• Der Anaesthesist · May 1990

    Randomized Controlled Trial Comparative Study Clinical Trial

    [The hemodynamic effects of a treatment with beta-receptor blockers during coronary surgery. A comparison between acebutolol and esmolol].

    • D Kling, J Boldt, B Zickmann, F Dapper, and G Hempelmann.
    • Abteilung für Anaesthesiologie und Operative Intensivmedizin, Justus-Liebig-Universität Giessen.
    • Anaesthesist. 1990 May 1;39(5):264-8.

    UnlabelledPatients undergoing coronary artery bypass grafting are at risk for perioperative myocardial ischemia. Most such ischemic episodes occur without obvious hemodynamic changes. Tachycardia as a predictor for increased myocardial oxygen consumption doubles the incidence of myocardial ischemia when heart rate increases to over 110 beats/min. During the operative procedure for coronary revascularization, some maneuvers, e.g. intubation, sternotomy and mediastinal preparation, may be associated with tachycardia and increases in blood pressure despite an adequate level of anesthesia, so that the administration of beta-receptor blocking agents seems to be indicated.MethodsThe study included 20 patients undergoing elective aortocoronary bypass grafting. All patients developed tachycardia (heart rate greater than 100 beats/min) before the start of extracorporeal circulation. The hemodynamic effects of 0.1 mg/kg acebutolol given i.v. as a bolus over 30 s and hemodynamic effects of the ultrashort-acting esmolol by continuous infusion (loading dose 500 micrograms/kg over 1 min followed by a dose of 100 micrograms/kg per min) were randomly investigated. Anesthesia was maintained with fentanyl, midazolam and pancuronium bromide. All patients were invasively monitored by means of a pulmonary artery catheter. In addition, left ventricular pressure (LVP), left ventricular end diastolic pressure (LVEDP) and dp/dtmax were measured.ResultsBoth acebutolol and esmolol, decreased the heart rate significantly (-24%, -27.5%), while the mean arterial pressure remained nearly unchanged. The cardiac index was diminished following acebutolol (-15.4%) and esmolol (-27.4%), while no significant change in stroke volume index was observed; systemic vascular resistance rose in all patients. Pulmonary artery pressure, PCP, PRA, LVP and LVEDP were unchanged, whereas dp/dtmax decreased both with acebutolol (-23.5%) and with esmolol (-36.5%).ConclusionBoth beta-receptor blockers--acebutolol and the ultrashort-acting esmolol--diminish heart rate sufficiently when tachycardia occurs during coronary artery bypass grafting. Reduction of heart rate is associated with a decrease of cardiac output and an impairment of myocardial contractility. From the hemodynamic point of view there is no major difference between the two beta-receptor blockers investigated, but esmolol may have an advantage over acebutolol because of its short elimination half-life.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…