الفهرس 
Introduction
Post-cardiac Surgery Atrial FibrillationOnly 14 pages are availabe for public view
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Abstract
Cardiac surgery is widely used for acquired cardiac disease and remains the therapy of choice for advanced coronary artery disease or severe aortic valve stenosis.
Although advances in anesthetic and surgical techniques, patients are still at risk of perioperative hemodynamic instability, inadequate protection during cardiopulmonary bypass.Therefore, a significant effort has been made to develop novel surgical techniques and pharmacologic agents that may reduce these risks and improve patient’s outcome.
One of most common complication after cardiac procedure is arrhythmia. Atrial fibrillation is the most common arrhythmia after cardiac surgery.
This prospective randomized study was carried out in Assiut University Hospital cardiothoracic surgery center to evaluate the efficacy of atorvastatin versus magnesium sulfate in antiarrhythmic effect and myocardial protective effect.
Magnesium is a physiologic calcium antagonist that inhibits calcium entry into vascular smooth muscle Cells. In addition, it has an antiarrhythmic effect and cardioprotective effect.
HMG-CoA reductase inhibitors (statins) mainly used treatment of hyperlipidemia and are used in the primary and secondary prevention of coronary artery disease. Recent studies have shown that statins also possess powerful pleiotropic effects that are independent of their cholesterol lowering properties. One of the most interesting pleotropic effect of statins is it can act like antiarrhythmic and anti-inflammatory agent.
In our study 60 patients were studied in 3 groups;
• Atorvastatin group (group S):
Patients in this group received atorvastatin in a dose of 80 mgs in the following times:
Twelve hours preoperatively.
Two hours preoperatively.
On the 2nd, 3rd, 4th and 5th postoperative days.
• Magnesium sulfate group (group M):
Patients in this group received Magnesium sulfate in a dose of 3 grams (dissolved in 100 mL of isotonic saline and infused over 2 hours) in the following times:
Twelve hours preoperatively.
Within the first hour of ICU arrival.
On the 2nd and 3rd postoperative days.
• Control group (group C):
Patients in this group did not receive atorvastatin nor magnesium sulfate during the study.
All patients were subjected to the same anesthetic management as regard to drugs used, monitoring, and the management of cardiopulmonary bypass.
Postoperative monitoring includes heart rate, rhythm, mean systemic arterial pressure, central venous pressure, arterial blood gas analysis, serum level of WBCs, electrolyte, CRP, Troponin I, and IL-6. Also, the inotropic score and duration of both mechanical ventilation and ICU stay.
In our study, there were no significant differences among the three groups regarding demographic data, lesion characteristics and operative details. Also, there was no significant difference among the three groups regarding the rhythm after declamping.
The incidence of POAF during the first five postoperative days was significantly lower in atorvastatin group (20%) compared to the control group (50%), and in magnesium sulfate group (10%) compared to the control group. No significant difference in the incidence of POAF between atorvastatin group and magnesium sulfate group.
WBCs count showed no statistical significant difference among the three groups in the base line and during the 1st day postoperative but in the next four postoperative days there were significant differences among means of the three groups, WBCs counts on day (2,3,4,5) were significantly lower in S group in comparison to C group. There were no significant differences between group S and group M nor group M and group C.
Regarding the serum level of CRP, there were no statistically significant difference among the three groups during the 1st and 2nd postoperative days but in the 3rd, 4th, and 5th postoperative days CRP level is significantly lower in group S compared to group C, and in group M compered to C group, with no significant difference between group S and group M. while the results regarding the serum level of IL_6, the results during Post-induction, At the end of cardiopulmonary bypass, six hours post-cardiopulmonary bypass and Twenty-four hours after induction of anesthesia had no significant difference among the three groups. However, in the 5th postoperative day. Serum IL-6 is significantly lower in group S and M group in compared to group C, and there was no significant difference between S and M group.
Also, our study showed no significant differences in troponin I level, inotropic score, the intubation time nor hospital stay among the three groups.