Postoperative haemodynamic and pharmacological responses in patients with positive technetium pyrophosphate...

The aim of this prospective study was to evaluate the postoperative haemodynamic variables and medication requirements in patients with perioperative myocardial infarction (PMI), following elective coronary artery bypass graft (CABG) surgery, as documented by technetium pyrophosphate scintigraphy using single-photon emission computed tomography (TcPPi-SPECT). A high-dose fentanyl anaesthetic technique was applied. Twelve of 58 patients (21%) developed PMI with an infarcted myocardial mass of 35.7 +/- 3.9 g. Over the 48 hr postoperative period, patients with positive TcPPi-SPECT (n = 12) did not differ from those with negative TcPPi-SPECT (n = 46) in mean heart rate (below 100 bpm), systolic blood pressure (100-120 mmHg) or central venous pressure (8-16 mmHg). However, patients with positive TcPPi-SPECT had higher pulmonary artery diastolic pressures at 5-8 hr after surgery. No differences were found in the incidence and dosage requirements for postoperative sedative or vasoactive drugs (morphine, diazepam, propranolol, lidocaine, nitroglycerin and nitroprusside) between the two groups. There was no difference in the incidence of dopamine requirement between the groups (positive-scan: 16.7%, negative-scan: 13.0%). However, the dopamine dosage for inotropic support was higher in the positive TcPPi-SPECT group over 24 hr (318.5 +/- 125.2 mg vs 71.2 +/- 24.7 mg, P less than 0.05) and 48 hr (869.1 +/- 19.0 mg vs 142.3 +/- 49.4 mg, P less than 0.001) periods after surgery. We postulate that careful control of postoperative haemodynamic variables did not prevent but may limit the extent of PMI in elective CABG patients.