelet surface thus inhibiting platelet aggregation. Recently, the emergence of two new P2Y12 inhibitors, prasugrel and ticagrelor, has challenged the role of clopidogrel. Similar to clopidogrel, prasugrel is a prodrug that needs hepatic conversion to its active metabolite to provide irreversible P2Y12 inhibition. In contrast, ticagrelor is a direct-acting allosteric P2Y12 antagonist inhibiting the P2Y12 receptor reversibly. Both drugs provide a better pro- tection against cardiovascular outcomes than clopidogrel as evidenced by large clinical trials. This benefit might partly reflect the rapid onset of action and the pronounced antiplatelet effect of these drugs compared to clopidogrel. So far, no direct comparison of prasugrel and ticagrelor has been performed, but ongoing trials will provide data to clarify the clinical role of these drugs. The present review outlines the key milestones of the history of P2Y12 inhibitors and provides an up- to-date overview and comparison of the clinical applicability of these drugs.

Research Article Open Access

Serum Total Homocysteine Level: A True Cardiovascular: Risk Factor or an Acute Phase Reactant Protein?

Pages 11 - 20

Abstract

Atherosclerosis is the leading cause of death in the developed world1.In Pakistan; the disease seems to follow an accelerated course with ischaemic events occurring a decade earlier than those reported worldwide2. While many risk factors of cardiovascular diseases are well established, many are still under evaluation; like homocysteine, which is now being considered an independent risk factor for cardiovascular diseases3. Homocysteine is a sulfur containing amino acid which is not our dietary constituent but is formed by metabolism of methionine, another amino acid present in our daily protein diet. In case of excess formation of homocysteine as compared to its consumption, it appears in urine if levels are too high3. Normal plasma homocysteine concentration ranges from 5 to 15µmol/litre. Of this, almost 75% is bound to proteins, especially albumin, through disulfide bond. Classification of hyperhomo- cysteinemia described by Kang SS 4 is followed widely. Moderate hyperhomocysteinemia (15 to 30 µmol/litre) Intermediate hyperhomocysteinemia (30 to 100µmol/litre) Severe hyperhomocysteinemia (>100 µmol/litre)

Case Report Open Access

Prolonged Asystole During Head-up Tilt Test: A Case Report and Overview

Yahya Islamoglu, MD, Musa Cakici, MD, Hayri Alici, MD & Vedat Davutoglu, MD

Pages 1 - 10

Abstract

The head-up tilt (HUT) test is a standard diagnostic test that is widely accepted in the evaluation of patients with recurrent syncope of unknown etiology. Prolonged asystole during the HUT test is rarely encountered in patients with neurocardiogenic syncope. The incidence of prolonged asystole in patients with neurocar- diogenic syncope is 18% (>3 seconds) and 9.1% (>5 seconds) (1-3). According to our knowledge, there have been few reports related to prolonged asystole longer than 30 seconds during the HUT test (4-8). Asystole lasting for approximately 30 seconds during a HUT test was observed in the present case, which was pre-during HUT.

European Journal of Cardiovascular Medicine

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