Abstract
BackgroundSinus tachycardia coupled with high-dose catecholamine is common after cardiopulmonary bypass (CPB). The present study assessed the hemodynamic efficacy and safety of combination therapy using low-dose β1-selective adrenergic blocker (landiolol) and inotropes.MethodsThis was a retrospective, single center, self-comparison study at post-anesthesia care unit within a tertiary care center. The study included adults who underwent cardiac surgery with CPB and received landiolol between April 2007 and November 2011. We assessed hemodynamic data prior to and 1 h after initiation of landiolol therapy.ResultsWe evaluated 11 patients who were administered 2.6 ± 1.3 μg/kg/min (mean ± SD) landiolol with sinus tachycardia and received catecholamine therapy after on-pump cardiovascular surgery. Landiolol administration led to a significant reduction in heart rate (HR; 112.4 ± 5.8 vs 126.0 ± 7.6 beats/min, p < 0.001), and a significant increase in stroke volume index (SVI) assessed by pulmonary artery catheterization (22.4 ± 5.4 vs. 18.9 ± 4.2 mL/m2, p = 0.04). Only one patient showed no HR reduction, whereas seven patients showed decreased HR and increased SVI (64, 95% confidence interval: 30–98%). Moreover, all five patients who received high-dose catecholamine support showed improved hemodynamics. In terms of safety, no patients required cessation of landiolol therapy.ConclusionsLow-dose landiolol therapy may safely decrease HR and improve hemodynamics among patients with sinus tachycardia receiving catecholamine treatment after cardiovascular surgery.Trial registrationThis study is retrospective. Registration number: 11. Duration of registration: April 2007~November 2011.
Highlights
Sinus tachycardia coupled with high-dose catecholamine is a common problem after cardiopulmonary bypass (CPB)
Since tachycardia is associated with mortality and cardiac morbidity in the general population [1, 2] as well as in patients following surgery [3, 4], heart failure [5], and/or coronary artery disease [6], anesthesiologists should carefully manage heart rate (HR) throughout the perioperative period
The inclusion criteria were as follows: (1) patients who had persistent sinus tachycardia (HR > 100 beats/min) induced by catecholamine support after CPB; (2) patients who received continuous intravenous landiolol for sinus tachycardia based on the decision of the attending physician; (3) landiolol administration overlapped with constant dose of inotropic drugs for at least for 1 h; (4) patients who had a pulmonary artery catheter; and (5) patients who were sedated and supported via mechanical ventilation
Summary
Sinus tachycardia coupled with high-dose catecholamine is common after cardiopulmonary bypass (CPB). The present study assessed the hemodynamic efficacy and safety of combination therapy using low-dose β1-selective adrenergic blocker (landiolol) and inotropes. Sinus tachycardia coupled with high-dose catecholamine is a common problem after cardiopulmonary bypass (CPB). Catecholamine therapy after CPB aids cardiac performance by stabilizing hemodynamic conditions. High-dose catecholamine therapy frequently induces sinus tachycardia, and its treatment remains highly controversial. Continuation of tachycardia may compromise the myocardial oxygen balance, followed by global cardiac performance deterioration. Reducing inotropic stimulation can induce a decrease in cardiac output, followed by deterioration of hemodynamic conditions. An effective approach that avoids this vicious circle is necessary
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