A comparative study on the administration of sodium bicarbonate to correct acidosis in patients under CABG surgery by on-pump and off-pump techniques in Shahid Madani hospital in 2019

Abstract

Background: Coronary Artery Bypass Grafting (CABG) is a surgical procedure with lots of complications and costs. Therefore, adequate care during and after surgery is important and more researches are needed to timely prescribe medications and select the appropriate surgical method. Objective: The aim of present work was comparative study on the administration of sodium bicarbonate to correct acidosis in patients under CABG surgery by on-pump and off-pump techniques in Shahid Madani hospital in 2019. Methods and Materials: This retrospective cross-sectional study was done during 12 months. The demographic data, history of underlying diseases, drug regimen, patients' addiction, arterial blood gas analysis and dosage of sodium bicarbonate (before and during the surgery, as well as before and after injecting the agent within 24 hours after the surgery) were recorded on a questionnaire form. Results: Among 106 studied patients, 53 patients were under off-pump and 53 patients were under on-pump CABG. The amount of sodium bicarbonate used during and after the on-pump CABG was higher, but this difference was not significant (p>0.05). Blood pH level, buffer bicarbonate and base excess during 4 recorded times were higher in on-pump method. Difference were significant for the three factors during surgery, and for buffer bicarbonate and base excess during 24 hours after on-pump surgery (p<0.05). In the case of PaCO2 level, many changes were shown during and after surgery by on-pump technique, while the changes were less in the off-pump method and were significant only within 24 hours after the surgery. Conclusion: The results showed that the amount of sodium bicarbonate used during and after on-pump surgery is partially higher, so that the levels of ABG factors remain in the normal range during this technique. In addition, 4 ABG factors reach the normal range in on-pump method after injecting the agent, while in off-pump surgery, only blood pH and carbon dioxide levels remain in the normal values. Within 24 hours after surgery, acidosis was not a clinical problem for patients in this technique. Regarding clinical findings, partially low sodium bicarbonate use and improvement of patients' acidosis, it seems that off-pump CABG method would be the better choice for CABG surgeries.