Document Detail


Use of esmolol in hypertension after cardiac surgery.
MedLine Citation:
PMID:  2864849     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Systolic hypertension, which is common soon after cardiac surgery, increases cardiac work and may threaten fresh vascular anastomoses. Because postoperative hypertension is often associated with elevated catecholamines and preoperative use of beta-blocking agents, esmolol, an ultrashort-acting beta-blocking agent, was compared with nitroprusside in a crossover study in this setting. Twelve patients, 18 to 28 hours after cardiac surgery (coronary artery bypass graft in 9, aortic valve replacement in 2 and valved aortic conduit with reimplantation of coronary arteries in 1 patient) received controlled infusions of esmolol (mean dosage 142 +/- 100 micrograms/kg/min, range 50 to 300 micrograms/kg/min) and nitroprusside (mean dose 1.6 +/- 1.3 micrograms/kg/min, range 0.5 to 2.75 micrograms/kg/min). In this open-label study, choice of the first drug was randomized, after which patients were then crossed over to the other study drug. Therapeutic response (greater than or equal to 15% systolic blood pressure reduction) was achieved in 11 of 12 esmolol patients and 12 of 12 nitroprusside patients. Both drugs significantly lowered systolic and diastolic blood pressure, as well as left ventricular stroke work index. While the cardiac index was decreased by esmolol and increased by nitroprusside, neither drug significantly changed stroke volume index. Systemic vascular resistance, unchanged by esmolol, was decreased significantly by nitroprusside. Oxygen saturation and Pao2, unchanged with esmolol, were both significantly reduced with nitroprusside. Thus, for hypertension early after cardiac surgery, esmolol is safe, effective and rapid and, compared with nitroprusside, results in less unwanted decrease in diastolic blood pressure and oxygen saturation, but there is more decrease in heart rate and cardiac index.
Authors:
R J Gray; T M Bateman; L S Czer; C Conklin; J M Matloff
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The American journal of cardiology     Volume:  56     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1985 Oct 
Date Detail:
Created Date:  1985-11-19     Completed Date:  1985-11-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  49F-56F     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / adverse effects,  therapeutic use*
Adult
Aged
Drug Administration Schedule
Female
Heart Diseases / complications,  surgery*
Hemodynamics / drug effects
Humans
Hypertension / drug therapy*,  etiology
Male
Middle Aged
Nitroprusside / therapeutic use
Postoperative Complications
Propanolamines / adverse effects,  therapeutic use*
Random Allocation
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Propanolamines; 15078-28-1/Nitroprusside; 84057-94-3/esmolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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