Haemodynamic changes during minimally invasive coronary artery bypass surgery using high-dose esmolol.
We aimed to investigate the effects of high-dose esmolol on haemodynamics and oxygen extraction in minimally invasive direct coronary artery bypass (MIDCAB) surgery patients.


METHODS
In 18 patients, heart rate (HR), mean arterial (MAP), central venous (CVP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and mixed venous oxygen saturation (Sv0(2)) were prospectively measured after induction of anaesthesia (T1), start of surgery (T2), during bypass grafting with beta-blockade (T3), and at the end of surgery (T4).


RESULTS
Mean esmolol dose at T3 was 0.44+/-0.2mgkg(-1)min(-1). HR was unchanged, whereas significant decreases in mean CO (3.1+/-0. 8 vs 4.8+/-1.0lmin(-1)m(-2), pre-esmolol), MAP (53+/-10 vs 89+/-14mmHg), and SvO(2) (65+/-10 vs 81+/-4%) were observed during esmolol administration. All haemodynamic parameters normalized immediately after termination of esmolol (T4).


CONCLUSIONS
Despite unchanged HR esmolol reduced CO and MAP suggesting a favorable reduction of myocardial oxygen consumption. Mean Sv0(2) during esmolol administration reflects an acceptable ratio of whole-body oxygen delivery and consumption. Haemodynamic changes with high-dose esmolol during MIDCAB surgery remain within safety margins.
Aleksic
I
I
Department of Thoracic and Cardiovascular Surgery, Georg-August University, Göttingen, Germany. ialeksic@gudg.de
Buhre
W
W
Baryalei
M M
MM
Reitmeier
F
F
Tirilomis
T
T
Weyland
A
A
Dalichau
H
H
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011412:Propanolamines / Q000494:pharmacology*; D011446:Prospective Studies
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C036604:esmolol