Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-16T09:21:12.530Z Has data issue: false hasContentIssue false
  • English
  • Français

The use of esmolol and magnesium to prevent haemodynamic responses to extubation after coronary artery grafting

Published online by Cambridge University Press:  01 October 2007

C. Arar ,
A. Colak ,
A. Alagol ,
S. S. Uzer ,
T. Ege ,
N. Turan ,
E. Duran  and
Z. Pamukcu
C. Arar
Affiliation:
Trakya University Medical Faculty, Department of Anesthesiology, Edirne, Turkey
A. Colak*
Affiliation:
Trakya University Medical Faculty, Department of Anesthesiology, Edirne, Turkey
A. Alagol
Affiliation:
Trakya University Medical Faculty, Department of Anesthesiology, Edirne, Turkey
S. S. Uzer
Affiliation:
Trakya University Medical Faculty, Department of Anesthesiology, Edirne, Turkey
T. Ege
Affiliation:
Trakya University Medical Faculty, Department of Cardiovascular Surgery, Edirne, Turkey
N. Turan
Affiliation:
Trakya University Medical Faculty, Department of Biostatistics, Edirne, Turkey
E. Duran
Affiliation:
Trakya University Medical Faculty, Department of Cardiovascular Surgery, Edirne, Turkey
Z. Pamukcu
Affiliation:
Trakya University Medical Faculty, Department of Anesthesiology, Edirne, Turkey
*
Correspondence to: Alkin Colak, Department of Anesthesiology, Faculty of Medicine, Trakya University, Edirne 22030, Turkey. E-mail: [email protected]; Tel: +90 284 2357641; Fax: +90 284 2358096
Get access

Summary

Background and Objective

The haemodynamic responses during extubation can cause complications after open-heart surgery. In this study, we aimed to examine the effect of esmolol and magnesium before extubation on these haemodynamic responses.

Methods

Following the approval of local Ethics Committee, 120 patients having coronary artery bypass grafting with extubation in the intensive care unit were included in the study. Patients were allocated to receive esmolol 1 mg kg−1 (group I, n = 40), magnesium 30 mg kg−1 (Group II, n = 40) or normal saline (Group III, n = 40). Study medication was administered as a 20-min infusion in a volume of 20 mL. Patients were extubated just after termination of the infusion. Heart rate, blood pressure and central venous pressure were recorded prior to drug administration, before extubation, during extubation and 1 min after extubation.

Results

Heart rate was lower in Group I than in Groups II (P < 0.05) and III (P < 0.001) and lower in Group II than in Group III (P < 0.05) during extubation. It was also lower in Group I than in Group III (P < 0.05) after extubation. Systolic blood pressure was lower in Group I than in Groups II and III (P < 0.001) during extubation. Diastolic blood pressure was higher in Group III than in Groups I and II during extubation (P < 0.001) and after extubation (P < 0.05). Mean arterial pressure was lower in Group I than in Groups II and III (P < 0.001) during extubation, lower in Group II than in Group III (P < 0.05) during extubation and lower in Group I than in Group III (P < 0.05) after extubation.

Conclusion

We found that using esmolol before extubation following coronary artery bypass graft surgery prevents undesirable haemodynamic responses while magnesium reduces undesirable haemodynamic responses but does not prevent them.

Keywords

CORONARY ARTERY BYPASS GRAFTINGINTUBATION INTRATRACHEAL, extubationCARDIOVASCULAR SYSTEM, responsesADRENERGIC β-AGONISTS, esmololMAGNESIUM
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 10 , October 2007 , pp. 826 - 831
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hartley, M, Vaughan, RS. Problems associated with tracheal extubation. Br J Anaesth 1993; 71: 561–568.CrossRefGoogle ScholarPubMed
2.Barham, NJ, Boomers, OW, Sherry, KM, Locke, TJ. Myocardial ischaemia during tracheal extubation in patients after cardiac surgery: an observational study. Br J Anaesth 1998; 80: 832–833.CrossRefGoogle ScholarPubMed
3.Conti, J, Smith, D. Haemodynamic responses to extubation after cardiac surgery with and without continued sedation. Br J Anaesth 1998; 80: 834–836.CrossRefGoogle ScholarPubMed
4.Zaroslinski, J, Borgman, RJ, O’Donnell, JP et al. . Ultra-short acting beta-blockers: a proposal for the treatment of the critically ill patient. Life Sci 1982; 31: 899–907.CrossRefGoogle ScholarPubMed
5.Gorczynski, RJ, Shaffer, JE, Lee, RJ. Pharmacology of ASL-8052, a novel beta-adrenergic receptor antagonist with an ultrashort duration of action. J Cardiovasc Pharmacol 1983; 5: 668–677.CrossRefGoogle ScholarPubMed
6.Douglas, WW, Rubin, RP. The mechanism of catecholamine release from the adrenal medulla and the role of calcium in stimulus–secretion coupling. J Physiol 1963; 167: 288–310.CrossRefGoogle ScholarPubMed
7.Gambling, DR, Birmingham, CL, Jenkins, LC. Magnesium and the anaesthetist. Can J Anaesth 1988; 35: 644–654.CrossRefGoogle ScholarPubMed
8.Kimura, T, Yasue, H, Sakaino, N, Rokutanda, M, Jougasaki, M, Araki, H. Effects of magnesium on the tone of isolated human coronary arteries. Comparison with diltiazem and nitroglycerin. Circulation 1989; 79: 1118–1124.CrossRefGoogle ScholarPubMed
9.Miyagi, H, Yasue, H, Okumura, K, Ogawa, H, Goto, K, Oshima, S. Effect of magnesium on anginal attack induced by hyperventilation in patients with variant angina. Circulation 1989; 79: 597–602.CrossRefGoogle ScholarPubMed
10.Dube, L, Granry, JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth 2003; 50: 732–746.CrossRefGoogle Scholar
11.Horner, SM . Efficacy of intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality. Meta-analysis of magnesium in acute myocardial infarction. Circulation 1992; 86: 774–779.CrossRefGoogle ScholarPubMed
12.Warltier, DC, Pagel, PS, Kersten, JR. Approaches to the prevention of perioperative myocardial ischemia. Anesthesiology 2000; 92: 253–259.CrossRefGoogle Scholar
13.Poldermans, D, Boersma, E, Bax, JJ et al. . The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999; 341: 1789–1794.CrossRefGoogle ScholarPubMed
14.Dyson, A, Isaac, PA, Pennant, JH, Giesecke, AH, Lipton, JM. Esmolol attenuates cardiovascular responses to extubation. Anesth Analg 1990; 71: 675–678.CrossRefGoogle ScholarPubMed
15.Kurian, SM, Evans, R, Fernandes, NO, Sherry, KM. The effect of an infusion of esmolol on the incidence of myocardial ischaemia during tracheal extubation following coronary artery surgery. Anaesthesia 2001; 56: 1163–1168.CrossRefGoogle ScholarPubMed
16.Wang, YQ, Guo, QL, Xie, D. Effects of different doses of esmolol on cardiovascular responses to tracheal extubation. Hunan Yi Ke Da Xue Xue Bao 2003; 28: 259–262.Google ScholarPubMed
17.Akazawa, S, Shimizu, R, Nakaigawa, Y, Ishii, R, Ikeno, S, Yamato, R. Effects of magnesium sulphate on atrioventricular conduction times and surface electrocardiogram in dogs anaesthetized with sevoflurane. Br J Anaesth 1997; 78: 75–80.CrossRefGoogle ScholarPubMed
18.Vigorito, C, Giordano, A, Ferraro, P et al. . Hemodynamic effects of magnesium sulfate on the normal human heart. Am J Cardiol 1991; 67: 1435–1437.CrossRefGoogle ScholarPubMed
19.Delhumeau, A, Granry, JC, Cottineau, C, Bukowski, JG, Corbeau, JJ, Moreau, X. Comparison of vascular effects of magnesium sulfate and nicardipine during extracorporeal circulation. Ann Fr Anesth Reanim 1995; 14: 149–153.CrossRefGoogle ScholarPubMed
20.James, MF, Beer, RE, Esser, JD. Intravenous magnesium sulfate inhibits catecholamine release associated with tracheal intubation. Anesth Analg 1989; 68: 772–776.CrossRefGoogle ScholarPubMed
21.Puri, GD, Marudhachalam, KS, Chari, P, Suri, RK. The effect of magnesium sulphate on hemodynamics and its efficacy in attenuating the response to endotracheal intubation in patients with coronary artery disease. Anesth Analg 1998; 87: 808–811.CrossRefGoogle ScholarPubMed
22.Yap, LC, Ho, RT, Jawan, B, Lee, JH. Effects of magnesium sulfate pretreatment on succinylcholine-facilitated tracheal intubation. Acta Anaesthesiol Sin 1994; 32: 45–50.Google ScholarPubMed
23.Ashton, WB, James, MF, Janicki, P, Uys, PC. Attenuation of the pressor response to tracheal intubation by magnesium sulphate with and without alfentanil in hypertensive proteinuric patients undergoing caesarean section. Br J Anaesth 1991; 67: 741–747.CrossRefGoogle ScholarPubMed