Effect of Esmolol on Cardiac Recovery after Cardiopulmonary Bypass Surgery (original) (raw)
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Journal of Cardiothoracic and Vascular Anesthesia, 2009
Objective: -Blockers were associated with a reduction of mortality and morbidity in noncardiac surgery until recently when the POISE trial showed that -blockers could be harmful in the perioperative period because of hypotension and bradycardia. Esmolol is an ultra-short-acting -blocker mostly used in emergency and high-risk patients. The authors performed a meta-analysis to evaluate the clinical effects of esmolol in cardiac surgery.
Esmolol Administration for the Treatment of Refractory Ventricular Fibrillation
Bezmialem Science, 2016
Ventricular fibrillation (VF) after releasing an aortic cross clamp in patients undergoing open heart surgery procedures is not rare. Ischemia-reperfusion injury after release of the aortic clamp, increased adrenergic tone, and insufficient protection of the myocardium are the possible causes. Amiodarone, lidocaine, and beta blockers have been added to the cardioplegia solutions as a preventive measure for reperfusion VF. We report a case of life-threatening, shock-resistant VF during the weaning period of a cardiopulmonary bypass (CPB) in a 61-year-old male who underwent a mitral valve repair surgery for mitral valve regurgitation. After several defibrillation attempts, refractory VF was turned to normal sinus rhythm shortly after ultra-short acting, beta blocking agent esmolol administration. CPB was terminated successfully following this. In conclusion, VF is still a major problem for clinicians and the treatment of refractory VF is not well defined. In contrast with the absence of the sufficient randomized controlled human studies, theoretically beta blockers could be a choice alternative for shock refractory VF.
Patients who under go surgery, especially with pre existing high cardiovascular risk and high-risk surgery are vulnerable for developing myocardial ischemia or tachyarrhythmias through sympathetic stimulation during anesthesia. Aim of this systematic review is a summary of the evidence from all randomized controlled trials on the efficacy and safety of the short acting β1-selective adrenoreceptor blocker esmolol in the prevention and treatment of tachyarrhythmias and critical rises in blood pressure to avoid myocardial ischemia.
Journal of Pharmacy and Pharmacology, 2021
To investigate the efficiency and safety of (β+α)-adrenoblocker esmolol for postoperative arterial hypertention (PAH) in patients with ischemic heart disease. The study included 25 patients (45-65 years, mean age 51.5 ± 7.3) who underwent coronary artery bypass grafting surgery with continuous blood purification (CPB). PAH developed during first post-op hours, all patients were ventilated with 2-4 scale sedation by RASS. All patients had arterial hypertension and were on constant therapy. Esmolol was administered IV push 20 mg within a minute. When required, injection was repeated in 5 min until full required effect. Maximum dose was 100 mg. For intraoperative treatment of hypertension 80 mg bolus within 30 sec was injected followed by 150 mg/kg/min infusion when required. Post-op dosage was administered similarly. Esmolol treatment was efficient in 82.6% of cases. Most frequent target AH was achieved using up to 40 and 60 mg in 20% and 36.9% of cases accordingly. Antihypertension effect maintained within 24 hours after injection. Esmolol cause moderate reduction of heart rate (4-7%), making it possible to use in case of hypertension without tachycardia. It is well tolerated and safe as no side effects were observed. The study showed high efficiency and safety of using esmolol to manage post-op arterial hypertension in cardiac surgery patients.
Efficacy of esmolol as a myocardial protective agent during continuous retrograde blood cardioplegia
The Journal of Thoracic and Cardiovascular Surgery, 2003
Objective: Esmolol, an ultra-short-acting -blocker, is known to attenuate myocardial ischemia-reperfusion injury. The aim of this study was to compare the effects of esmolol and potassium on myocardial metabolism during continuous normothermic retrograde blood cardioplegia. Methods: Forty-one patients operated on for isolated aortic valve stenosis were randomly assigned to continuous coronary infusion with either potassium or esmolol during cardiopulmonary bypass. Myocardial metabolism was assessed by measuring the transmyocardial gradient of oxygen content indexed to left ventricular mass of glucose, lactate, and nitric oxide. To do so, blood samples were simultaneously withdrawn upstream (in the cardioplegia line) and downstream of the myocardium (in the left coronary ostium) 10 and 30 minutes after aortic crossclamping. Results: Although the cardioplegia flow rate and pressure were similar, esmolol markedly reduced the transmyocardial gradient of oxygen content indexed to left ventricular mass compared with potassium: 13 Ϯ 6 vs 20 Ϯ 6 mL of oxygen per liter of blood per 100 g of myocardium, respectively, at 10 minutes and 16 Ϯ 8 vs 24 Ϯ 8 mL of oxygen per liter of blood per 100 g of myocardium, respectively, at 30 minutes (P ϭ .009). Coronary glucose and lactate transmyocardial gradients were similar in both groups, indicating adequate myocardial perfusion in all patients at all times. In addition, during retrograde cardioplegia, esmolol showed a lower nitric oxide release compared with that caused by potassium (39 Ϯ 49 mol ϫ L Ϫ1 for potassium vs 14 Ϯ 8 mol ϫ L Ϫ1 for esmolol at 10 minutes and 39 Ϯ 47 mol ϫ L Ϫ1 for potassium vs 6 Ϯ 8 mol ϫ L Ϫ1 for esmolol at 30 minutes, P ϭ .05). However, hemodynamic parameters and plasma troponin I levels remained unchanged postoperatively between the 2 types of cardioplegia. Conclusion: Esmolol provides potent myocardial protection in hypertrophied hearts, at least in part, by reducing myocardial oxygen metabolism.
European Journal of Cardio-Thoracic Surgery, 2008
Objective: Myocardial dysfunction after reperfusion can be a clinical problem in the early postoperative phase after on-pump cardiac surgery. The aim was, in an experimental setting, to investigate if administration of the b-adrenergic receptor blocker esmolol prior to cross-clamping for 80 min with cold oxygenated blood cardioplegia would improve myocardial protection and early postoperative function. Methods: Twenty-four anaesthetised pigs were randomly allocated into one of two equally sized groups and put on mild hypothermic cardiopulmonary bypass. Esmolol 1 mg kg À1 or saline was administered into the arterial line 4 min prior to aortic cross-clamp. Cardiac arrest during 80 min of cross-clamp was obtained with repeated antegrade cold oxygenated blood cardioplegia; the pigs were weaned from bypass following a standardised protocol. Left ventricular global and regional myocardial function and tissue blood flow were evaluated with conductance catheter, echocardiography and coloured microspheres at baseline and at 1, 2 and 3 h after declamping. Four animals did not fulfil the protocol and were excluded. Results: No significant differences between groups could be demonstrated for left ventricular global and local function and tissue blood flow at baseline. At 1 h after declamping the slope of preload recruitable stroke work (PRSW slope ) averaged 73.7 AE 12.7 mmHg (SD) in controls and 72.7 AE 11.1 mmHg in esmolol-treated animals. In controls PRSW slope decreased to 62.1 AE 11.0 and 58.4 AE 12.7 mmHg after 2 and 3 h, respectively ( p < 0.005 vs 1 h for both). In the esmolol-treated animals PRSW slope remained unchanged at 72.0 AE 11.4 and 73.7 AE 12.9 mmHg at 2 and 3 h after declamp and were significantly higher ( p < 0.025 and <0.001) than the corresponding values in the control group. The slope of the end systolic pressure volume relationship did not differ between groups at 1 and 2 h after declamp, but were 1.85 AE 0.86 and 2.51 AE 0.96 mmHg ml À1 in controls and in esmolol-treated animals, respectively, after 3 h ( p < 0.025). Conclusions: Esmolol administered prior to cold oxygenated cardioplegic arrest alleviates left ventricular dysfunction in the early hours after cardiopulmonary bypass. #