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Procaine is effective for minimizing postischemic ventricular fibrillation in cardiac surgery
O F Sellevold1, E M Berg, O W Levang
1Department of Anesthesia, University Hospital, St. Elisabeth Hospital for Cardiac Surgery, Trondheim, Norway.
Insights
Adding procaine hydrochloride to cardioplegia significantly reduced ventricular fibrillation after aortic declamping in cardiac surgery. This stabilization of postischemic rhythm in coronary artery bypass grafting (CABG) patients improved outcomes with no adverse effects.
Area of Science:
- Cardiology
- Cardiac Surgery
- Anesthesiology
Background:
- Postischemic ventricular fibrillation is a common complication after cardiac surgery.
- Stabilizing heart rhythm after aortic declamping is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the efficacy of procaine hydrochloride in cardioplegia for stabilizing postischemic rhythm during cardiac surgery.
- To assess the impact of procaine on the incidence of ventricular fibrillation and other arrhythmias after aortic declamping in coronary artery bypass grafting (CABG) procedures.
Main Methods:
- A randomized, double-blind study involving 56 patients undergoing CABG.
- Procaine hydrochloride (1 mM) was added to the cardioplegic solution (Plegisol) in the study group (n=28), while the control group (n=28) received saline.
- Ventricular fibrillation (VF) and other arrhythmias were monitored and treated post-aortic declamping.
Main Results:
- Significantly fewer patients in the procaine group required direct current (DC) shock for VF (7% vs. 100%, P < 0.001).
- The procaine group required less lidocaine for dysrhythmias (3.6 mg vs. 35.7 mg, P < 0.002) and fewer synchronized DC shocks for atrial fibrillation (P < 0.05).
- Lower enzyme release was observed in the procaine group on the first postoperative day (P < 0.05).
Conclusions:
- Procaine hydrochloride (1 mM) in cardioplegia effectively stabilizes postischemic rhythm in CABG surgery.
- The addition of procaine to cardioplegia reduces the incidence of ventricular fibrillation and improves overall rhythm stability.
- Procaine demonstrates a favorable safety profile with no observed adverse effects in this patient cohort.
Abstract:
Procaine hydrochloride was added to cardioplegia and studied for its efficacy in stabilizing the postischemic rhythm after aortic declamping in cardiac surgery. Fifty-six patients scheduled for coronary artery bypass grafting (CABG), were included in a randomized, double-blind study. The patients were anesthetized with isoflurane, low-dose fentanyl, diazepam, and pancuronium. In the study group (28 patients), St. Thomas' Hospital cardioplegic solution II (Plegisol) was prepared with 1 mM procaine. The control group (28 patients) was given the same cardioplegia with saline. Ventricular fibrillation (VF) occurring after declamping was treated with direct current (DC) shock (8-12-12-20 J). There were no significant differences with regard to demographic properties or anesthesiologic and surgical treatment. Two patients (7%) in the procaine group required DC shock for VF, compared to 28 (100%) in the control group (P < 0.001). The amount of lidocaine (mean +/- SEM) given for resistant dysrhythmias was 3.6 mg +/- 3.6 in the procaine group compared to 35.7 mg +/- 9.2 in the control group (P < 0.002). One patient in each group required temporary pacing. The number of synchronized DC shocks for conversion of atrial fibrillation was lower in the procaine group (P < 0.05). The enzyme release the first day after surgery was lower in the procaine group (P < 0.05). Procaine (1 mM) in cardioplegia stabilizes the postischemic rhythm in CABG surgery in humans without any observed adverse effects.