Protective effect of esmolol on myocardial ischemic injury during open heart surgery in children

Abstract

SummaryObjectives: To investigate the efficacy of esmolol in protecting the myocardium from ischemia during pediatric cardiac surgery. Background: Esmolol, an ultra-short acting beta 1-adrenoceptor blocker, reduces myocardial injury in adult cardiac operations. However, this technique is rarely used in pediatric cardiac surgery. Methods: Thirty children with ventricular septal defect were randomly allocated to the esmolol group and the control group. Patients received intravenous esmolol (0.05 mgÁkg À1 ÁminÀ1 after tracheal intubation, 0.3 mgÁkg À1 Ámin À1 during cardiopulmonary bypass (CPB) and 0.03-0.05 mgÁkg À1 Ámin À1 until the end of surgery) or placebo, respectively. Results: Plasma levels of creatine kinase-MB, cardiac troponin I in the esmolol group 2 min after completion of CPB, at the end of surgery, 4 h after surgery, and the first postoperative day were significantly lower than those in the control group. Values of heart rate 10 min after induction, 2 min before institution of CPB, 2 min after completion of CPB, and at the end of surgery were significantly lower in the esmolol group; however, mean arterial pressure, CPB time, cross-clamp time, and the rate of heart spontaneous rebeating were not statistically different between two groups. Cumulative postoperative dosage of dopamine in the esmolol group (100.1 AE 53.1 mg) was significantly less than that in the control group (171.4 AE 92.1 mg). Conclusions: Esmolol can protect the myocardium from ischemic injury during CPB in children and significantly reduce the use of inotropic drug.

Strategies for Pharmacological Organoprotection during Extracorporeal Circulation Targeting Ischemia-Reperfusion Injury

“…Esmolol has been used during CPB in children and it was demonstrated that patients of the esmolol group had lower creatine kinase, troponin I and lactate levels and less need for inotropic support. Moreover, myocardial structure was better preserved (Kuhn-Regnier et al, 1999 ; Gui et al, 2013 ).…”

The effect of esmolol on myocardial protection in patients with tetrology of Fallot

“…[15] In one of the studies in which esmolol infusion was used for children operated on for the treatment of VSD, a dose of 0.05 mg/kg/min was used until the CPB, 0.03 mg/kg/min during the bypass and 0.03-0.05 mg/kg/min after CPB. [16] In our clinical practice, we have been using esmolol infusion and, since we have experienced that doses higher than 0.07 mg/kg/min may negatively affect the hemodynamic parameters, we have fixed the dose at 0.05 mg/kg/min. During CPB, the dose is reduced to 0.025 mg/kg/min.…”

Pediatric antiarrhythmics and toxicity: A clinical review

“…Among infants with SVT, esmolol is commonly used, along with other adjunctive therapies, as an abortive medication in the acute care setting 45 . It has also been used as an adjunct to anesthesia during cardiac surgeries in children requiring cardiopulmonary bypass 49 …”