Comparing the Effect of Lidocaine - Magnesium Sulfate Combination with Amiodarone - Magnesium Sulfate Combination in Preventing Ventricular Fibrillation After Aortic Artery Cross-clamp Removal During Coronary Artery Bypass Graft Surgery (original) (raw)
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International Journal of Advanced Research (IJAR), 2019
Background:Reperfusion ventricular fibrillation (VF) after aortic cross-clamp (ACC) release is one of the most common complications after Aortic valve surgery. Materials and methods:Eighty seven patients who had undergone Aortic valve surgery were assigned randomly to three groups (29 patients each). The lidocaine group received lidocaine with magnesium sulfate (mgso4) (100 mg lidocaine and 2g mgso4) in 25 ml isotonic saline, the amiodarone group received (300 mg amiodarone) diluted in 25 ml of an isotonic saline, and the control group received 25 ml normal saline by a pump circuit 3 min before ACC release. Anesthetic management, weaning protocol from cardiopulmonary bypass, were standardized. All the patients were monitored after the release of ACC and VF were recorded. Results:Incidence of VF after release of ACC was lower in the lidocaine with mgso4 group compared with the amiodarone and control group [6 (20.7%), 8 (27.6%) vs. 12 (41.4%)] but there was no statistically significant difference between all groups (P = 0.215). Also, the incidence of an atrioventricular block and bradycardia after release ACC was higher in the lidocaine mgso4 group compared with the amiodarone and control groups [7 (24.1%) vs. 4 (13.8%) and 3 (10.3%), respectively)] but there was no statistically significant difference between all groups (P = 0.331). Conclusion:The administration of lidocaine with mgso4 before the release of ACC reduced the incidence of VF. However, the administration of Lidocaine with mgso4 was associated with more transient atrioventricular block.
Journal of Cardiac Surgery, 2006
Background: To evaluate whether postoperative administration of intravenous low-dose amiodarone and magnesium sulfate (MgSO 4 ) combination would reduce the incidence of atrial fibrillation following coronary artery bypass grafting (CABG) in normomagnesemic high-risk patients for postoperative atrial fibrillation (POAF). Methods: A total of 136 patients undergoing elective CABG and had ≥3 risk factors for POAF were prospectively randomized to one of three groups, to receive a single dose of amiodarone (5 mg/kg) and MgSO 4 (1.5 g) (combination group, n = 44), or an equal dose of amiodarone (amiadorone group, n = 44) or equal volumes of saline (control group, n = 48) at early postoperative period. Continuous electrocardiographic (ECG) monitorization was performed for first 48 hours and an ECG was recorded every 8 hours later. POAF longer than 30 minutes or for any length requiring treatment, and the drug-related side effects were recorded. Results: The study population showed a homogeneous distribution regarding risk factors for POAF and there was no significant difference in patient characteristics, echocardiographic variables, or operative variables among three groups. POAF developed in 4 patients in combination group, in 16 patients in amiodarone group and in 16 patients in control group, representing a 24% relative risk reduction between the combination group and control group (p = 0.023). No statistically significant difference regarding incidence of POAF was observed between amiodarone and control groups. Conclusions: Combined prophylactic therapy with amiodarone and MgSO 4 at the early postoperative period without a maintenance phase is an effective, simple, well-tolerated, and possibly cost-effective regimen to prevent POAF in normomagnesemic, high-risk patients.
ARYA atherosclerosis, 2013
Reperfusion ventricular fibrillation after aortic cross clamp is one of the important complications of open cardiac surgery and its prevention could reduce myocardial injuries. This study aimed to evaluate the efficacy of single dose of amiodarone or lidocaine by the way of pump circuit three minutes before aortic cross clamp release and compare the results with normal saline as placebo in a randomized double blinded controlled trial. One hundred fifty patients scheduled for first time elective coronary artery bypass graft surgery were randomly assigned to receive either single dose of amiodarone (150 mg), lidocaine (100 mg), or normal saline (5 ml) three minutes before aortic cross clamp release. The incidence of ventricular fibrillation and the need for reuse of drug were compared between these groups by chi-square, Student's t-test, Mann-Whitney test, and One-way ANOVA. SPSS software was used for statistical analysis. The incidence of ventricular fibrillation is higher in the...
The Journal of Thoracic and Cardiovascular Surgery, 2012
Objective: Ventricular fibrillation occurs commonly after aortic crossclamping in patients undergoing cardiac surgery. Ventricular fibrillation increases myocardial oxygen consumption, and defibrillation may harm the myocardium. Thus, a pharmacologic approach to decreasing the incidence of ventricular fibrillation or the number of shocks required may be beneficial. The goal of this study was to evaluate whether amiodarone or lidocaine was superior to placebo for the prevention of ventricular fibrillation after aortic crossclamping in patients undergoing a variety of cardiac surgical procedures. Methods: Patients undergoing cardiac surgery requiring aortic crossclamping were randomized to receive lidocaine 1.5 mg/kg, amiodarone 300 mg, or placebo before aortic crossclamp removal The primary outcomes were the incidence of ventricular fibrillation and the number of shocks required to terminate ventricular fibrillation. Results: A total of 342 patients completed the trial. On multivariate analysis, there was no difference in the incidence of ventricular fibrillation among treatment groups. The number of required shocks was categorized as 0, 1 to 3, and greater than 3. On multivariate analysis, patients receiving amiodarone required fewer shocks to terminate ventricular fibrillation (odds ratio, 0.51; 95% confidence interval, 0.31-0.83; P ¼ .008 vs placebo). There was no difference between lidocaine and placebo in the number of required shocks (odds ratio, 0.86; 95% confidence interval, 0.52-1.41; P ¼ .541). Conclusions: In patients undergoing a variety of cardiac surgical procedures, neither amiodarone nor lidocaine reduced the incidence of ventricular fibrillation. Amiodarone decreased the number of shocks required to terminate ventricular fibrillation.
Ain-Shams Journal of Anesthesiology, 2019
Background: Techniques of coronary artery bypass grafting (CABG) have developed rapidly over the last decades. However, dysrhythmia is a common feature during off pump CABG. The aim of this work was to study effect of perioperative magnesium sulphate infusion on the incidence of cardiac arrhythmia in off-pump CABG: and comparing such effects to lidocaine alone or combined to magnesium. Methodology: Ninety patients undergoing elective coronary artery bypass grafting surgery were randomly divided into three equal groups: magnesium group received magnesium over 12 h prior to off-pump surgery and over 30 min intraoperatively; lidocaine group were given an intravenous bolus injection of lidocaine followed by a continuous infusion; and combination group received half the doses of magnesium and lidocaine prescribed for the other two groups. The patients' perioperative hemodynamic data (heart rate and mean arterial pressure) and the occurrence of intraoperative and postoperative arrhythmia were recorded. Results: There was statistically significant difference between study groups as regards mean intraoperative heart rate and intraoperative mean arterial pressure. In addition, the need for intraoperative beta-blockers was significantly higher in lidocaine group; there was no need for intraoperative beta-blockers for combination group. Also, the need for perioperative aortic balloon pump was significantly higher in lidocaine group (20.0%), followed by 6.7% in magnesium group, and none in combination group. The percentage of ventricular tachycardia was significantly higher in lidocaine group (16.7%), followed by magnesium group (3.3%) and none in combination group. Conclusion: Results of the present study revealed that combination of both perioperative magnesium and lidocaine when compared to each of both drugs separately has a better effect in controlling hemodynamics (heart rate and mean arterial blood pressure intraoperatively), less ventricular tachycardia, and reduction in the need for beta blockers and aortic balloon pump perioperatively. In addition, magnesium was superior to lidocaine, although both are effective.
Journal of Cardiothoracic Anesthesia, 1990
The authors compared bretylium and lidocaine for reducing the incidence and persistence of ventricular fibrillation following aortic cross-clamp release performed during coronary artery bypass surgery. Thirtythree adult patients scheduled for elective bypass surgery were randomly assigned in a double-blind fashion to receive a bolus of bretylium, 10 mg/kg, lidocaine, 2 mg/kg, or saline, in equal volumes prior to the release of the aortic cross-clamp. Coronary artery bypass surgery was conducted using standard cardiopulmonary bypass (CPB) procedures with systemic cooling to 24" to 28°C. Temperature, arterial blood gases, and electrolytes were recorded. After clamp release, the first electrical rhythm was noted. Abnormal rhythms (ventricular fibrillation) were allowed to persist for 1 to 2 minutes, and if spontaneous conversion to a supraventricular rhythm did not occur, defibrillation with internal DC countershocks
Interactive cardiovascular and thoracic surgery, 2008
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the administration of amiodarone or lidocaine in patients with refractory VT/VF after cardiac surgery results in successful cardioversion. Altogether more than 434 papers were found using the reported search, from which 23 articles were used to answer the clinical question. No randomized trials have been found in which amiodarone was studied in patients with refractory VF/VT after cardiac surgery. Recommendations on the use of amiodarone in patients with refractory VF/VT in both European and American 2005 Guidelines on Resuscitation are mainly based on expert consensus and are supported by a few randomized trials in patients with out-of-hospital cardiac arrest. We would therefore recommend that amiodarone is the first line drug that should be used in patients with refractory ventricular arrhythmias after cardiac surgery that persist after three failed attempts ...