Nicardipine for preservation of myocardial metabolism and function in patients undergoing coronary artery surgery.
The present study was designed to evaluate the myocardial protective effect of nicardipine (NIC) in patients with normal left ventricular (LV) function (control vs. NIC treatment group) and impaired LV function (control vs. NIC treatment group) during extracorporeal circulation for coronary artery surgery. NIC infusions were begun approximately 12 min before aortic cross clamping (AoX) at an infusion rate of 5 micrograms.kg-1.min-1 and maintained for 10 min. Prior to AoX an additional bolus of NIC 5 mg was given. Coronary hemodynamics, myocardial metabolic parameters (continuous thermodilution), and regional LV function (two-dimensional transesophageal echocardiography) were measured. At 15 min after discontinuation of AoX, lactate production was found in the two control groups but not in the two NIC treatment groups. In the control groups, lactate production returned to extraction at sternal closure. At that time regional area ejection fraction (RAEF) had significantly improved in both groups with impaired LV function compared with postintubation (baseline) values. In NIC-treated patients with impaired LV function, however, the percentage improvement in RAEF was significantly greater than that in the control groups. Between the groups, there were no differences in the number of patients requiring inotropic support, pacing, and/or diuretics after bypass or postoperatively. There were no significant differences in postoperative creatine kinase myocardial band release or in the incidence of dysrhythmias, myocardial infarction, or mortality. The results of the present study suggest that NIC iv may be used to provide additional myocardial protection during extracorporeal circulation. In addition, in NIC-treated patients with compromised LV function, this may be associated with a more apparent improvement in RAEF than that seen in nontreated patients.
Koolen
J J
JJ
Department of Anesthesiology, Academisch Medisch Centrum, Amsterdam, The Netherlands.
van Wezel
H B
HB
Visser
C A
CA
Moulijn
A C
AC
Leyssius
A T
AT
van Hal
J M
JM
Deen
L
L
Dunning
A J
AJ
D000368:Aged; D002314:Cardioplegic Solutions; D003331:Coronary Vessels / Q000601:surgery*; D005112:Extracorporeal Circulation; D006321:Heart / Q000187:drug effects*; D006439:Hemodynamics; D006801:Humans; D007036:Hypothermia, Induced; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D009206:Myocardium / Q000378:metabolism*; D009529:Nicardipine / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
D002314:Cardioplegic Solutions; D009529:Nicardipine