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Protective effect of esmolol on myocardial ischemic injury during open heart surgery in children
Ping Gui1, Qingping Wu, Jing Wu
1Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Esmolol effectively protects children's hearts from ischemia during cardiac surgery. This beta-blocker reduces cardiac enzyme release and the need for inotropic drugs post-operation.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Pharmacology
Background:
- Esmolol, a beta-1 adrenoceptor blocker, is known to reduce myocardial injury in adult cardiac surgery.
- Its use in pediatric cardiac surgery is less common.
Purpose of the Study:
- To evaluate the myocardial protective effects of esmolol during pediatric cardiac surgery.
- To assess esmolol's efficacy in reducing ischemia-related injury in children undergoing cardiac procedures.
Main Methods:
- A randomized controlled trial involving 30 children with ventricular septal defect.
- Patients were assigned to receive either intravenous esmolol or a placebo during surgery.
- Esmolol was administered at specific doses during induction, cardiopulmonary bypass (CPB), and until surgery completion.
Main Results:
- Significantly lower plasma levels of creatine kinase-MB and cardiac troponin I were observed in the esmolol group.
- Heart rate was significantly lower in the esmolol group post-induction and during CPB.
- The esmolol group required significantly less postoperative dopamine compared to the control group.
Conclusions:
- Esmolol demonstrates significant myocardial protection against ischemic injury during cardiopulmonary bypass in pediatric patients.
- Esmolol administration can lead to a notable reduction in the requirement for inotropic drug support post-surgery.
Objectives:
To investigate the efficacy of esmolol in protecting the myocardium from ischemia during pediatric cardiac surgery.
Background:
Esmolol, an ultra-short acting beta 1-adrenoceptor blocker, reduces myocardial injury in adult cardiac operations. However, this technique is rarely used in pediatric cardiac surgery.
Methods:
Thirty children with ventricular septal defect were randomly allocated to the esmolol group and the control group. Patients received intravenous esmolol (0.05 mg·kg(-1) ·min(-1) after tracheal intubation, 0.3 mg·kg(-1) ·min(-1) during cardiopulmonary bypass (CPB) and 0.03-0.05 mg·kg(-1) ·min(-1) until the end of surgery) or placebo, respectively.
Results:
Plasma levels of creatine kinase-MB, cardiac troponin I in the esmolol group 2 min after completion of CPB, at the end of surgery, 4 h after surgery, and the first postoperative day were significantly lower than those in the control group. Values of heart rate 10 min after induction, 2 min before institution of CPB, 2 min after completion of CPB, and at the end of surgery were significantly lower in the esmolol group; however, mean arterial pressure, CPB time, cross-clamp time, and the rate of heart spontaneous rebeating were not statistically different between two groups. Cumulative postoperative dosage of dopamine in the esmolol group (100.1 ± 53.1 mg) was significantly less than that in the control group (171.4 ± 92.1 mg).
Conclusions:
Esmolol can protect the myocardium from ischemic injury during CPB in children and significantly reduce the use of inotropic drug.
