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Cardiovascular Diseases Research Center,Birjand University of Medical Sciences, Birjand, Iran
Abstract: (10 Views)
Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease that is associated with an increased risk of heart disease. However, when these patients undergo open-heart surgery, several points must be considered compared to other patients undergoing surgery. The case we reported was a middle-aged woman who underwent scheduled coronary artery bypass surgery. The patient had a history of long-term corticosteroid use due to inflammatory RA. We performed several necessary and care measures compared to other open-heart surgery patients. These measures were performed from induction of anesthesia to cardiopulmonary bypass (CPB) and during extubation. Intraoperatively, the patient exhibited heparin resistance, manifested by an inadequate activated clotting time (ACT) response of 250 seconds following an initial dose of 300 units/kg of heparin. This was successfully managed through the administration of fresh frozen plasma (FFP) and supplemental heparin, achieving the target ACT for safe CPB initiation. Furthermore, to mitigate systemic inflammatory response and hemodilution, a modified pump prime solution containing albumin, FFP, and heparin was utilized. Anesthesia, pump, and nursing measures for inflammatory patients undergoing open-heart surgery should differ from those for patients without inflammation.
Keywords: Anesthesia, Cardiopulmonary Bypass (CPB), Coronary Artery Bypass Grafting, Heparin Resistance, Rheumatoid Arthritis (RA)
Type of Study: Case Report |
Subject:
Heart Surgery
Received: 2026/06/28 | Accepted: 2026/08/31 | ePublished ahead of print: 2026/11/10
Received: 2026/06/28 | Accepted: 2026/08/31 | ePublished ahead of print: 2026/11/10
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