Esmolol in Cardiac Surgery: A Randomized Controlled Trial

Zangrillo, Alberto; Bignami, Elena; Noe', Beatrice; Nardelli, Pasquale; Licheri, Margherita; Gerli, Chiara; Crivellari, Martina; Oriani, A.; Prima, Ambra Licia Di; Fominskiy, Evgeny; Tomasso, Nora Di; Lembo, Rosalba; Landoni, Giovanni; Crescenzi, Giuseppe; Monaco, Fabrizio

doi:10.1053/j.jvca.2020.12.029

Cited by 9 publications

(7 citation statements)

References 28 publications

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“…Esmolol is a highly selective β1 receptor blocker with short half-life, which can be pumped drip. It has the advantages of rapid onset, good tolerance and easy regulation, which is the most commonly used preparation in critical care medicine (Alberto, et al, 2021). Considering the negative inotropic effect of β-receptor, it can reduce myocardial contractility and cardiac output, which has the potential risk of further aggravating shock.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Esmolol for Septic Shock: A Systematic Review and Meta-analysis of Randomized Controlled Trials

et al. 2021

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Purpose: The meta-analysis aims to identify whether septic shock patients can benefit from esmolol.Materials and Methods: The relevant studies from MEDLINE, Cochrane Library, Embase were searched by two independent investigators using a variety of keywords. Stata software (version 12.0, Stata Corp LP, College Station, TX, United States)was used for statistical analysis.Results: A total of 14 studies were identified and incorporated into the meta-analysis. For overall analysis, the treatment of esmolol was associated with decreased 28-day mortality (RR = 0.66, 95% CI = 0.56–0.77, p < 0.001). Meanwhile, our analysis found that, esmolol could decrease HR (SMD: −1.70; 95% CI: [−2.24−(−1.17)], cTnI (SMD: −1.61; 95% CI: [−2.06−(−1.16)] compared with standard treatment. No significant differences between the two groups were found in MAP, Lac, CI, and SVI.Conclusion: The findings of this meta-analysis intend to demonstrate that septic shock patients with high heart beats rate might be benefit from esmolol treatment despite enough fluid resuscitation. While, dependent on the study published, with the further development of septic shock, the positive impact of esmolol varies. The appropriate heart rate change interval cannot be confirmed, further high-quality and large-scale RCTs should be performed to verify it and screening more suitable heart rate levels.Systematic Review Registration: CRD42021239513

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Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Esmolol for Septic Shock: A Systematic Review and Meta-analysis of Randomized Controlled Trials

et al. 2021

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“…The efficacy of esmolol has been demonstrated in clinical practice in the treatment of supraventricular arrhythmias and perioperative tachycardia and hypertension [ 24 ]. In the literature, we found that esmolol has cardioprotective effects in a number of settings (acute myocardial infarction, during cardioplegic cardiac arrest and after cardiopulmonary bypass) [ 15 , 25 ] but not in cardiovascular remodeling. Our group demonstrated vascular protection by esmolol in an animal model of arterial hypertension and coronary damage and its persistence after discontinuation of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Esmolol is an ultrashort-acting cardioselective β-adrenergic receptor antagonist with a different pharmacokinetic profile from that of classic β-blockers [ 14 ]. Esmolol has a cardioprotective effect [ 15 ]. In clinical practice, esmolol decreases myocardial ischemia [ 16 ], and, in preclinical studies, it increases nitric oxide bioavailability and reduces asymmetric dimethylarginine (ADMA) concentration in plasma (both related to vascular remodeling) [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Maintenance over Time of the Effect Produced by Esmolol on the Structure and Function of Coronary Arteries in Hypertensive Heart Diseases

et al. 2022

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We previously observed that esmolol treatment for 48 h reduced vascular lesions in spontaneously hypertensive rats (SHRs). Therefore, we investigated whether this beneficial effect is persistent after withdrawal. Fourteen-month-old SHRs (SHR-Es) were treated with esmolol (300 μg/kg/min) or a vehicle for 48 h. Two separate groups were also given identical treatment, but they were then monitored for a further 1 week and 1 month after drug withdrawal. We analyzed the geometry and composition of the coronary artery, vascular reactivity and plasma redox status. Esmolol significantly decreased wall thickness (medial layer thickness and cell count), external diameter and cross-sectional area of the artery, and this effect persisted 1 month after drug withdrawal. Esmolol significantly improved endothelium-dependent relaxation by ACh (10−9–10−4 mol/L); this effect persisted 1 week (10−9–10−4 mol/L) and 1 month (10−6–10−4 mol/L) after withdrawal. Esmolol reduced the contraction induced by 5-HT (3 × 10−8–3 × 10−5 mol/L), and this effect persisted 1 week after withdrawal (10−6–3 × 10−5 mol/L). Esmolol increased nitrates and reduced glutathione, and it decreased malondialdehyde and carbonyls; this enhancement was maintained 1 month after withdrawal. This study shows that the effect of esmolol on coronary remodeling is persistent after treatment withdrawal in SHRs, and the improvement in plasma oxidative status can be implicated in this effect.

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“…It was further suggested that esmolol could be effective for myocardial protection in hypertrophied hearts by reducing myocardial oxygen metabolism [ 120 ]. In another randomized single-centre trial, esmolol was used as adjunct to high K + cardioplegia and it enhanced postoperative cardiac performance and reduced the postoperative troponin leakage in high-risk patients undergoing elective cardiac surgery [ 121 , 122 ]. In contrast, Rinne and colleagues showed that the addition of esmolol to blood cardioplegia did not increase the efficacy of cardioprotection in unstable patients during urgent coronary revascularization [ 123 ].…”

Section: Polarized Arrest As a Clinical Alternativementioning

confidence: 99%

Cardioplegia between Evolution and Revolution: From Depolarized to Polarized Cardiac Arrest in Adult Cardiac Surgery

Francica

Tonelli

Rossetti

et al. 2021

JCM

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Despite current advances in perioperative care, intraoperative myocardial protection during cardiac surgery has not kept the same pace. High potassium cardioplegic solutions were introduced in the 1950s, and in the early 1960s they were soon recognized as harmful. Since that time, surgeons have minimized many of the adverse effects by lowering the temperature of the heart, lowering K+ concentration, reducing contact K+ time, changing the vehicle from a crystalloid solution to whole-blood, adding many pharmacological protectants and modifying reperfusion conditions. Despite these attempts, high potassium remains a suboptimalway to arrest the heart. We briefly review the historical advances and failures of finding alternatives to high potassium, the drawbacks of a prolonged depolarized membrane, altered Ca2+ intracellular circuits and heterogeneity in atrial-ventricular K+ repolarization during reanimation. Many of these untoward effects may be alleviated by a polarized membrane, and we will discuss the basic science and clinical experience from a number of institutions trialling different alternatives, and our institution with a non-depolarizing adenosine, lidocaine and magnesium (ALM) cardioplegia. The future of polarized arrest is an exciting one and may play an important role in treating the next generation of patients who are older, and sicker with multiple comorbidities and require more complex operations with prolonged cross-clamping times.

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Esmolol in Cardiac Surgery: A Randomized Controlled Trial

Cited by 9 publications

References 28 publications

The Efficacy and Safety of Esmolol for Septic Shock: A Systematic Review and Meta-analysis of Randomized Controlled Trials

The Efficacy and Safety of Esmolol for Septic Shock: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Maintenance over Time of the Effect Produced by Esmolol on the Structure and Function of Coronary Arteries in Hypertensive Heart Diseases

Cardioplegia between Evolution and Revolution: From Depolarized to Polarized Cardiac Arrest in Adult Cardiac Surgery

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