Beyond Hyperkalemia: β-Blocker–Induced Cardiac Arrest for Normothermic Cardiac Operations

Ede, Mauricio; Ye, Jian; Gregorash, Lori; Summers, Randy; Pargaonkar, S; Lehouerou, D.; Lessana, A; Salerno, Tomás A.; Deslauriers, Roxanne

doi:10.1016/s0003-4975(96)01114-9

Cited by 25 publications

(11 citation statements)

References 14 publications

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“…Hyperkalemia due to B-blokers overdose was detected by Ede et al (1997). Beta blockade, especially of the beta-1 receptor at the macula densa inhibits renin release, thus decreasing the release of aldosterone.…”

Section: Discussionmentioning

confidence: 99%

Study of Electrocardiographic Changes Associated with Acute Poisoning in Tanta Poison Center

Heshmat

Maklad

Elsheikh

et al. 2012

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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Poisoning or intoxication is the occurrence of harmful effects resulting from exposure to a foreign substance. According to the Center for Disease Control, approximately 1 million of the 110 million annual emergency department (ED) visits are related to poisoning and other toxic effects. Electrocardiogram (ECG) is a noninvasive, relatively inexpensive diagnostic test that provides important information regarding not only the heart, but also non-cardiac events impacting the cardiac system. The aim of this study was to evaluate the electrocardiographic changes conducted on 282 cases of acute poisoning admitted to Tanta Poison Center, Faculty of Medicine, Tanta Emergency University Hospital during the period from the start of July-2009 to the end of June-2010. In order to fulfill this aim, each patient was subjected to history taking, complete physical examination, laboratory investigations and ECG analysis. This study found that poisons associated with ECG changes account for 58.5 % of patients included in this study. Furthermore, 36.17% of patients are mainly in the middle age group between 20 and 30 years. Organophosphorus compounds (34.4%) were responsible for most cases of intoxication of ECG changes. Sinus tachycardia (73.94%) was the commonest ECG change among them. Followed by prolonged QT corrected for heart rate (QTc) interval (21.82 %) and sinus bradycardia (11.51 %).

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Section: Discussionmentioning

confidence: 99%

Study of Electrocardiographic Changes Associated with Acute Poisoning in Tanta Poison Center

Heshmat

Maklad

Elsheikh

et al. 2012

Ain Shams Journal of Forensic Medicine and Clinical Toxicology

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“…Esmolol-HCl is an ultra-short-acting beta-blocker with a half-life of about 10 min, and at high concentrations can both arrest the heart and attenuate myocardial ischemia-reperfusion injury (Geissler, 2002; Chambers, 2003). Although Chambers showed that multidose infusions (2 min given every 15 min) of a 1.0 mmol/L esmolol solution arrested and protected isolated crystalloid-perfused rat hearts for up to 90 min at normothermic temperatures (Chambers, 2003), earlier work by Deslauriers and colleagues (Ede et al, 1997) reported esmolol-related increases in left ventricular diastolic pressure and pulmonary arterial pressures during arrest, and a difficulty in weaning the pigs off bypass (Ede et al, 1997). Further work is required to test the surgical applications of esmolol in the clinical setting.…”

Section: Five Decades Of Searching For Alternatives To Depolarizing Pmentioning

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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“…15,26 Esmolol has previously been shown to induce ventricular arrest when used at high concentrations. Ede and colleagues 28 arrested rat hearts at a dose of 1.36 mmol/L. Pirk and coworkers 29 demonstrated that 250 mg/L esmolol (approximately 0.7 mmol/L) was an optimal concentration for arrest of the rat heart, whereas 500 mg/L (approximately 1.4 mmol/L) resulted in reduced recovery of cardiac function (when washed out).…”

Section: Discussionmentioning

confidence: 99%

“…It is tempting to speculate that similar effects on ionic homeostasis may be occurring in our study with the multiple infusions of esmolol car-dioplegic solution, particularly in view of the suggested lidocaine-like activity (sodium-channel blocking effect) of esmolol at high doses. 28 The efficacy of myocardial protection with β-blockers may require multiple infusion. It has been demonstrated 34 that acute β-blockade was only effective during relatively short ischemic periods, and this would be supported by the present data.…”

Section: Cardioplegic Infusion Regimen: Effects Of Single-dose Multimentioning

confidence: 99%

Myocardial protection: The efficacy of an ultra-short-acting β-blocker, esmolol, as a cardioplegic agent

Bessho

Chambers

2001

The Journal of Thoracic and Cardiovascular Surgery

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Intermittent arrest with esmolol did not enhance protection of intermittent crossclamping with fibrillation; however, multiple esmolol infusions during global ischemia provided improved protection. Administration (constant flow or constant pressure) of arresting solutions influenced outcome only during continuous infusion. Multidose esmolol arrest may be a beneficial alternative to intermittent crossclamping with fibrillation or conventional cardioplegia.

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Beyond Hyperkalemia: β-Blocker–Induced Cardiac Arrest for Normothermic Cardiac Operations

Cited by 25 publications

References 14 publications

Study of Electrocardiographic Changes Associated with Acute Poisoning in Tanta Poison Center

Study of Electrocardiographic Changes Associated with Acute Poisoning in Tanta Poison Center

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

Myocardial protection: The efficacy of an ultra-short-acting β-blocker, esmolol, as a cardioplegic agent

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