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Perioperatif Beta Blokör Kullanılan Hastaların Beating Heart Yöntemi ile Yapılan Koroner Revaskülarizasyon Operasyonlarında Pankuronyum ve Vekuronyum Kullanımının Hemodinamik ve Biyokimyasal Olarak Karşılaştırılması

Yıl 2024, Cilt: 7 Sayı: 1, 1 - 11, 30.06.2024
https://doi.org/10.56728/dustad.1399038

Öz

Bu çalışmada preoperatif oral yolla metoprolol alan, atan kalpte koroner arter bypass ameliyatları (Beating heart-CABG) sırasında kas gevşetici olarak vekuronyum veya pankuronyum kullanılan hastalarda, intraoperatif iv yolla metoprolol uygulanmasının, hemodinami ve kardiyak enzimler üzerine etkilerinin incelenmesi amaçlandı. Çalışmaya 23 hasta dahil edildi. Tüm hastalarda kalp hızı (HR), sistolik ve diyastolik arter basıncı (sırasıyla SAB, DAB), santral venöz basınç (CVP), pulmoner arter basıncı (PAB), kardiyak indeks (CI), atım volümü (SV), sol ventrikül atım iş indeksi (LVSWI), sağ ventrikül atım iş indeksi (RVSWİ), pulmoner vasküler rezistans (PVR), sistemik vasküler rezistans (SVR) perioperatif dönemde izlendi. Grup V vekuronyum, Grup P pankuronyum grubu idi. Preoperatif oral, anastomoz öncesi ise iv yolla metoprolol uygulandı. İki grup arasında SAB, DAB, CI, SVI, LVSWI, RVSWI, SVR, PVR ler arasında aynı dönemlerde anlamlı fark bulunmadı (p>0,05). Her iki grupta metoprolol ile anastomoz başlangıcında HR, SAB, DAB, CI azaldı. İntraoperatif toplam metoprolol dozları Grup V’ de (11.5± 6.3 mg), Grup P‘ye (21.7±8.7) göre düşük bulundu (p<0,01). İki grupta da periperatif miyokardiyal iskemi, aritmi gelişmedi. Beating heart-CABG ameliyatlarında intraoperatif iv yolla metoprolol uygulaması, vekuronyum veya pankuronyumun kullanıldığı hasta gruplarında benzer hemodinamik değişikliğe yol açmıştır. Ancak metoprolol gereksiniminin daha düşük olması nedeniyle vekuronyum kullanımı daha uygun görünmektedir.

Etik Beyan

Yazarlar arası çıkar çatışması yoktur.

Kaynakça

  • Androshchuk, V., Sabharwal, N., St Noble, V., & Kelion, A. (2021). Speeding up beta-blockade prior to coronary CT angiography: can we predict the dose of intravenous metoprolol required to achieve target heart rate in a given patient?. Clinical radiology, 76(3), 236.e21–236.e25. https://doi.org/10,1016/j.crad.2020,09.026
  • Barth, C., Ojile, M., Pearson, A. C., & Labovitz, A. J. (1991). Ultra short-acting intravenous beta-adrenergic blockade as add-on therapy in acute unstable angina. American Heart Journal, 121(3 Pt 1), 782–788. https://doi.org/10,1016/0002-8703(91)90189-o
  • Cronnelly, R., Fisher, D. M., Miller, R. D., Gencarelli, P., Nguyen-Gruenke, L., & Castagnoli, N., Jr (1983). Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC45) and pancuronium in anesthetized humans. Anesthesiology, 58(5), 405–408. https://doi.org/10,1097/00000542-198305000-00002
  • De Oliveira Jr, M. T., Baptista, R., Chavez-Leal, S. A., & Bonatto, M. G. (2024). Heart failure management with β-blockers: can we do better?. Current Medical Research and Opinion, 40(sup1), 43–54. https://doi.org/10,1080/03007995.2024.2318002
  • Egstrup, K., & Andersen Jr, P. E. (1993). Transient myocardial ischemia during nifedipine therapy in stable angina pectoris, and its relation to coronary collateral flow and comparison with metoprolol. The American Journal of Cardiology, 71(2), 177–183. https://doi.org/10,1016/0002-9149(93)90735-u
  • Pamir, G., & Candan, İ. (1992). Kronik konjestif kalp yetmezliği tedavisi. Türkiye Klinikleri J Med Sci, 12(2),128-38.
  • Karzai, W., Günnicker, M., Vorgrimler-Karzai, U. M., Freund, U., & Zerkowski, H. R. (1994). The effects of beta-adrenoreceptor blockade on oxygen consumption during cardiopulmonary bypass. Anesthesia and Analgesia, 79(1), 19–22. https://doi.org/10,1213/00000539-199407000-00005
  • Kayaalp, S. O. (Ed). (1995). Beta-adrenerjik reseptör blokerleri. Rasyonel tedavi yönünden tıbbi farmakoloji. Feryal Matbaacılık.
  • Kirshenbaum, J. M., Kloner, R. F., McGowan, N., & Antman, E. M. (1988). Use of an ultrashort-acting beta-receptor blocker (esmolol) in patients with acute myocardial ischemia and relative contraindications to beta-blockade therapy. Journal of the American College of Cardiology, 12(3), 773–780, https://doi.org/10,1016/0735-1097(88)90320-8
  • Kloner, R. A., & Chaitman, B. (2017). Angina and Its Management. Journal of Cardiovascular Pharmacology and Therapeutics, 22(3), 199–209. https://doi.org/10,1177/1074248416679733
  • Kloner, R. A., Fishbein, M. C., Cotran, R. S., Braunwald, E., & Maroko, P. R. (1977). The effect of propranolol on microvascular injury in acute myocardial ischemia. Circulation, 55(6), 872–880, https://doi.org/10,1161/01.cir.55.6.872
  • Kobori, M., Mouri, Y., Shida, K., & Hosoyamada, A. (1993). Masui. The Japanese Journal of Anesthesiology, 42(9), 1324–1329.
  • Marchetti, G., Merlo, L., & Noseda, V. (1968). Myocardial uptake of free fatty acids and carbohydrates after beta adrenergic blockade. The American Journal of Cardiology, 22(3), 370–374. https://doi.org/10,1016/0002-9149(68)90121-5
  • Marie, P. Y., Zannad, F., Parisot, M., & Royer, R. J. (1989). Role of ancillary properties of beta-adrenoceptor antagonists in protecting the heart from anoxia. European Journal of Pharmacology, 163(2-3), 337–343. https://doi.org/10,1016/0014-2999(89)90203-3
  • Maroko, P. R., Libby, P., & Braunwald, E. (1973). Effect of pharmacologic agents on the function of the ischemic heart. The American Journal of Cardiology, 32(7), 930–936. https://doi.org/10,1016/s0002-9149(73)80160-2
  • McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., … Ponikowski, P. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal, 33(14), 1787–1847. https://doi.org/10,1093/eurheartj/ehs104
  • Mueller, H. S., & Ayres, S. M. (1977). The role of propranolol in the treatment of acute myocardial infarction. Progress in Cardiovascular Diseases, 19(5), 405–412. https://doi.org/10,1016/0033-0620(77)90018-4
  • Mueller, H. S., & Ayres, S. M. (1980). Propranolol decreases sympathetic nervous activity reflected by plasma catecholamines during evolution of myocardial infarction in man. The Journal of Clinical Investigation, 65(2), 338–346. https://doi.org/10,1172/JCI109677
  • Novitzky, D., & Boswell, B. B. (2000). Total myocardial revascularization without cardiopulmonary bypass utilizing computer-processed monitoring to assess cerebral perfusion. The Heart Surgery Forum, 3(3), 198–202.
  • O'Connor, J. P., Ramsay, J. G., Wynands, J. E., Ralley, F. E., Casey, W. F., Smith, C. E., … Sami, M. H. (1989). The incidence of myocardial ischemia during anesthesia for coronary artery bypass surgery in patients receiving pancuronium or vecuronium. Anesthesiology, 70(2), 230–236. https://doi.org/10,1097/00000542-198902000-00009
  • Opie, L. H., & Thomas, M. (1976). Propranolol and experimental myocardial infarction: substrate effects. Postgraduate Medical Journal, 52(4), 124-132.
  • Paulissian, R., Mahdi, M., Joseph, N. J., Salem, M. R., Pavlovich, B., & Crystal, G. J. (1991). Hemodynamic responses to pancuronium and vecuronium during high-dose fentanyl anesthesia for coronary artery bypass grafting. Journal of Cardiothoracic and Vascular Anesthesia, 5(2), 120–125. https://doi.org/10,1016/1053-0770(91)90322-k
  • Sivaprakasam, M. C., Veldtman, G. R., Salmon, A. P., Cope, R., Pierce, T., & Vettukattil, J. J. (2006). Esmolol-assisted balloon and stent angioplasty for aortic coarctation. Pediatric Cardiology, 27(4), 460–464. https://doi.org/10,1007/s00246-006-1287-2
  • Slogoff, S., & Keats, A. S. (1985). Does perioperative myocardial ischemia lead to postoperative myocardial infarction?. Anesthesiology, 62(2), 107–114. https://doi.org/10,1097/00000542-198502000-00002
  • Stone, J. G., Foëx, P., Sear, J. W., Johnson, L. L., Khambatta, H. J., & Triner, L. (1998). Myocardial ischemia in untreated hypertensive patients: effect of a single small oral dose of a beta-adrenergic blocking agent. Anesthesiology, 68(4), 495-500.
  • Tekin, E. E., Yeşiltaş, M. A., & Haberal, İ. (2022). Short-term results of ivabradine versus metoprolol: The effects on atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. Braz J Cardiovasc Surg, 37(6), 857-865. doi: 10,21470/1678-9741-2021-0201
  • Virmani, S., Mallik, I., Mohire, V. B., Geelani, M. A., & Minhas, H.S. (2023). Effect of preoperative ivabradine on hemodynamics during elective off-pump CABG. Ann Card Anaesth, 26(3), 260-267. doi: 10,4103/aca.aca_97_22
  • Welman, E. (1979). Stabilization of lysosomes in anoxic myocardium by propranolol. British Journal of Pharmacology, 65(3), 479–482. https://doi.org/10,1111/j.1476-5381.1979.tb07854.x
  • Zmudka, K., Dubiel, J., Vanhaecke, J., Flameng, W., & De Geest, H. (1994). Intravenous metoprolol preceding thrombolysis in acute thrombotic myocardial infarction in the dog; effects on infarct size, myocardial blood flow, and left ventricular function. J Cardiovasc Pharmacol, 24(1), 78-86. doi: 10,1097/00005344-199407000-00014.

Hemodynamic and Biochemical Comparison of the Use of Pancuronium and Vecuronium in Coronary Revascularization Operations Performed with the Beating Heart Method in Patients Using Perioperative Beta Blockers

Yıl 2024, Cilt: 7 Sayı: 1, 1 - 11, 30.06.2024
https://doi.org/10.56728/dustad.1399038

Öz

The aim of this study was to investigate the effects of preoperative oral and intraoperative administration of metoprolol on hemodynamics and cardiac enzymes in patients using vecuronium or pancuronium as muscle relaxants during beating heart coronary artery bypass surgery. 23 patients were included in the study. In all patients, heart rate (HR), systolic and diastolic arterial pressure (SAP, DAP, respectively), central venous pressure (CVP), pulmonary arterial pressure (PAP), cardiac index (CI), stroke volume (SV), left ventricular stroke work index (LVSWI), right ventricular stroke work index (RVWWI), pulmonary vascular resistance (PVR), and systemic vascular resistance (SVR) were monitored in the perioperative period. Group V was the vecuronium group and group P was the pancuronium group. Metoprolol was administered orally preoperatively and intravenously before anastomosis. There was no significant difference between the two groups in SAB, DAB, CI, SVI, LVSWI, RVSWI, SVR, PVR in the same periods (p>0,05). HR, SAB, DAB, CI decreased at the beginning of anastomosis with metoprolol in both groups. The intraoperative total metoprolol doses were found to be lower in Group V (11.5± 6.3 mg) than in Group P (21.7±8.7) (p<0,01). Perioperative myocardial ischemia or arrhythmia did not occur in either group. Intraoperative intravenous administration of metoprolol in beating heart-CABG surgeries cresulted in similar hemodynamic changes in the groups of patients in whom vecuronium or pancuronium was used. However, the use of vecuronium appears to be more appropriate because of the lewer metoprolol requirements.

Kaynakça

  • Androshchuk, V., Sabharwal, N., St Noble, V., & Kelion, A. (2021). Speeding up beta-blockade prior to coronary CT angiography: can we predict the dose of intravenous metoprolol required to achieve target heart rate in a given patient?. Clinical radiology, 76(3), 236.e21–236.e25. https://doi.org/10,1016/j.crad.2020,09.026
  • Barth, C., Ojile, M., Pearson, A. C., & Labovitz, A. J. (1991). Ultra short-acting intravenous beta-adrenergic blockade as add-on therapy in acute unstable angina. American Heart Journal, 121(3 Pt 1), 782–788. https://doi.org/10,1016/0002-8703(91)90189-o
  • Cronnelly, R., Fisher, D. M., Miller, R. D., Gencarelli, P., Nguyen-Gruenke, L., & Castagnoli, N., Jr (1983). Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC45) and pancuronium in anesthetized humans. Anesthesiology, 58(5), 405–408. https://doi.org/10,1097/00000542-198305000-00002
  • De Oliveira Jr, M. T., Baptista, R., Chavez-Leal, S. A., & Bonatto, M. G. (2024). Heart failure management with β-blockers: can we do better?. Current Medical Research and Opinion, 40(sup1), 43–54. https://doi.org/10,1080/03007995.2024.2318002
  • Egstrup, K., & Andersen Jr, P. E. (1993). Transient myocardial ischemia during nifedipine therapy in stable angina pectoris, and its relation to coronary collateral flow and comparison with metoprolol. The American Journal of Cardiology, 71(2), 177–183. https://doi.org/10,1016/0002-9149(93)90735-u
  • Pamir, G., & Candan, İ. (1992). Kronik konjestif kalp yetmezliği tedavisi. Türkiye Klinikleri J Med Sci, 12(2),128-38.
  • Karzai, W., Günnicker, M., Vorgrimler-Karzai, U. M., Freund, U., & Zerkowski, H. R. (1994). The effects of beta-adrenoreceptor blockade on oxygen consumption during cardiopulmonary bypass. Anesthesia and Analgesia, 79(1), 19–22. https://doi.org/10,1213/00000539-199407000-00005
  • Kayaalp, S. O. (Ed). (1995). Beta-adrenerjik reseptör blokerleri. Rasyonel tedavi yönünden tıbbi farmakoloji. Feryal Matbaacılık.
  • Kirshenbaum, J. M., Kloner, R. F., McGowan, N., & Antman, E. M. (1988). Use of an ultrashort-acting beta-receptor blocker (esmolol) in patients with acute myocardial ischemia and relative contraindications to beta-blockade therapy. Journal of the American College of Cardiology, 12(3), 773–780, https://doi.org/10,1016/0735-1097(88)90320-8
  • Kloner, R. A., & Chaitman, B. (2017). Angina and Its Management. Journal of Cardiovascular Pharmacology and Therapeutics, 22(3), 199–209. https://doi.org/10,1177/1074248416679733
  • Kloner, R. A., Fishbein, M. C., Cotran, R. S., Braunwald, E., & Maroko, P. R. (1977). The effect of propranolol on microvascular injury in acute myocardial ischemia. Circulation, 55(6), 872–880, https://doi.org/10,1161/01.cir.55.6.872
  • Kobori, M., Mouri, Y., Shida, K., & Hosoyamada, A. (1993). Masui. The Japanese Journal of Anesthesiology, 42(9), 1324–1329.
  • Marchetti, G., Merlo, L., & Noseda, V. (1968). Myocardial uptake of free fatty acids and carbohydrates after beta adrenergic blockade. The American Journal of Cardiology, 22(3), 370–374. https://doi.org/10,1016/0002-9149(68)90121-5
  • Marie, P. Y., Zannad, F., Parisot, M., & Royer, R. J. (1989). Role of ancillary properties of beta-adrenoceptor antagonists in protecting the heart from anoxia. European Journal of Pharmacology, 163(2-3), 337–343. https://doi.org/10,1016/0014-2999(89)90203-3
  • Maroko, P. R., Libby, P., & Braunwald, E. (1973). Effect of pharmacologic agents on the function of the ischemic heart. The American Journal of Cardiology, 32(7), 930–936. https://doi.org/10,1016/s0002-9149(73)80160-2
  • McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., … Ponikowski, P. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal, 33(14), 1787–1847. https://doi.org/10,1093/eurheartj/ehs104
  • Mueller, H. S., & Ayres, S. M. (1977). The role of propranolol in the treatment of acute myocardial infarction. Progress in Cardiovascular Diseases, 19(5), 405–412. https://doi.org/10,1016/0033-0620(77)90018-4
  • Mueller, H. S., & Ayres, S. M. (1980). Propranolol decreases sympathetic nervous activity reflected by plasma catecholamines during evolution of myocardial infarction in man. The Journal of Clinical Investigation, 65(2), 338–346. https://doi.org/10,1172/JCI109677
  • Novitzky, D., & Boswell, B. B. (2000). Total myocardial revascularization without cardiopulmonary bypass utilizing computer-processed monitoring to assess cerebral perfusion. The Heart Surgery Forum, 3(3), 198–202.
  • O'Connor, J. P., Ramsay, J. G., Wynands, J. E., Ralley, F. E., Casey, W. F., Smith, C. E., … Sami, M. H. (1989). The incidence of myocardial ischemia during anesthesia for coronary artery bypass surgery in patients receiving pancuronium or vecuronium. Anesthesiology, 70(2), 230–236. https://doi.org/10,1097/00000542-198902000-00009
  • Opie, L. H., & Thomas, M. (1976). Propranolol and experimental myocardial infarction: substrate effects. Postgraduate Medical Journal, 52(4), 124-132.
  • Paulissian, R., Mahdi, M., Joseph, N. J., Salem, M. R., Pavlovich, B., & Crystal, G. J. (1991). Hemodynamic responses to pancuronium and vecuronium during high-dose fentanyl anesthesia for coronary artery bypass grafting. Journal of Cardiothoracic and Vascular Anesthesia, 5(2), 120–125. https://doi.org/10,1016/1053-0770(91)90322-k
  • Sivaprakasam, M. C., Veldtman, G. R., Salmon, A. P., Cope, R., Pierce, T., & Vettukattil, J. J. (2006). Esmolol-assisted balloon and stent angioplasty for aortic coarctation. Pediatric Cardiology, 27(4), 460–464. https://doi.org/10,1007/s00246-006-1287-2
  • Slogoff, S., & Keats, A. S. (1985). Does perioperative myocardial ischemia lead to postoperative myocardial infarction?. Anesthesiology, 62(2), 107–114. https://doi.org/10,1097/00000542-198502000-00002
  • Stone, J. G., Foëx, P., Sear, J. W., Johnson, L. L., Khambatta, H. J., & Triner, L. (1998). Myocardial ischemia in untreated hypertensive patients: effect of a single small oral dose of a beta-adrenergic blocking agent. Anesthesiology, 68(4), 495-500.
  • Tekin, E. E., Yeşiltaş, M. A., & Haberal, İ. (2022). Short-term results of ivabradine versus metoprolol: The effects on atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. Braz J Cardiovasc Surg, 37(6), 857-865. doi: 10,21470/1678-9741-2021-0201
  • Virmani, S., Mallik, I., Mohire, V. B., Geelani, M. A., & Minhas, H.S. (2023). Effect of preoperative ivabradine on hemodynamics during elective off-pump CABG. Ann Card Anaesth, 26(3), 260-267. doi: 10,4103/aca.aca_97_22
  • Welman, E. (1979). Stabilization of lysosomes in anoxic myocardium by propranolol. British Journal of Pharmacology, 65(3), 479–482. https://doi.org/10,1111/j.1476-5381.1979.tb07854.x
  • Zmudka, K., Dubiel, J., Vanhaecke, J., Flameng, W., & De Geest, H. (1994). Intravenous metoprolol preceding thrombolysis in acute thrombotic myocardial infarction in the dog; effects on infarct size, myocardial blood flow, and left ventricular function. J Cardiovasc Pharmacol, 24(1), 78-86. doi: 10,1097/00005344-199407000-00014.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Anesteziyoloji
Bölüm Makaleler
Yazarlar

Halide Oğuş 0000-0002-6541-957X

Tuncer Koçak 0000-0002-6428-8694

Yayımlanma Tarihi 30 Haziran 2024
Gönderilme Tarihi 4 Aralık 2023
Kabul Tarihi 10 Haziran 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 7 Sayı: 1

Kaynak Göster

APA Oğuş, H., & Koçak, T. (2024). Perioperatif Beta Blokör Kullanılan Hastaların Beating Heart Yöntemi ile Yapılan Koroner Revaskülarizasyon Operasyonlarında Pankuronyum ve Vekuronyum Kullanımının Hemodinamik ve Biyokimyasal Olarak Karşılaştırılması. Dünya Sağlık Ve Tabiat Bilimleri Dergisi, 7(1), 1-11. https://doi.org/10.56728/dustad.1399038