Hemodynamic response to adenosine infusion before and after coronary artery bypass surgery.
This study describes the hemodynamic dose-response characteristics of a titrated, continuous adenosine infusion before and 1 h (anesthetized), 1 week, and 1 year after coronary artery bypass graft (CABG) surgery. Average tolerated adenosine infusion rates were less 1 h and 1 week after surgery (128 +/- 23 and 118 +/- 27 microg/kg/min, respectively) than before (156 +/- 29 microg/kg/min) and 1 year after surgery (156 +/- 24 microg/kg/min). Heart rate (HR) increased with a 120-microg/kg/min adenosine infusion rate both preoperatively (21 +/- 11%) and 1 year postoperatively (16 +/- 8%). Systolic blood pressure (BP) decreased 26 +/- 11%, 14 +/- 7%, and 9 +/- 6% with 120 microg/kg/min adenosine for the three postoperative examinations. The integral of the outflow tract velocity with 120 microg/kg/min adenosine increased 49 +/- 22% and 29 +/- 12% after 1 h and 1 week, respectively, whereas its product with HR increased equally for all examinations (40 +/- 22%, 62 +/- 27%, 46 +/- 13%, and 39 +/- 11%). The average preoperative left ventricular area shortening was 45 +/- 10% and neither it nor end-diastolic left ventricular area (preload) changed with surgery, time after surgery, or with adenosine. A titrated adenosine infusion is well suited to patients requiring a pharmacologic provocation to expose reversible myocardial ischemia during the first hours or days after CABG surgery. The anesthetized and anemic patient are particularly unsuited for the commonly used fixed-infusion-rate protocol.
Anderson
R E
RE
Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
Lind
B
B
Owall
A
A
Brodin
L A
LA
D000241:Adenosine / Q000494:pharmacology* / Q000627:therapeutic use; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D001026:Coronary Artery Bypass; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control; D013318:Stroke Volume / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects
D000241:Adenosine