The effect of landiolol on cerebral blood flow in patients undergoing off-pump coronary artery bypass surgery

Goto, Koji; Hagiwara, Satoshi; Hidaka, Seigo; Yamamoto, Shunsuke; Kusaka, Junya; Yasuda, Norihisa; Shingu, Chihiro; Noguchi, Takayuki

doi:10.1007/s00540-009-0849-x

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…This study employed landiolol infusion at 5 µg/kg/min, but reports on cardiovascular surgery indicate that it exerts a significant effect when infused at only 2 µg/kg/min [9] [13]. As a significant reduction in cardiac output during landiolol infusion has been reported in patients with a low cardiac output (ejection fraction < 50%) [14], patients with an ASA-PS score of 4 or higher were excluded from the present study. Further studies need to be undertaken to determine the optimum infusion rate.…”

Section: Discussionmentioning

confidence: 99%

Safety of Landiolol Infusion in Patients Undergoing Lung Resection

Ito¹,

Nozaki²,

Sakamoto³

et al. 2014

OJAnes

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The efficacy of landiolol hydrochloride, an ultrashort-acting β-blocker with high β1 selectivity, has been confirmed in patients undergoing cardiac surgery in Japan, but there have been few reports about its use for patients having lung resection. We investigated the safety of continuous infusion of landiolol in patients undergoing lung resection. Between May 2008 and May 2011, 200 patients scheduled for lung resection were enrolled. Patients who underwent surgery before the introduction of landiolol in February 2010 were studied retrospectively (Group C) and were compared with those who received landiolol along with surgery (Group L). During the 48-hour study period, the incidence of arrhythmias, changes in heart rate and blood pressure, and occurrence of adverse reactions were examined. The white blood cell count and C-reactive protein level were measured before and after surgery to assess the anti-inflammatory effect. The heart rate was significantly lower in Group L throughout the study period. No patient in Group L developed hypotension requiring discontinuation of landiolol therapy, and no respiratory symptoms (including asthma or hypoxemia) were observed. White blood cell and C-reactive protein were significantly increased after surgery in both groups, and there were no between-group differences. Arrhythmic events occurred in 1.1% (1/99) and 9.2% (7/76) of Group L and Group C, respectively. One patient in Group C developed ventricular tachycardia. Landiolol can be administered safely during the perioperative period in patients undergoing lung resection.

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Section: Discussionmentioning

confidence: 99%

Safety of Landiolol Infusion in Patients Undergoing Lung Resection

Ito¹,

Nozaki²,

Sakamoto³

et al. 2014

OJAnes

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“…Besides describing the effects of the inhibition of tachycardia and blood pressure elevation at the time of endotracheal intubation [Kitamura 1997;Goyagi 2005;Yamazaki 2005], inhibition of HR elevation and the bispectral index at the time of endotracheal intubation [Oda 2005], and HR stabilization at the time of awakening from anesthesia and extubation [Shirasaka 2008], reports on the use of landiolol hydrochloride have also described occasional observations of an effect on preventing myocardial ischemia [Kimura-Kurosawa 2007]. In cases of left ventricular dysfunction, however, there have also been reports claiming that landiolol could decrease both HR and cardiac output, as with conventional β-blockers [Goto 2010]. Therefore, there has been a tendency to refrain from using landiolol hydrochloride.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of an Ultrashort-Acting ?1-Blocker on Left Ventricular Dysfunction

Ito¹,

Tashiro²,

Morishige³

et al. 2012

HSF

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Landiolol hydrochloride, an ultrashort-acting β1-selective blocker, is a highly regulated drug. This study evaluated the safety and efficacy of this drug for cases of coronary artery bypass grafting (CABG) with left ventricular dysfunction. Between September 2006 and August 2009, 32 patients with a left ventricular ejection fraction of <40% underwent CABG. Two groups of patients, a group administered landiolol hydrochloride and a control group not administered this drug, were compared. The administration of landiolol hydrochloride was initiated at 1 μg/kg per minute (γ) after cardiopulmonary bypass in on-pump cases and after completion of all the distal anastomoses in off-pump cases. We observed no significant differences between the groups with respect to preoperative patient background or incidences of complications, except for postoperative atrial fibrillation. The heart rate decreased significantly 30 minutes after landiolol hydrochloride administration, but no change was observed in arterial pressure. No change was observed in other parameters; the hemodynamics were stable. The occurrence of atrial fibrillation during the intensive care unit stay (during landiolol hydrochloride administration) was significantly lower in the administration group. The difference remained significant after multiple logistic regression analysis; landiolol hydrochloride was the sole inhibitory factor.

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Landiolol: A Review of its use in Intraoperative and Postoperative Tachyarrhythmias

Plosker¹

2013

Drugs

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Landiolol (Onoact(®)) is an intravenously administered, ultra short-acting β1-blocker with an elimination half-life of 3-4 min and ≈8-fold greater cardioselectivity than esmolol in vitro. It is approved in Japan for the treatment of intraoperative and postoperative tachyarrhythmias, but in clinical practice is also used to prevent postoperative tachyarrhythmias, such as atrial fibrillation after coronary artery bypass grafting. Randomized controlled trials in patients undergoing open-heart surgery demonstrated that various dosages of landiolol (0.0005-0.04 mg/kg/min) [0.5-40 μg/kg/min] were more effective than diltiazem in converting postoperative atrial fibrillation to normal sinus rhythm during the first 8 h after surgery, and were more effective than placebo (or no landiolol) in preventing the development of atrial fibrillation during the first week after surgery (primary efficacy endpoints). In patients undergoing surgical procedures, landiolol 0.125 mg/kg/min for 1 min followed by 0.04 mg/kg/min for 10 min was superior to placebo in improving intraoperative tachycardia in randomized double-blind trials. The beneficial effects of landiolol in attenuating adverse haemodynamic or other changes that can occur during surgery or invasive procedures (e.g. percutaneous coronary intervention) have been demonstrated in a large number of randomized controlled trials. For example, several studies showed that landiolol attenuated the increase in heart rate associated with tracheal intubation, without adversely affecting blood pressure or other haemodynamic parameters. Landiolol was generally well tolerated in clinical trials, with a relatively low risk of hypotension and bradycardia, although routine monitoring of cardiac function during landiolol administration is important. In general, adverse events such as reduced blood pressure resolve quickly after discontinuation of landiolol. Thus, as an ultra short-acting β1-blocker with a rapid onset of action and readily titratable and rapidly reversible effects, landiolol represents an important agent for the management of intraoperative and postoperative tachyarrhythmias.

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The effect of landiolol on cerebral blood flow in patients undergoing off-pump coronary artery bypass surgery

Abstract: Continuous administration of landiolol at a dose of 0.04 mg/kg/min after 1 min rapid i.v. administration at a dose of 0.125 mg/kg/min decreases HR without causing aggravation of CBF during treatment of intraoperative tachycardia in patients with normal and deteriorated cardiac function.

Cited by 3 publications

References 27 publications

Safety of Landiolol Infusion in Patients Undergoing Lung Resection

Safety of Landiolol Infusion in Patients Undergoing Lung Resection

Safety and Efficacy of an Ultrashort-Acting ?1-Blocker on Left Ventricular Dysfunction

Landiolol: A Review of its use in Intraoperative and Postoperative Tachyarrhythmias

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