Document Detail


Influence of continuous perioperative beta-blockade in combination with phosphodiesterase inhibition on haemodynamics and myocardial ischaemia in high-risk vascular surgery patients.
MedLine Citation:
PMID:  19336536     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We sought to assess the intra- and postoperative haemodynamic effects of continuous perioperative beta-adrenergic blockade combined with phosphodiesterase (PDE) III inhibition and its potential benefits in limiting perioperative myocardial ischaemia in high-risk vascular surgery patients.
METHODS: Seventy-five patients were randomly assigned to receive tight heart rate (HR) control by a continuous infusion of: esmolol in combination with the PDE III inhibitor enoximone (esmolol+enoximone group), esmolol infusion alone (esmolol group), or standard therapy (control group) for a period of 48 h. Myocardial ischaemia and dysfunction were detected by serial plasma Troponin T (TnT) and B-type natriuretic peptide (BNP) measurements.
RESULTS: Cardiac index (CI) increased significantly only in esmolol+enoximone-treated patients [CI: from 2.4 (0.2) litre min(-1) m(-2) at baseline to 3.2 (0.2) litre min(-1) m(-2) at 24 h after surgery; P=0.001] and was significantly higher than in the esmolol [CI: from 2.5 (0.2) litre min(-1) m(-2) at baseline to 2.6 (0.2) litre min(-1) m(-2) at 24 h; P=0.18] and the control groups [CI: from 2.4 (0.2) litre min(-1) m(-2) at baseline to 2.7 (0.2) litre min(-1) m(-2) at 24 h; P=0.13]. A significant postoperative release of TnT was detected only in control patients. Plasma BNP levels increased towards the end of surgery in all patients. Peak plasma BNP concentrations were significantly higher in control patients [293 (98) pg ml(-1)] than in esmolol [118 (71) pg ml(-1)] and in esmolol+enoximone-treated patients [78 (21) pg ml(-1)].
CONCLUSIONS: Inotropic therapy with the PDE III inhibitor enoximone combined with tight HR control by a continuous infusion of esmolol improved cardiac function and reduced myocardial ischaemia in high-risk vascular surgery patients. CLINICAL TRIAL REGISTRATION INFORMATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00348101.
Authors:
S Suttner; J Boldt; A Mengistu; K Lang; J Mayer
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Retracted Publication     Date:  2009-03-31
Journal Detail:
Title:  British journal of anaesthesia     Volume:  102     ISSN:  1471-6771     ISO Abbreviation:  Br J Anaesth     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-10     Completed Date:  2009-05-27     Revised Date:  2011-08-10    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  597-607     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany. suttner@gmx.de
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00348101
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / administration & dosage,  therapeutic use*
Aged
Aorta, Abdominal / surgery*
Cardiac Output / drug effects
Cardiotonic Agents / administration & dosage,  therapeutic use
Drug Administration Schedule
Drug Therapy, Combination
Enoximone / administration & dosage,  therapeutic use
Female
Humans
Intraoperative Complications / prevention & control
Male
Middle Aged
Myocardial Ischemia / prevention & control*
Perioperative Care / methods*
Phosphodiesterase 3 Inhibitors
Phosphodiesterase Inhibitors / administration & dosage,  therapeutic use*
Postoperative Complications / prevention & control*
Propanolamines / administration & dosage,  therapeutic use
Prospective Studies
Single-Blind Method
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Cardiotonic Agents; 0/Phosphodiesterase 3 Inhibitors; 0/Phosphodiesterase Inhibitors; 0/Propanolamines; 77671-31-9/Enoximone; 84057-94-3/esmolol
Comments/Corrections
Retraction In:
Reilly C. Br J Anaesth. 2011 Jul;107(1):116-7   [PMID:  21685126 ]

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