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The effect of mannitol on oxygenation and creatine kinase MB release in patients undergoing multivessel off-pump coronary artery bypass surgery

Authors
 Jae Kwang Shim  ;  Seung Ho Choi  ;  Young Lan Kwak  ;  Kyung Jong Yoo  ;  Chang Seok Kim  ;  Young Jun Oh 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.133(3) : 704-709, 2007 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2007
MeSH
Aged ; Blood Gas Analysis ; Coronary Angiography ; Coronary Artery Bypass, Off-Pump/adverse effects ; Coronary Artery Bypass, Off-Pump/methods* ; Coronary Stenosis/diagnostic imaging ; Coronary Stenosis/mortality ; Coronary Stenosis/surgery* ; Creatine Kinase, MB Form/drug effects* ; Creatine Kinase, MB Form/metabolism ; Double-Blind Method ; Female ; Follow-Up Studies ; Humans ; Infusions, Intravenous ; Intraoperative Care ; Male ; Mannitol/therapeutic use* ; Middle Aged ; Oxygen Consumption/drug effects* ; Postoperative Complications/prevention & control ; Preoperative Care ; Probability ; Prospective Studies ; Pulmonary Gas Exchange ; Reference Values ; Risk Assessment ; Survival Rate ; Treatment Outcome
Abstract
OBJECTIVES: Despite avoiding cardiopulmonary bypass, off-pump coronary artery bypass surgery is associated with reduction in PaO2 and postoperative respiratory compliance. Also, transient interruption of coronary flow is necessary during distal anastomoses and may impose ischemia-reperfusion myocardial injury. Mannitol is an osmotic diuretic with free radical scavenging properties, and we have evaluated the effects of mannitol on oxygenation and cardiac enzyme release in patients undergoing multivessel off-pump bypass surgery in a prospective, randomized, controlled, double-blind trial. METHODS: Fifty patients were randomly allocated to receive either 20% mannitol 0.5 g/kg (n = 25) or normal saline 2.5 mL/kg (n = 25) during Y-graft construction. Pulmonary variables and serum sodium concentrations were measured 15 minutes after induction of anesthesia and sternum closure. Creatine kinase MB was measured before and after the operation. Intraoperative and postoperative fluid input and output, time to extubation, and intraoperative hemodynamic variables were also recorded. RESULTS: PaO2 after sternum closure was significantly higher in the mannitol group, with faster time to extubation and shorter length of stay in the intensive care unit. Intraoperative urine output was significantly greater in the mannitol group, without significant differences in fluid input, serum sodium concentration, and hemodynamic variables. Number of patients with a creatine kinase MB level more than 3 times the upper limit of normal was significantly higher in the control group. CONCLUSION: Mannitol could be safely used without adverse side effects in patients undergoing multivessel off-pump bypass surgery with beneficial effects in terms of preserving oxygenation, earlier extubation, and fewer patients with significant creatine kinase MB elevation.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022522306018769
DOI
10.1016/j.jtcvs.2006.10.017
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, Chang Seok(김창석)
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Oh, Young Jun(오영준) ORCID logo https://orcid.org/0000-0002-6258-5695
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0001-8442-4406
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/96695
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