Impact of Variable Types of Preconditioning Upon the Inotrope Score in Adult Patients, Undergoing Cardiac Surgery

Study Overview
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Brief Summary
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Preconditioning (PC) of the heart occurs when brief exposure to a stimulus protects the heart from subsequent ischemia. PC stimulus may be (ischemic ; pharmacologic or Physical).

Detailed Description
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Preconditioning (PC) of the heart occurs when brief exposure to a stimulus protects the heart from subsequent ischemia. PC stimulus may be ( ischemic ; pharmacologic or Physical) Pharmacological PC may be induced by variable agents e.g. (Sevoflurane ;isoflorane, opioids etc) Ischemic PC includes local; remote and the idea is temporary interruption of blood supply to the organ so that liberation of protective mediators occurs. The liberated mediators have favorable effects not only upon the myocardium, but it extend to protect other organs against inflammatory activation; ischemia reperfusion injury Inotropic score (IS) is already an evident predictor of postoperative cardiac morbidity and mortality Aim of the work: Is to validate the impact of Sevoflurane versus ischemic & Sevoflurane PC upon postoperative inotropic score in adult patient undergoing open heart surgery

Official Title
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Impact of Variable Types of Preconditioning Upon the Inotrope Score in Adult Patients, Undergoing Cardiac Surgery

Conditions
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Myocardial Ischemia

Intervention / Treatment
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* Drug: A pharmacologic cardiac preconditioning (Sevoflurane)
* Procedure: B ischeamic preconditioning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-60 years old American Society of Anesthesiologists physical status II and III Patients scheduled for open heart surgery Exclusion Criteria: Emergency surgery Clinically significant kidney or liver disease Patients allergic to local anesthetic Patients with prolonged cardiopulmonary bypass time (>120 min) Patients required intra-aortic balloon pump Postoperative hemodynamic instability (including the occurrence of serious arrhythmia) or bleeding that required surgical re-exploration

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: A pharmacologic cardiac preconditioning<br>Sevoflurane as a pharmacologic preconditioner for the heart | Drug: A pharmacologic cardiac preconditioning (Sevoflurane)<br>* A Patients are anaesthetized by Sevoflurane more than 1 mac.<br>|
| Active Comparator: B ischeamic preconditioning<br>ischemic preconditioning by inflation the cuff of blood pressure | Procedure: B ischeamic preconditioning<br>* B ischemic preconditioning will be done after induction and before cardiopulmonary bypass by inflation the cuff of blood pressure above 200mmhg in the lower limb every 5 min for 3cycles<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Highest inotropic score |  | first 24 hour | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Myocardial Preconditioning, inotropic score