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Hemodynamic changes after nafcillin administration during coronary artery bypass surgery
P A Casthely1, M A Ergin, T Yoganathan
1Department of Anesthesiology, State University of New York Health Science Center, Brooklyn 11203.
Journal of Cardiothoracic Anesthesia
|April 1, 1989
Summary
Nafcillin bolus administration during coronary artery bypass grafting (CABG) caused significant hypotension and vasodilation. Slow infusion lessened these hemodynamic effects, while phenylephrine reversed them.
Area of Science:
- Cardiovascular Anesthesiology
- Pharmacology
- Cardiac Surgery
Background:
- Nafcillin is an antibiotic used perioperatively.
- Its hemodynamic effects during cardiac surgery are not well-defined.
- Patients undergoing coronary artery bypass grafting (CABG) have specific hemodynamic considerations.
Purpose of the Study:
- To investigate the hemodynamic response to intravenous nafcillin administration in patients undergoing CABG.
- To compare the effects of bolus versus slow infusion of nafcillin.
- To assess the impact on hemodynamic variables, histamine, and catecholamine levels.
Main Methods:
- 45 patients undergoing CABG were divided into three groups: IV bolus nafcillin, slow IV infusion nafcillin, and control.
- Hemodynamic parameters, plasma histamine, and catecholamines were measured.
- CaCl2 and phenylephrine were administered to assess responses.
Main Results:
- Bolus nafcillin caused significant hypotension and vasodilation, increasing cardiac index and decreasing vascular resistance.
- Slow infusion of nafcillin resulted in less pronounced hemodynamic changes.
- Plasma epinephrine, norepinephrine, and histamine levels increased by over 100% with bolus administration.
Conclusions:
- Intravenous nafcillin bolus administration can induce significant hemodynamic instability in CABG patients.
- Slow infusion may mitigate these adverse effects.
- Nafcillin administration is associated with increased histamine and catecholamine release.