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KMID : 0350519950480020461
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Journal of Catholic Medical College
1995 Volume.48 No. 2 p.461 ~ p.473
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The Effect of Esmolol Combined with Nitroglycerin on Cardiac Hemodynamics and Myocardial Oxygen Balance during Cross- Clamping of Thoracic Aorta in Induced Ischemic Canine Heart
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Abstract
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Survival rate of the elective aortic reconstruction to treat either aneurysmal or occlusive disease has been improved by the advances of surgical technique and anesthetic management. However, several preoperative conditions such as ischemic heart
disease, pulmonary disease, diabetes mellitus, and renal disease remain as majon factors increasing perioperative mortality of major vascular surgery.
The volume shifts and hemodynamic derangements that occur upon application of an aortic crossclamping are particularly stressful to the patient with ischemic heart disease. So the prevention of myocardial damage from surgical stress during
operation is
prime importance for management of anesthesia.
The purpose of this study is to investigate the effect of esmolol during cross-clamping of descending thoracic aorta on the ischemic myocardium induced by the ligation of the left anterior descending coronary artery (LAD) in dogs.
The effect of esmolol was evaluated by hemodynamic parameters, the oxygen content and lactate level of coronary circuiation.
LAD was ligated for 15 min followed by reperfusion. Nitroglycerin with or without esmolol were continuously infused throughout the procedure after reperfusion and the thoracic aorta was crossclamped for 45 mins. Eighteen dogs were divided into
three
groups ; group C-no drug administered, group N-nitroglycerin (5 ㎍/kg/mil)+esmolol (0.5 mg/kg as loading dose following 50㎍/kg/min as maintenance dose).
Heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac index (CI), left ventricular stroke work index (LVSWI), pulmonary capillary wedge pressure (PCWP), triple index (TI), mixed venous oxygen tension of great cardiac vein
(PgvO2),
Ca-vDO2 (carotid arterial oxygen content-great cardiac vein oxygen content) and lactate were measured three times in each group ; before ligation of LAD (stage 1) 15 minutes after LAD ligation (stage 2) and 45 minutes after cross-clamping of
descending
thoracic aorta (stage 3).
@ES The results were as follows :
@EN 1. HR of group NE at stage 3 was significantly low compared with group C and group N. A significant change was observed between group C and group N as well (P<0.05).
2. MAP of group NE at stage 3 was significantly high compared with group C but low compared with group N (P<0.05).
3. SV of group NE at stage 3 was significantly high compared with group C and group N. A significant change was also observed between group C and group N (P<0.05).
4. CI of group NE at stage 3 was significantly high compared with group C but not significantly high compared with group N (P<0.05).
5. LVSWI of group NE at stage 3 was significantly high compared with group C but not significantly high compared with group N (P<0.05).
6. PCWP of group NE at stage 3 was significantly low compared with group C and group N. A significant change was also observed between group C and group N P(<0.05).
7. TI of group NE at stage 3 was significantly low compared with group C and group N, but no significant change was observed between group C and group N (P<0.05).
8. PgvO2 of group NE at stage 3 was significantly high compared with group C but not significantly high compared with group N (P<0.05).
9. Ca-vDO2 of group NE at stage 3 was significantly low compared with group C and group N, but no significant change was observed between group C and group N (P<0.05).
10. Lactate level of group NE at stage 3 was significantly low compared with group C and group N. A significant change was also observed between group C and group N (P<0.05).
These results suggest that esmolo could protect ischemic myocardium from progressive damage via reduction of myocardial oxygen consumption without decrease of cardiac output and left ventricular stroke work index.
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KEYWORD
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