Safety and efficacy of continued propranolol administration through coronary bypass surgery

Boudoulas, Harisios; Snyder, Gary L.; Lewis, Richard P.; Kates, Robert E.; Karayannacos, Panayotis E.; Vasko, John S.

doi:10.1016/0002-9149(78)90210-2

Cited by 6 publications

(3 citation statements)

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“…The reeent demonstration by Todd and assoeiates 24 that preoperative propranolol prevented the hypokalemia eommon with hypothermie eardiopulmonary bypass may presage a more cIearly defined role for propranolol in seleeted patients undergoing eardiae surgery. Boudoulas and eo-workers 6 have urged that patients undergoing eoronary artery bypass surgery have propranolol eontinued throughout the proeedure so as to avoid postoperative beta reeeptor hypersensitivity whieh may result when the drug is diseontinued. :i If propranolol should be used in or near the time of hypothermie surgieal proeedures, the data reported here gain inereased relevanee sinee the demonstrated alterations in propran-0101 elimination kineties must be eonsidered when drug dosage and duration of effeet are estimated prospeetively.…”

Section: Discussionmentioning

confidence: 99%

Effects of hypothermia on propranolol kinetics

McAllister

Bourne

Tan

et al. 1979

Clin Pharma and Therapeutics

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Propranolol may be uniquely useful in cardiac surgical procedures, since beta adrenergic blockade can prevent the hypokalemia and associated arrhythmias which result from systemic hypothermia. To determine the effects of hypothermic cardiopulmonary bypass (HCPB) on the in vivo handling of propranolol, serial drug plasma concentrations (Cp) were measured during HCPB in 12 patients who had been treated chronically with propranolol prior to surgery. Although no further propranolol was given during the procedure, Cp values (corrected for plasma volume dilution) were higher during hypothermia than in the preoperative period, falling to or below control levels after rewarming. Due to the variables inherent in patient surgery, meaningful kinetic analysis could not be carried out. Therefore, intravenous propranolol (1 mg/kg) was given twice to each of 5 dogs, first after anesthesia only, then after anesthesia and systemic cooling to 26 degrees in a water bath Cp values measured serially over 2 hr after drug administration were consistently higher during hypothermia. Compared with the paired normothermic control studies, hypothermia markedly reduced the apparent volume of distribution (6.78 +/- 1.65 vs 2.08 +/- 0.58 L/kg; p less than 0.001) and the total body clearance of propranolol (64.4 +/- 11.0 vs 32.3 +/- 7.2 ml/kg/min; p less than 0.005). These data show that hypothermia substantially alters the pharmacokinetics of propranolol, resulting in plasma drug levels higher than those predicted from kinetic patterns derived under normothermic conditions.

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Section: Discussionmentioning

confidence: 99%

Effects of hypothermia on propranolol kinetics

McAllister

Bourne

Tan

et al. 1979

Clin Pharma and Therapeutics

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“…JORGE O paciente DJ adulto, masculino, 66 anos, 80kg, 175 cm, não obeso (DP:~,40/0) pós-infarto do miocárdio, com estória de angina instável e hipertensão arterial sistêmica (HAS) com indicação de cirurgia cardíaca para revascularização do miocárdio com circulação extracorpórea (CEC) apresentou após impregnação com propranolol meia-vida prolongada (10,7 vs 3,5-4,3 horas), depuração plasmática reduzida (4,7 vs 11-21mUminlkg) e volume de distribuição (4,3 vs3,9 Ukg) frente aos valores de referência. Opaciente apresentou depuração reduzida e meia-vida prolongada nos dois períodos frente aos limites reportados na literatura.…”

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“…Opaciente inicialmente impregnado com 30 mg/dia Lé, 10mg de 8 em 8 horas de propranolol no pré-operatório necessitou de redução da dose para 10 mg/dia no 1 0 PO para manutenção do efeito desejado. A redução da dose de propranolol no 1 0 PO em 3 vezes evidenciou concentrações plasmáticas comparáveis no pico 23 vs 27ng/mL, entretanto aumentada em 2 vezes no vale, 7 vs 15nglmL sugerindo prolongamento na meia-vida de eliminação e maior BUNJI SAKURAI O paciente BS adulto, masculino 65kg, 162 em, não obeso (DP:-+4,8%J ponador de angina instável, hipertensão arterial sistêmica (HAS) com indicação de cirurgia cardiaca para revascularização do miocárdio com circulação extracorp6rea (CEC) apresentou após impregnação com propranolol meia-vida curta (2,5 vs 3,5-4,3 horas), depuração plasmática(9,5 vs 11-21mUminlkg) e volume de distribuição reduzidos (2.2 vs 3,7-4,9 Llkg) frente aos valores de referência. Opaciente apresentou meia-vida encurtada, depuração bem como Vd prejudicados nos dois períodos frente aos limites reportados na literatura.…”

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