Prophylactic Use of Esmolol in Patients Undergoing Coronary Artery Bypass Grafting
Soha Tarek El Said Kamal Talaat;
Abstract
During the past two decades, ß-adrenergic blockade has been demonstrated to improve acute outcomes and long-term prognosis in ischemic heart disease. ß-blocker therapy has also been demonstrated to reduce perioperative events among high-risk patients undergoing major non-cardiac and vascular surgery.
Also, the administration of ß-adrenergic antagonists is known to attenuate myocardial ischemia-reperfusion injury during cardiac surgery. However, ß-adrenergic antagonists have been avoided during cardiopulmonary bypass (CPB) because of concern that the negative inotropic effects induced may make it difficult to terminate CPB.
Esmolol is the first intravenous, short-acting, titratable β-blocker available for use in critical care and surgical settings. Esmolol is thought to be a “jack of all trades” among drugs used in anesthesia because it prevents and treats cardiovascular responses due to perioperative stimuli. Although with clinical relevance proven for several years, only recently is esmolol being more widely used in anesthesia. Esmolol produces a dose-dependent decrease in heart rate, cardiac contractility, cardiac output, and blood pressure. Recovery of these effects is nearly complete within 15 to 30 minutes after discontinuation of the infusion.
In our study, esmolol infusion was associated with decreased systemic lactate production with the implication that esmolol is providing additional protection to the rest of the body (non-myocardial) from possible ischemic effects of low-flow CPB.
Although esmolol seem to decrease arterial oxygen content due to relatively longer bypass time and thus lower hemoglobin level in the esmolol group but oxygen consumption was lowered.
The postoperative variables and complications we achieved in our study remain controversial compared to other studies related to esmolol though still large scale studies need to be conducted.
Our results showed decreased incidence of supraventricular arrhythmias postoperatively in the esmolol group accompanied with less dependence on inotropic support and thus faster weaning from ventilatory support which all goes in favour of our drug. But, the higher number of patients in need for pacing is still a point of debate against our hypothesis.
There was no significant difference noticed in the 2 groups regarding ICU stay and postoperative mortality and morbidity within a month post-CABG which is another point of debate as it proves esmolol to be not cost effective.
The conclusion we have reached is that esmolol has other beneficial effects than those only cardiac in origin. Further large scale randomized studied need to be conducted to prove it is cost effective.
Also, the administration of ß-adrenergic antagonists is known to attenuate myocardial ischemia-reperfusion injury during cardiac surgery. However, ß-adrenergic antagonists have been avoided during cardiopulmonary bypass (CPB) because of concern that the negative inotropic effects induced may make it difficult to terminate CPB.
Esmolol is the first intravenous, short-acting, titratable β-blocker available for use in critical care and surgical settings. Esmolol is thought to be a “jack of all trades” among drugs used in anesthesia because it prevents and treats cardiovascular responses due to perioperative stimuli. Although with clinical relevance proven for several years, only recently is esmolol being more widely used in anesthesia. Esmolol produces a dose-dependent decrease in heart rate, cardiac contractility, cardiac output, and blood pressure. Recovery of these effects is nearly complete within 15 to 30 minutes after discontinuation of the infusion.
In our study, esmolol infusion was associated with decreased systemic lactate production with the implication that esmolol is providing additional protection to the rest of the body (non-myocardial) from possible ischemic effects of low-flow CPB.
Although esmolol seem to decrease arterial oxygen content due to relatively longer bypass time and thus lower hemoglobin level in the esmolol group but oxygen consumption was lowered.
The postoperative variables and complications we achieved in our study remain controversial compared to other studies related to esmolol though still large scale studies need to be conducted.
Our results showed decreased incidence of supraventricular arrhythmias postoperatively in the esmolol group accompanied with less dependence on inotropic support and thus faster weaning from ventilatory support which all goes in favour of our drug. But, the higher number of patients in need for pacing is still a point of debate against our hypothesis.
There was no significant difference noticed in the 2 groups regarding ICU stay and postoperative mortality and morbidity within a month post-CABG which is another point of debate as it proves esmolol to be not cost effective.
The conclusion we have reached is that esmolol has other beneficial effects than those only cardiac in origin. Further large scale randomized studied need to be conducted to prove it is cost effective.
Other data
| Title | Prophylactic Use of Esmolol in Patients Undergoing Coronary Artery Bypass Grafting | Other Titles | الاستخدام الوقائي لعقار الازمولول في المرضي الذين يخضعون لعمليات استبدال الشرايين التاجية | Authors | Soha Tarek El Said Kamal Talaat | Issue Date | 2014 |
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