الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
from this study the following can be concluded:• Coronary artery bypass surgery (CABG) surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries or veins from elsewhere in the patient’s body are grafted to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium.
• This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass. Alternate methods of minimally invasive coronary artery bypass surgery have been developed. Off-pump coronary artery bypass (OPCAB) is a technique of performing bypass surgery without the use of cardiopulmonary bypass (the heart-lung machine).
• Of the 2 techniques, on-pump CABG is the oldest and time-honored method. Advances in technology allow on-pump CABG to be performed with very low mortality and morbidity and with excellent results.
• The optimization of fluid status in the cardiac surgical patient is a primary management objective of anaesthesiologists and critical care clinicians in the perioperative period. However, achieving the goal of “optimal fluid status” in a cardiac surgical patient population may present a challenge for clinicians.
• Perioperative fluid management is further complicated by the fact that the “ideal” volume therapy for the cardiac surgical patient is unknown. In the absence of outcome data clearly supporting any particular fluid regimen, the choice of crystalloid or colloid is determined primarily by clinician preference or institutional protocol.
• Clinical assessment and vital signs are poor predictors of the overall hemodynamic state.
• Optimal measurement of the response to fluid resuscitation and hemodynamics has previously required invasive measurement with radial and pulmonary artery catheterization.
• Impedance cardiography is a safe, non invasive hemodynamic monitoring tool that measures and monitors the cardiac cycle and provides specific measurements which include, cardiac output, stroke volume, systemic vascular resistance, contractility and fluid status. Date are analysed, and displayed graphically as an impedance waveform (similar to arterial waveform, but based on aortic blood flow, rather than pressure) and an ECG waveform.
• ICG detects and records changes in hemodynamic function using thoracic electrical bioimpedance (TEB) technology. ICG is a safe, accurate, reproducible technology that provides a cost effective alternative for hemodynamic evaluation and continuous monitoring.
• In the current study, before sternotomy and after transfusing 250cc (HES 130 / 0.4) (Voluven 6%) mean arterial blood pressure (MABP), heart rate (HR), and cardiac index(CI) showed no statistically significant difference from the baseline readings with, while central venous pressure (CVP), stroke volume (SV), and thoracic fluid content index (TFCI) showed statistically significant increase compared to baseline readings with mean ±SD ( from 7.86 ± 1.59 to 9.74±1.58, from 7.86 ± 1.59 to 65.78±8.55, and from 19.63 ± 2.57 to 22.49±2.96 respectively), on the other hand, preejection period (PEP) showed significant decrease compared to baseline readings with mean ±SD (from 75.64±10.44 to 82.02 ±10.36) . Also before sternotomy and after transfusing 500cc (HES 130 / 0.4) (Voluven 6%) significant increase in MABP, CVP, SV, TFCI, and CI was noticed with mean ±SD (from 72.06 ± 8.93 to 79.58±9.64, from 7.86 ± 1.59 to 11.14±1.60, from 19.63 ± 2.57 to 24.20±3.02 and from 2.60 ± 0.40 to 3.07±0.45 respectively), PEP showed significant decrease compared to baseline readings with mean ±SD (from 75.64±10.44 to 69.82±10.22), while HR showed no statistically significant decrease compared to baseline readings.