A pilot study of perioperative esmolol for myocardial protection during on-pump cardiac surgery

Abstract

The protective effects of preprocedural esmolol on myocardial injury and hemodynamics have not, to date, been investigated in patients who were scheduled for cardiac surgeries under a cardiopulmonary bypass (CPB). A pilot randomized controlled trial was performed at The First Affiliated Hospital of Dalian Medical University (Dalian, China). Patients scheduled for elective open-heart surgeries under CBP were included, and were randomized to esmolol and control groups. For patients in the esmolol groups, intravenous esmolol (70 µg/kg/min) was administered at the time of incision until CPB was performed. For patients assigned to the control group, equal volumes of 0.9% saline were administered. Markers of myocardial injury and hemodynamic parameters were observed until 12 h post surgery. A total of 24 patients were included in the present study. No significant differences in hemodynamic parameters, including the central venous pressure and heart rate, were detected between patients in the two groups during the perioperative period or within the first 12 h post-surgery (P>0.05), except for the mean arterial pressure, which was higher in the esmolol group compared with the control group at 5 and 12 h post-surgery (P<0.05). However, the serum level of cardiac troponin I was higher in patients of the control group compared with those of the esmolol group during the preoperative period (P<0.05). Although creatinine kinase was significantly different at T2 between the two groups, its MB isoenzyme was not significantly different between the groups (P>0.05). In addition, administration of esmolol was not associated with an increased risk for severe complications and adverse events in these patients. In conclusion, preoperative esmolol may be an effective and safe measure of myocardial protection for patients who undergo elective cardiac surgeries under CBP.

Meta-analysis of the benefit of beta-blockers for the reduction of isolated atrial fibrillation incidence after cardiac surgery

“…The final 21 papers were reviewed in full text, and the following were excluded due to the following reasons: 1 study did not have a control group, 6 1 study used sotalol as its study drug, 7 1 study did not segregate outcomes between isolated AF and other forms of SVT, 8 and 1 study focused on the combination therapy of b-blocker and magnesium. 9 Eventually, 17 RCTs, 5 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 fully satisfying our predefined inclusion criteria, were selected from papers published in varying years. Figure 1 is the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols flow chart of our study as per established 2009 guidelines.…”

“…Eleven trials only included patients who underwent coronary artery bypass grafting (CABG) surgery, 10 , 11 , 12 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 whereas 6 other trials included patients with a variety of surgeries (CABG and valve). 5 , 13 , 15 , 23 , 24 , 25 Study characteristics are summarized in Table 1 . According to the Jadad scale, overall risk of bias within RCTs was low because all studies scored 3 or more points ( Table 2 ).…”

“…The final 21 papers were reviewed in full text, and the following were excluded due to the following reasons: 1 study did not have a control group, 6 1 study used sotalol as its study drug, 7 1 study did not segregate outcomes between isolated AF and other forms of SVT, 8 and 1 study focused on the combination therapy of b-blocker and magnesium. 9 Eventually, 17 RCTs, 5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] fully satisfying our predefined inclusion criteria, were selected from papers published in varying years. Figure 1 The included studies were published between 1983 and 2020 and are from 9 different countries (United States, United Kingdom, Germany, Turkey, Austria, Japan, China, Brazil, Australia) ( Table 1).…”

“…Moreover, comorbidities were found in patients of 12 RCTs. 10,12,[14][15][16][17][20][21][22][23][24][25] We observed that patients with hypertension (n ¼ 288) were the most common in the b-blocker arm, followed by diabetes mellitus (n ¼ 164), hyperlipidemia (n ¼ 135), recent myocardial infarction (n ¼ 120), and chronic obstructive pulmonary disease (COPD) (n ¼ 5). With regards to the control arm, patients with hypertension (n ¼ 309) were the most common, followed by diabetes mellitus (n ¼ 168), hyperlipidemia (n ¼ 158), recent myocardial infarction (n ¼ 133), and COPD (n ¼ 4).…”

“…5,11,12,19 Starting dose of b-blocker was similarly varied. Among studies with IV administration, dosage ranged from <2 mg/kg/min (n ¼ 1), 5 2 mg/kg/min (n ¼ 4), 5,17,18,24 >2 mg/kg/min (n ¼ 5), 13,19,20,22,25 1 mg (n ¼ 1), 10 and <50 mg/d (n ¼ 1). 23 In contrast, with regards to oral administration, dosage ranged from<50 mg/d (n ¼ 1), 11 50 mg/d (n ¼ 2), 14,16 and >50 mg/d (n ¼ 3).…”