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[Heart rate reduction using edrophonium during coronary artery bypass grafting without cardiopulmonary bypass]
K Kooguchi1, Y Maegawa, M Namba
1Department of Anesthesiology, Kyoto Prefectural University of Medicine.
Insights
Edrophonium effectively reduces heart rate for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB). This method aids high-risk patients by stabilizing the heart during anastomosis without causing significant hypotension.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is increasingly common.
- Beating heart surgery presents technical challenges, especially for high-risk patients.
- Existing heart rate-lowering drugs (beta-blockers, calcium-channel antagonists) can cause hypotension due to negative inotropic effects.
Purpose of the Study:
- To evaluate the efficacy of edrophonium in reducing heart rate (HR) during off-pump CABG in high-risk patients.
- To assess the hemodynamic effects of edrophonium, specifically its impact on systemic blood pressure (sBP) and cardiac index (CI).
Main Methods:
- A prospective study involving ten high-risk patients undergoing CABG without CPB.
- Edrophonium was administered during the anastomosis phase to control HR.
- Systemic blood pressure, heart rate, and cardiac index were monitored throughout the procedure.
Main Results:
- All surgeries were completed successfully without major complications.
- Edrophonium administration successfully reduced HR to below 60 bpm during anastomosis.
- Cardiac index decreased slightly from 2.19 to 1.95 L/min/m², while sBP remained stable above 90 mmHg with methoxamine infusion.
Conclusions:
- Edrophonium appears to be a safe and effective option for heart rate reduction in high-risk patients undergoing off-pump CABG.
- It facilitates myocardial stabilization during anastomosis without inducing significant hypotension, unlike other agents.
Abstract:
Coronary artery bypass grafting without the use of cardiopulmonary bypass (CPB) is performed with increasing frequency. Performing revascularization on a beating heart is technically more demanding than performing revascularization on the arrested heart, especially in high-risk patients. beta-Blockers and calcium-channel antagonists have been used for the reduction of heart rate (HR) for the local immobilization of the anastomotic site. However, their negative inotropic actions often lead to serious hypotension. Therefore, we investigated the effect of edrophonium on HR reduction in high-risk patients undergoing CABG without CPB. Ten high-risk patients undergoing CABG without CPB were selected. To reduce HR during anastomosis, edrophonium was administered during the procedure. Systemic blood pressure (sBP), HR, and cardiac index (CI) were measured from the induction of anesthesia to the end of surgery. All surgeries were successfully performed without serious complications. To keep the rate under 60 bpm, edrophonium was administered at the time of anastomosis and this decreased the cardiac index from 2.19 to 1.95, while the sPB was maintained easily over 90 mmHg with the infusion of methoxamine. Edrophonium may be useful for the reduction of HR during coronary anastomosis in high-risk patients undergoing CABG without CPB.