Perioperative use of a beta blocker in coronary artery bypass grafting

Ogawa, Shinji; Okawa, Yasuhide; Aoki, Masakazu; Baba, Hiroshi

doi:10.1177/0218492312451166

Cited by 21 publications

(23 citation statements)

References 13 publications

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“…Blood pressure is not different compared with control or diltiazem groups in five studies [18–20, 22, 23]. In one study [21], the values of heart rate and blood pressure were not described.…”

Section: Resultsmentioning

confidence: 99%

“…However, the PASCAL trial (UMIN-CTR Clinical Trial #UMIN000001442) [18], which was performed in double-blinded manner, revealed not only reduction of POAF but also reduction of the length of hospital stay. In addition, the anti-inflammation effects of landiolol were described in three trials [18, 19, 21]. Moreover, the impact of perioperative landiolol administration on prognosis is not clear.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Landiolol Administration reduces Atrial Fibrillation after Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

2014

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IntroductionPostoperative atrial fibrillation (POAF) is one of the most common complications after cardiac surgery. Patients who develop POAF have a prolonged stay in the intensive care unit and hospital and an increased risk of postoperative stroke. Many guidelines for the management of cardiac surgery patients, therefore, recommend perioperative administration of beta-blockers to prevent and treat POAF. Landiolol is an ultra-short acting beta-blocker, and some randomized controlled trials of landiolol administration for the prevention of POAF have been conducted in Japan. This meta-analysis evaluated the effectiveness of landiolol administration for the prevention of POAF after cardiac surgery.MethodsThe Medline/PubMed and BioMed Central databases were searched for randomized controlled trials comparing cardiac surgery patients who received perioperative landiolol with a control group (saline administration, no drug administration, or other treatment). Two independent reviewers selected the studies for inclusion. Data regarding POAF and safety outcomes were extracted. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel method (fixed effects model).ResultsSix trials with a total of 560 patients were included in the meta-analysis. Landiolol administration significantly reduced the incidence of POAF after cardiac surgery (OR 0.26, 95% CI 0.17–0.40). The effectiveness of landiolol administration was similar in three groups: all patients who underwent coronary artery bypass grafting (CABG) (OR 0.27, 95% CI 0.17–0.43), patients who underwent CABG compared with a control group who received saline or nothing (OR 0.28, 95% CI 0.17–0.45), and all patients who underwent cardiac surgery compared with a control group who received saline or nothing (OR 0.27, 95% CI 0.17–0.42). Only two adverse events associated with landiolol administration were observed (2/302, 0.7%): hypotension in one patient and asthma in one patient.ConclusionLandiolol administration reduces the incidence of POAF after cardiac surgery and is well tolerated.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-014-0116-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perioperative Landiolol Administration reduces Atrial Fibrillation after Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

2014

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“…29 In patients who undergo cardiac surgery, β-blockers are administered perioperatively without contraindications to reduce the incidence of postoperative atrial fibrillation. 9,30 Landiolol has been shown to inhibit postoperative atrial fibrillation after coronary artery bypass surgery, 9,14,15,[31][32][33] acute type A aortic dissection repair, 34 and heart valve surgery. 9,35 One study showed that landiolol was more effective than diltiazem for patients with postoperative atrial fibrillation after open heart surgery.…”

Section: Clinical Use Of Landiololmentioning

confidence: 99%

“…7,18,65,67 When continuous injection between 3 and 5 µg/kg/min was used to control the heart rate after cardiac surgery, ten of 68 patients experienced bradycardia (heart rate ,50 bpm), which recovered after cessation of drug infusion and administration of a cardiotonic agent. 15 Hypotension Hypotension is a rare side effect when a bolus injection of 0.125 mg/kg landiolol is used, 7,18,67 although Nakamura et al 66 reported hypotension (86/55 mmHg) in one out of 188 patients, which recovered after 10 minutes. Another study reported that one of 28 patients who received 0.25 mg/kg landiolol had mild hypotension, which resolved without any treatment.…”

Section: Bradycardiamentioning

confidence: 99%

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Clinical utility of landiolol for use in coronary CT angiography

Tomizawa¹,

Hayakawa²,

Inoh³

et al. 2015

RRCC

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Although remarkable advancement in computed tomography (CT) has been achieved, heart rate control is important to maintain an optimal image quality in coronary CT angiography. Oral or intravenous β-blockers are used as premedication for this purpose. Landiolol was developed as a β-blocker with very high cardioselectivity (β1/β2 =255) and short half-life (4 minutes). In this review, we report the pharmacological features and usage of landiolol and also its effects on heart rate and image quality in coronary CT angiography. In addition, we discuss the safety of landiolol.

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Perioperative beta-blockers for preventing surgery-related mortality and morbidity

Blessberger

Kammler

Domanovits

et al. 2014

Cochrane Database of Systematic Reviews

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According to our findings, perioperative application of beta-blockers still plays a pivotal role in cardiac surgery , as they can substantially reduce the high burden of supraventricular and ventricular arrhythmias in the aftermath of surgery. Their influence on mortality, AMI, stroke, congestive heart failure, hypotension and bradycardia in this setting remains unclear.In non-cardiac surgery, evidence from low risk of bias trials shows an increase in all-cause mortality and stroke with the use of beta-blockers. As the quality of evidence is still low to moderate, more evidence is needed before a definitive conclusion can be drawn. The substantial reduction in supraventricular arrhythmias and AMI in this setting seems to be offset by the potential increase in mortality and stroke.

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Perioperative use of a beta blocker in coronary artery bypass grafting

Abstract: Low-dose continuous infusion of landiolol reduced the incidence of postoperative atrial fibrillation, and significantly suppressed inflammation.

Cited by 21 publications

References 13 publications

Perioperative Landiolol Administration reduces Atrial Fibrillation after Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Perioperative Landiolol Administration reduces Atrial Fibrillation after Cardiac Surgery: A Meta-analysis of Randomized Controlled Trials

Clinical utility of landiolol for use in coronary CT angiography

Perioperative beta-blockers for preventing surgery-related mortality and morbidity

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