Nurse Anesthesia

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https://hdl.handle.net/20.500.11888/3201

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Browsing Nurse Anesthesia by Author "Jaber, Mohammad"

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    Clinical Comparison Between Isoflurane and Sevoflurane In Patients with Open-Heart Surgery: A Prospective, Observational Study from Palestine
    (Mohammad Masoud Jaber, 2018-04-05) Jaber, Mohammad
    Background: volatile anesthetic agents sevoflurane and isoflurane gases can effects on hemodynamic intra- and post-operative course on-pump coronary artery bypass surgery in patients. Anesthesia type affects adequate depth of anesthesia, reduction in need of analgesic dosage, early extubation and transfer from the Intensive Care Unit (ICU). Objectives: Study objectives were to compare the induction and recovery criteria following anesthesia with sevoflurane and isoflurane in open heart surgery, intra and post operation. Methods: This study was an observational, cohort prospective study, it was performed at the Arab Specialized Hospital in Nablus, Heart Center in the West Bank/Palestine between May – August 2016 on all patients who were between 30-70 years and admitted to open heart surgery. All information was collected from files and observational and data collection. The statistical package of social science (SPSS) was used for data entry in statistical analysis. Results: During the study period, 63 patients were included, among them, 32 patients were given isoflurane, and 31 patients were given sevoflurane during open heart surgery. Systolic blood pressure (SBP) value was significantly lower in the isoflurane group compared to the sevoflurane group at the time of induction, once the sternum was opened, and once the sternum was closed (P< 0.05). Furthermore, diastolic blood pressure values were significantly lower in the isoflurane group compared to the sevoflurane group at the time of induction, once the sternum was opened (P = 0.004), and once the sternum was closed (P = 0.009). The median heart rate (HR) between the two groups revealed higher values in the isoflurane group, which were statistically significant when compared to the sevoflurane group at time of induction (P < 0.001 ), once the sternum was open (P = 0.001), and once the sternum was closed (P = 0.010). However, the HR values between the two groups did not reveal a statistically significant difference before induction, after Cardiac Care Unit (CCU) admission, and at extubation time (P > 0.05). The median respiratory rate in the isoflurane group was statistically significantly higher when compared to the sevoflurane group at extubation time (P < 0.001).Patients in the isoflurane group had a higher total intubation time compared to patients in the sevoflurane group (P = 0.009). In addition, the median (interquartile range) of the recovery time among patients in the sevoflurane group was significantly shorter than that among patients in the isoflurane group (120 (90-150) min versus 150 (120-180) min, respectively (P-value< 0.001)). Furthermore, regarding the duration of hospital stay, patients who received isoflurane had significantly longer hospital stays (7 [7-8] days) than patients who received sevoflurane (7 [6-7] days), (P = 0.012). Patients in the sevoflurane group were extubated earlier than those in the isoflurane group. Regarding complications that occurred post open heart surgery in patients, there was no significant difference regarding the prevalence of arrhythmias through or post open heart surgery among the two groups. Atrial fibrillation (AF) was seen in the isoflurane group in five (7.9%) patients, and in two patients (3.2%) in sevoflurane group (P = 0.226). Furthermore, no significant differences were noted in the type and incidence of complications regarding bleeding or cerebral vascular attack (CVA). Bleeding post open heart surgery was seen in five (7.9%) patients who were on isoflurane, and in three patients (4.8%) who were receiving sevoflurane (P = 0.372). CVA was reported in two patients (3.2%) in the isoflurane group and in none of the patients in the sevoflurane group (P = 0.254). On the other hand, nausea and vomiting occurred in nine (14.3%) patients who were administered isoflurane, but in only two (3.2%) patients who were administered sevoflurane (P = 0.026). Conclusions: The results reflect that sevoflurane has a better impact on hemodynamic stability than isoflurane. Sevoflurane produces better results in regards to systolic and diastolic pressure, HR, recovery time, ICU stay, analgesia dosage and muscle relaxant dosage. Sevoflurane usage results in less complications than isoflurane, but not significantly.