title: Protective effect of esmolol on myocardial ischemic injury during open heart surgery in children.
abstract: OBJECTIVE
  To investigate the efficacy of esmolol in protecting the myocardium from ischemia during pediatric cardiac surgery.
  
  
  BACKGROUND
  Esmolol, an ultra-short acting beta 1-adrenoceptor blocker, reduces myocardial injury in adult cardiac operations. However, this technique is rarely used in pediatric cardiac surgery.
  
  
  METHODS
  Thirty children with ventricular septal defect were randomly allocated to the esmolol group and the control group. Patients received intravenous esmolol (0.05 mg·kg(-1) ·min(-1)  after tracheal intubation, 0.3 mg·kg(-1) ·min(-1)  during cardiopulmonary bypass (CPB) and 0.03-0.05 mg·kg(-1) ·min(-1)  until the end of surgery) or placebo, respectively.
  
  
  RESULTS
  Plasma levels of creatine kinase-MB, cardiac troponin I in the esmolol group 2 min after completion of CPB, at the end of surgery, 4 h after surgery, and the first postoperative day were significantly lower than those in the control group. Values of heart rate 10 min after induction, 2 min before institution of CPB, 2 min after completion of CPB, and at the end of surgery were significantly lower in the esmolol group; however, mean arterial pressure, CPB time, cross-clamp time, and the rate of heart spontaneous rebeating were not statistically different between two groups. Cumulative postoperative dosage of dopamine in the esmolol group (100.1 ± 53.1 mg) was significantly less than that in the control group (171.4 ± 92.1 mg).
  
  
  CONCLUSIONS
  Esmolol can protect the myocardium from ischemic injury during CPB in children and significantly reduce the use of inotropic drug.
authors: Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Ping
authors: P
authors: Gui
authors: Qingping
authors: Q
authors: Wu
authors: Jing
authors: J
authors: Wu
authors: Shanglong
authors: S
authors: Yao
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D062186:Arterial Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003402:Creatine Kinase / Q000097:blood; D004298:Dopamine / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D017202:Myocardial Ischemia / Q000517:prevention & control*; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D011229:Preanesthetic Medication; D011412:Propanolamines / Q000627:therapeutic use*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D011412:Propanolamines; D019210:Troponin I; D003402:Creatine Kinase; C036604:esmolol; D004298:Dopamine