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Pharmacologic Support of the Myocardium Following Aortocoronary Bypass Surgery: A Comparative Study
Author(s) -
Balderman Samuel C.,
Aldridge Janerio
Publication year - 1986
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1002/j.1552-4604.1986.tb02930.x
Subject(s) - medicine , dobutamine , pulmonary wedge pressure , cardiac index , anesthesia , epinephrine , central venous pressure , cardiology , cardiac output , heart rate , blood pressure , hemodynamics
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 μg/kg/min caused the PAWP to decrease by 37% ( P .005). All other parameters were not significantly different from control. Epinephrine at a dose of 0.06 ± 0.02 μg/kg/min increased the mean blood pressure by 21% ( P .005). The rate‐pressure product (RPP) and PAWP were elevated by 18% and 12%, respectively ( P .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 .01), and the left ventricular stroke work index increased by 21% ( P .01). Dobutamine 4.8 ± 1.0 μg/kg/min caused ventricular stroke work indexes to increase significantly ( P .005). The CVP and PAWP were unchanged with this mode of therapy. Therefore, nitroglycerin is a drug of choice in patients with normotensive heart failure, since cardiac index can be maintained at lower filling pressures without increasing the myocardial oxygen consumption as reflected by the constant RPP. In the presence of hypotension, dobutamine, possibly combined with a vasodilator, or epinephrine and nitroglycerin combined are effective in improving function. Epinephrine infusion alone should be avoided in the presence of ischemic heart disease .