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Effects of mannitol on cardiac function and postoperative arrhythmias after coronary artery bypass grafting: a
Masumeh Hemmati Maslakpak1, Sohrab Negargar2, Ali Farbod3
1Nursing and Midwifery School, Maternal and Childhood Obesity Research Center, Urmia University of Medical, Urmia, Iran.
Insights
Mannitol administration during coronary artery bypass grafting (CABG) showed a significant reduction in ventricular fibrillation incidence. However, this single-center study requires larger trials to confirm effects on other cardiac outcomes post-CABG.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Postoperative cardiac dysfunction and arrhythmias are common after cardiac surgery.
- These complications increase mortality, hospital stays, healthcare costs, and reduce patient quality of life.
- Coronary artery bypass grafting (CABG) is a major cardiac surgery procedure where these complications are a concern.
Purpose of the Study:
- To investigate the effects of mannitol on cardiac function.
- To assess the incidence of postoperative arrhythmias after CABG.
- To determine if mannitol impacts outcomes like ventricular fibrillation.
Main Methods:
- A single-center, double-blind, randomized controlled trial was conducted.
- Ninety patients undergoing elective on-pump CABG were randomized to receive mannitol or lactated Ringer's solution.
- Postoperative assessments included cardiac enzymes, arrhythmia incidence, and left ventricular ejection fraction.
Main Results:
- No significant differences were found in baseline demographics, cardiac enzymes, left ventricular ejection fraction, atrial fibrillation, or ventricular tachycardia between groups.
- Mannitol group showed a statistically significant reduction in ventricular fibrillation incidence (4.4% vs. 17.8%, p=0.045).
- Thirty-day mortality was similar between the mannitol and control groups.
Conclusions:
- Mannitol administration during CABG was associated with a lower incidence of ventricular fibrillation.
- This single-center study has limitations in power to detect differences in other outcomes.
- Larger, multi-center studies are necessary to validate these findings and explore other potential benefits of mannitol in cardiac surgery.
Objective:
Postoperative cardiac dysfunction and arrhythmias are significant complications following cardiac surgery, frequently resulting in increased mortality, longer hospital stays, higher healthcare costs, and diminished patient quality of life. This study investigates the effects of mannitol on cardiac function and the incidence of postoperative arrhythmias after coronary artery bypass grafting (CABG).
Methods:
In a single-center, double-blind, randomized controlled trial, ninety patients undergoing elective on-pump CABG were randomly assigned (1:1) to receive either 200 mL of mannitol 20% (n = 45) or 200 mL of lactated Ringer's solution (n = 45) during cardiopulmonary bypass priming. Postoperative assessments included cardiac enzyme levels (creatine phosphokinase, creatine kinase-MB isoenzyme, and cardiac troponin I), incidence of arrhythmias (atrial fibrillation, ventricular fibrillation, ventricular tachycardia), and left ventricular ejection fraction. Statistical significance was defined as a p-value < 0.05.
Results:
No significant differences were observed between the mannitol and control groups in baseline demographics or clinical risk factors (p > 0.05). Left ventricular ejection fraction was similar between the groups (45.22 ± 9.82 in the mannitol group vs. 42.66 ± 7.94 in the control group; p = 0.178). Atrial fibrillation occurred in 9 of 45 patients (20%) in the mannitol group and 12 of 45 (26.7%) in the control group (p = 0.309). Ventricular tachycardia was observed in 2 of 45 (4.4%) vs. 4 of 45 (8.9%) patients, respectively (p = 0.338). Thirty-day mortality was 2 of 45 (4.4%) in the mannitol group and 1 of 45 (2.2%) in the control group (p = 0.50). Cardiac enzyme levels (CPK, CK-MB, and cTnI) showed no significant differences between groups (p > 0.05). However, ventricular fibrillation occurred in 2 of 45 patients (4.4%) in the mannitol group versus 8 of 45 (17.8%) in the control group, a statistically significant difference (p = 0.045).
Conclusions:
In conclusion, while mannitol was associated with a lower incidence of ventricular fibrillation, this is a single-center study with limited power to detect differences in other outcomes. Further studies with larger sample sizes are needed to confirm these findings.
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