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Effect of N-acetylcysteine on pulmonary function in patients undergoing off-pump coronary artery bypass surgery

Authors
 J.-C. KIM  ;  S.-W. HONG  ;  J.-K. SHIM  ;  K.-J. YOO  ;  D.-H. CHUN  ;  Y.-L. KWAK 
Citation
 ACTA ANAESTHESIOLOGICA SCANDINAVICA, Vol.55(4) : 452-459, 2011 
Journal Title
 ACTA ANAESTHESIOLOGICA SCANDINAVICA 
ISSN
 0001-5172 
Issue Date
2011
MeSH
Aged ; Blood Loss, Surgical ; Blood Transfusion ; Coronary Artery Bypass, Off-Pump* ; Creatine Kinase/blood ; Double-Blind Method ; Female ; Free Radical Scavengers/pharmacology* ; Hemodynamics/drug effects ; Humans ; Lung/drug effects ; Lung/physiology* ; Male ; Middle Aged ; Myocardial Infarction/complications ; Postoperative Complications/epidemiology ; Postoperative Complications/mortality ; Postoperative Complications/prevention & control ; Pulmonary Circulation/drug effects ; Respiratory Function Tests ; Vascular Resistance/drug effects ; Ventricular Dysfunction, Left/physiopathology ; Water-Electrolyte Balance/physiology
Abstract
BACKGROUND: Pulmonary dysfunction related to inflammatory response and radical oxygen species remains a problem in off-pump coronary bypass graft surgery (OPCAB), especially in patients with reduced left ventricular (LV) function. The aim of this study was to evaluate the effect of N-acetylcysteine (NAC) on pulmonary function following OPCAB. METHODS: Patients with LV ejection fraction ≤40% were randomly assigned to receive either a bolus of 100 mg/kg of intravenous NAC over a 15-min period immediately after anesthetic induction, followed by an intravenous infusion at 40 mg/kg/day for 24 h (NAC group, n=24), or a placebo (control group, n=24). Hemodynamic and pulmonary parameters, and the incidence of acute lung injury (PaO(2)/FiO(2)<300 mmHg) were assessed and compared. RESULTS: The pulmonary vascular resistance index (PVRI) did not change during mechanical heart displacement compared with the baseline value in the NAC group while it was significantly increased in the control group. Significantly less number of patients developed acute lung injury at 2 h after the surgery in the NAC group. The other pulmonary parameters and the duration of ventilator care were all similar. CONCLUSIONS: NAC demonstrated promising results in terms of mitigating the increase in PVRI during mechanical heart displacement and attenuating the development of acute lung injury in the immediate post-operative period. However, NAC could not induce a definite improvement in the other important pulmonary variables including PaO(2)/FiO(2) and Q(s)/Q(t), and did not lead to a decreased duration of ventilatory care or length of stay in the intensive care unit.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2011.02407.x/abstract;jsessionid=B390280A532612A6FE8AD25C6F7576D6.f04t04
DOI
10.1111/j.1399-6576.2011.02407.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Kim, Jong Chan(김종찬)
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/92732
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