Esmolol cardioplegia in unstable coronary revascularisation patients. A randomised clinical trial.
BACKGROUND
Esmolol has been studied and applied to control hypertension and tachycardia during open heart surgery. Esmolol has been used on a minor scale as a single cardioplegic agent. Little information is available on esmolol as a component of blood cardioplegia. In this prospective, randomised, double-blind clinical study we investigated whether esmolol improves cardioprotection in patients scheduled for an urgent coronary operation.


METHODS
Forty patients with unstable angina were operated using cold blood cardioplegia as the basic cardioprotective method. Cardioplegia was infused intermittently, and esmolol was given into the cardioplegia line (15 mg/min) during cold infusions. Patients with ongoing myocardial infarction were excluded.


RESULTS
The arrest time during the cardioplegic induction or the rate of spontaneous resumption of the heart rhythm did not differ significantly between the groups. The serial measurements of plasma creatine kinase MB-fraction activity (P=0.27), serum creatine kinase MB-fraction mass assay (P=0.16), troponin I (P=0.41) and myoglobin (P=0.14) similarly did not differ between the groups, nor did myocardial lactate extraction (P= 0.12).


CONCLUSIONS
Esmolol addition to blood cardioplegia did not increase the efficacy of cardioprotection in the present study setting in unstable patients during urgent coronary revascularisation.
Rinne
T
T
Department of Anaesthesia and Intensive Care, Tampere University Hospital, Finland. timo.rinne@pp.fimnet.fi
Harmoinen
A
A
Kaukinen
S
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D003402:Creatine Kinase / Q000378:metabolism; D004311:Double-Blind Method; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D009204:Myocardial Revascularization; D009211:Myoglobin / Q000378:metabolism; D011183:Postoperative Complications / Q000188:drug therapy*; D011412:Propanolamines / Q000627:therapeutic use*; D011446:Prospective Studies; D014336:Troponin / Q000378:metabolism
D000319:Adrenergic beta-Antagonists; D002314:Cardioplegic Solutions; D009211:Myoglobin; D011412:Propanolamines; D014336:Troponin; D019344:Lactic Acid; D003402:Creatine Kinase; C036604:esmolol