Pretreatment with an adenosine A1 receptor agonist and lidocaine: A possible alternative to myocardial ischemic preconditioning

Canyon, Sarah; Dobson, Geoffrey P.

doi:10.1016/j.jtcvs.2004.12.052

Cited by 26 publications

(13 citation statements)

References 41 publications

(61 reference statements)

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“…In contrast, fifty-eight percent (58%) of saline controls died from ventricular fibrillation (Canyon and Dobson, 2004). In another study, the adenosine A 1 agonist 2-chloro-N6-cyclopentyladenosine (CCPA) was substituted for adenosine, and the CCPA-lidocaine combination showed remarkable infarct size reduction of over 80%, which was equivalent to that of ischemic preconditioning itself (Canyon and Dobson, 2005). In 2006, Canyon and Dobson showed using 31 P nuclear magnetic resonance (NMR) that the protective effects of AL constant infusion therapy were expressed as preservation of high-energy phosphates (ATP, PCr) in the area-at-risk of the left ventricle, and this was explained by a down-regulation of the myocardium during ischemia (Canyon and Dobson, 2006).…”

Section: Adenosine Lidocaine and Mg2+ (Alm™): A More Natural Way Tomentioning

confidence: 99%

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Dobson¹,

Faggian²,

Onorati³

et al. 2013

Front. Physiol.

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Despite surgical proficiency and innovation driving low mortality rates in cardiac surgery, the disease severity, comorbidity rate, and operative procedural difficulty have increased. Today's cardiac surgery patient is older, has a “sicker” heart and often presents with multiple comorbidities; a scenario that was relatively rare 20 years ago. The global challenge has been to find new ways to make surgery safer for the patient and more predictable for the surgeon. A confounding factor that may influence clinical outcome is high K+ cardioplegia. For over 40 years, potassium depolarization has been linked to transmembrane ionic imbalances, arrhythmias and conduction disturbances, vasoconstriction, coronary spasm, contractile stunning, and low output syndrome. Other than inducing rapid electrochemical arrest, high K+ cardioplegia offers little or no inherent protection to adult or pediatric patients. This review provides a brief history of high K+ cardioplegia, five areas of increasing concern with prolonged membrane K+ depolarization, and the basic science and clinical data underpinning a new normokalemic, “polarizing” cardioplegia comprising adenosine and lidocaine (AL) with magnesium (Mg2+) (ALM™). We argue that improved cardioprotection, better outcomes, faster recoveries and lower healthcare costs are achievable and, despite the early predictions from the stent industry and cardiology, the “cath lab” may not be the place where the new wave of high-risk morbid patients are best served.

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Section: Adenosine Lidocaine and Mg2+ (Alm™): A More Natural Way Tomentioning

confidence: 99%

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Dobson¹,

Faggian²,

Onorati³

et al. 2013

Front. Physiol.

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“…To explain this cardioprotective effects, it was reported that this effects are due to reduction in ventricular arrhythmias (Canyon and Dobson 2004;Canyon and Dobson 2005), decreased myocardial dysfunction (Wang et al 2007;Ebel et al 2001), reduction in phosphate waste (Dias et al 2004;Canyon and Dobson 2006), and in infarct size (Hinokiyama et al 2003;Canyon and Dobson 2005) and apoptosis (Kaczmarek et al 2009). Interestingly, these cardioprotective effects have also been observed in patients undergoing on-pump coronary bypass grafting surgery and during pediatric cardiac surgery (Rinne and Kaukinen 1998).…”

Section: Discussionmentioning

confidence: 99%

Comparing perioperative magnesium sulphate, lidocaine, and their combination in preventing ventricular arrhythmia in off-pump coronary artery bypass grafting

Sarhan

Mahmoud

Seddiq

2019

Ain-Shams J Anesthesiol

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Background: Techniques of coronary artery bypass grafting (CABG) have developed rapidly over the last decades. However, dysrhythmia is a common feature during off pump CABG. The aim of this work was to study effect of perioperative magnesium sulphate infusion on the incidence of cardiac arrhythmia in off-pump CABG: and comparing such effects to lidocaine alone or combined to magnesium. Methodology: Ninety patients undergoing elective coronary artery bypass grafting surgery were randomly divided into three equal groups: magnesium group received magnesium over 12 h prior to off-pump surgery and over 30 min intraoperatively; lidocaine group were given an intravenous bolus injection of lidocaine followed by a continuous infusion; and combination group received half the doses of magnesium and lidocaine prescribed for the other two groups. The patients' perioperative hemodynamic data (heart rate and mean arterial pressure) and the occurrence of intraoperative and postoperative arrhythmia were recorded. Results: There was statistically significant difference between study groups as regards mean intraoperative heart rate and intraoperative mean arterial pressure. In addition, the need for intraoperative beta-blockers was significantly higher in lidocaine group; there was no need for intraoperative beta-blockers for combination group. Also, the need for perioperative aortic balloon pump was significantly higher in lidocaine group (20.0%), followed by 6.7% in magnesium group, and none in combination group. The percentage of ventricular tachycardia was significantly higher in lidocaine group (16.7%), followed by magnesium group (3.3%) and none in combination group. Conclusion: Results of the present study revealed that combination of both perioperative magnesium and lidocaine when compared to each of both drugs separately has a better effect in controlling hemodynamics (heart rate and mean arterial blood pressure intraoperatively), less ventricular tachycardia, and reduction in the need for beta blockers and aortic balloon pump perioperatively. In addition, magnesium was superior to lidocaine, although both are effective.

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“…Important endogenous protective mechanisms include adenosine production, opening of ATP-sensitive potassium channels (KATP), release of nitric oxide, etc. [105,106]. Ischemia induces release of autocoids that activate complex intracellular signalling pathways some of which interconnect at the level of the mitochondria.…”

Section: Pharmacologic Approachmentioning

confidence: 99%

Acute Myocardial Injury: A Perspective on Lethal Reperfusion Injury

Jg¹

2017

Cardiovasc Pharm Open Access

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Acute myocardial infarction contributes significantly to mortality in patients with coronary artery disease. Timely reperfusion of an infarct-related artery within a reasonable time-frame after acute coronary occlusion continues to be the most effective intervention in patients to reduce morbidity and mortality. However, restoration of blood flow to reversibly injured cardiocytes (and other cardiac cell types) within the under-perfused region may also provoke additional damage-commonly referred to as lethal reperfusion injury. Debate has gone on, and continues regarding the existence of reperfusion injury and the pathways that are solicited. Consequently, findings from fundamental science studies have facilitated identification of therapeutic targets that may benefit patients with acute coronary syndromes. This review examines evidence from basic science and clinical studies that support the premise of cardiac injury caused by reperfusion. Pathogenesis of post-ischemic cellular injury is discussed along with potential interventions (pharmacologic and non-pharmacologic) currently being used to improve clinical outcomes.

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Pretreatment with an adenosine A1 receptor agonist and lidocaine: A possible alternative to myocardial ischemic preconditioning

Abstract: We conclude that activating adenosine A1 receptor subtype with CCPA and concomitantly modulating sodium fast channels with lidocaine was comparable with ischemic preconditioning and might offer a new therapeutic window to minimize myocardial damage during surgical ischemia and reperfusion.

Cited by 26 publications

References 41 publications

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

Comparing perioperative magnesium sulphate, lidocaine, and their combination in preventing ventricular arrhythmia in off-pump coronary artery bypass grafting

Acute Myocardial Injury: A Perspective on Lethal Reperfusion Injury

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