| Effects of a bolus injection of adenosine triphosphate on atrioventricular conduction and hemodynamics in patients undergoing coronary artery bypass grafting. | |
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MedLine Citation:
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PMID: 10230953 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To investigate the effects of adenosine triphosphate (ATP) on atrioventricular (A-V) conduction and hemodynamics in patients undergoing coronary artery surgery. DESIGN: A prospective study. SETTING: University teaching hospital. PARTICIPANTS: Patients scheduled for elective coronary artery bypass graft surgery. INTERVENTIONS: Anesthesia was induced with the same dose of intravenous fentanyl (300 microg) and midazolam (10 mg) for each patient. After the baseline measurement, a bolus dose of 10 mg of ATP (0.19+/-0.03 mg/kg, mean +/- SD) was rapidly injected through a central venous catheter. Right ventricular pacing was conducted at a rate of 40 beats/min during the development of complete A-V block. MEASUREMENTS AND MAIN RESULTS: ATP induced an A-V block in 10 of 12 patients (2:1 block in two patients and complete A-V block in eight patients). The onset of the A-V block was rapid (17.1+/-3.4 seconds) and the duration was short (12.1+/-7.0 seconds). Radial arterial pressure (AP) decreased with the appearance of the A-V block (p < 0.01). Heart rate (HR) returned to the baseline value quickly after the restoration of the A-V block, but recovery of radial AP was delayed. HR increased 1 minute after the ATP injection (p < 0.01). Both HR and radial AP returned to the baseline values 2 minutes after the ATP injection. ST segments on both leads II and V5 of electrocardiograms decreased more than 0.10 mV 1 minute after the ATP injection in one patient. CONCLUSION: A bolus injection of 10 mg of ATP successfully induced a transient A-V block in 83% of the 12 patients. The countermeasures, including ventricular pacing, are indispensable to cope with the subsequent hypotension that may lead to myocardial ischemia, especially in patients with ischemic heart disease. |
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Authors:
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S Watanabe; Y Kono; S Kaneko; T Kano |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of cardiothoracic and vascular anesthesia Volume: 13 ISSN: 1053-0770 ISO Abbreviation: J. Cardiothorac. Vasc. Anesth. Publication Date: 1999 Apr |
Date Detail:
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Created Date: 1999-06-17 Completed Date: 1999-06-17 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9110208 Medline TA: J Cardiothorac Vasc Anesth Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 181-5 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine Triphosphate
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administration & dosage,
therapeutic use* Anesthetics, Intravenous / administration & dosage Atrioventricular Node / drug effects* Blood Pressure / drug effects Bradycardia / physiopathology, therapy Cardiac Pacing, Artificial Catheterization, Central Venous Coronary Artery Bypass* Electrocardiography / drug effects Fentanyl / administration & dosage Heart Block / chemically induced, physiopathology Heart Rate / drug effects Hemodynamics / drug effects* Humans Hypotension / physiopathology, therapy Injections, Intravenous Midazolam / administration & dosage Middle Aged Myocardial Ischemia / physiopathology, therapy Neurotransmitter Agents / administration & dosage, therapeutic use* Prospective Studies Surgical Procedures, Elective Time Factors Ventricular Function, Right / drug effects |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Intravenous; 0/Neurotransmitter Agents; 437-38-7/Fentanyl; 56-65-5/Adenosine Triphosphate; 59467-70-8/Midazolam |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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