Pharmacologic support of the myocardium following aortocoronary bypass surgery: a comparative study

To evaluate the hemodynamic effects of simultaneous nitroglycerin and epinephrine infusion following aortocoronary bypass surgery, 16 patients were monitored and studied in the early postoperative period. All patients were given intravenous nitroglycerin, epinephrine, epinephrine combined with nitroglycerin, and dobutamine in a randomized manner. The dose of pharmacologic agent was gradually increased to achieve the required circulatory response. The measured variables included heart rate (HR), central venous pressure (CVP), arterial blood pressure (BP), pulmonary artery pressure (PA), pulmonary artery wedge pressure (PAWP), cardiac output, and arterial and venous oxygen saturations. A nitroglycerin infusion at 1.1 +/- 2 micrograms/kg/min caused the PAWP to decrease by 37% (P less than or equal to .005). All other parameters were not significantly different from control. Epinephrine at a dose of 0.06 +/- 0.02 micrograms/kg/min increased the mean blood pressure by 21% (P less than or equal to .005). The rate-pressure product (RPP) and PAWP were elevated by 18% and 12%, respectively (P less than or equal to .005). Cardiac index, however, was not increased. When nitroglycerin was added to the epinephrine infusion, a PAWP increase was not seen. Also the right ventricular stroke work index was increased by 23% (P less than or equal to .01), and the left ventricular stroke work index increased by 21% (P less than or equal to .01). Dobutamine 4.8 +/- 1.0 micrograms/kg/min caused ventricular stroke work indexes to increase significantly (P less than or equal to .005). The CVP and PAWP were unchanged with this mode of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)