Key result
N-acetylcysteine administered before off-pump coronary artery bypass grafting significantly attenuated oxidative stress, preserving glutathione levels (33.82 vs 24.25 nmol/ml) and improving pulmonary compliance.
Why the study?
Does N-acetylcysteine improve pulmonary function and reduce oxidative stress in patients undergoing elective off-pump coronary artery bypass grafting?
RCT (n=50)
Double-blind
Sealed envelope technique
No
Does N-acetylcysteine improve pulmonary function and reduce oxidative stress in patients undergoing elective off-pump coronary artery bypass grafting?
Absolute Event Rate: 33.82% vs 24.25%
p-value: p=0.005
Administration of N-acetylcysteine during elective off-pump coronary artery bypass grafting attenuates oxidative stress and improves pulmonary compliance and systemic oxygenation.
OBJECTIVE: Postoperative lung injury is one of the most frequent complications of cardiac surgery. Increasingly used Off Pump Coronary Artery Bypass Grafting (OPCABG) has significantly reduced the oxidative stress and the inflammatory response associated with the use of cardiopulmonary bypass (CPB). However, OPCABG is also associated with significant oxidative stress and its related complications. The present study is a prospective, randomized, double blind investigating the effects of N-acetylcysteine (NAC), a potent anti-oxidant on pulmonary functions in patients undergoing OPCABG. METHODS: Fifty patients undergoing elective OPCABG were randomized into two groups. Group A (n=25), the control group received 200ml of Normal saline immediately following induction whereas Group B (n=25), the study group received 150mg/kg of NAC in 200ml of Normal saline at the same time. Pulmonary Capillary Wedge Pressure (PCWP), Pulmonary Artery Pressure (PAP), Dynamic lung compliance (C Dyn), Static lung compliance (C Stat), Alveolar -arterial oxygen gradient (A-a Do2) were measured immediately following induction, after admission into ICU, and then 4 th hourly till extubation. Malondialdehyde (MDA) and Glutathione (GSH) levels were assayed once immediately following induction and again immediately after shifting to ICU. RESULTS: Demographic profile, pre-incision clinical and biochemical values were comparable in both the groups. PCWP, PAP-Diastole were lower and C Dyn and C Stat were significantly higher in study group when compared to control group. No difference in PAP-Systole was found. Both the groups had increased A-a Do2, but the increase was significantly lower in the study group. At the end of surgery, MDA levels were significantly raised in control group (p<0.001) whereas its levels were maintained in study group (p<0.569). GSH levels were significantly decreased in control group (p<0.001) whereas its levels were significantly increased in study group (p<0.001). CONCLUSION: OPCABG was associated with significant oxidative response but the administration of NAC attenuates this stress response by replenishing the GSH stores. NAC improves pulmonary function in terms of increased compliance and increased systemic oxygenation.
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Jalakandan et al. (2015) conducted an RCT in Elective Off Pump Coronary Artery Bypass Grafting (OPCABG) (n=50). N-acetylcysteine vs. Placebo (Normal saline) was evaluated on Glutathione (GSH) levels post-surgery (nmol/ml) (p=0.005). N-acetylcysteine administered before off-pump coronary artery bypass grafting significantly attenuated oxidative stress, preserving glutathione levels (33.82 vs 24.25 nmol/ml) and improving pulmonary compliance.
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