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BJA Advance Access originally published online on March 31, 2009
British Journal of Anaesthesia 2009 102(5):597-607; doi:10.1093/bja/aep062
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Influence of continuous perioperative beta-blockade in combination with phosphodiesterase inhibition on haemodynamics and myocardial ischaemia in high-risk vascular surgery patients

S. Suttner*, J. Boldt, A. Mengistu, K. Lang and J. Mayer

Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany

* Corresponding author. E-mail: suttner{at}gmx.de

Background: We sought to assess the intra- and postoperative haemodynamic effects of continuous perioperative β-adrenergic blockade combined with phosphodiesterase (PDE) III inhibition and its potential benefits in limiting perioperative myocardial ischaemia in high-risk vascular surgery patients.

Methods: Seventy-five patients were randomly assigned to receive tight heart rate (HR) control by a continuous infusion of: esmolol in combination with the PDE III inhibitor enoximone (esmolol+enoximone group), esmolol infusion alone (esmolol group), or standard therapy (control group) for a period of 48 h. Myocardial ischaemia and dysfunction were detected by serial plasma Troponin T (TnT) and B-type natriuretic peptide (BNP) measurements.

Results: Cardiac index (CI) increased significantly only in esmolol+enoximone-treated patients [CI: from 2.4 (0.2) litre min–1 m–2 at baseline to 3.2 (0.2) litre min–1 m–2 at 24 h after surgery; P=0.001] and was significantly higher than in the esmolol [CI: from 2.5 (0.2) litre min–1 m–2 at baseline to 2.6 (0.2) litre min–1 m–2 at 24 h; P=0.18] and the control groups [CI: from 2.4 (0.2) litre min–1 m–2 at baseline to 2.7 (0.2) litre min–1 m–2 at 24 h; P=0.13]. A significant postoperative release of TnT was detected only in control patients. Plasma BNP levels increased towards the end of surgery in all patients. Peak plasma BNP concentrations were significantly higher in control patients [293 (98) pg ml–1] than in esmolol [118 (71) pg ml–1] and in esmolol+enoximone-treated patients [78 (21) pg ml–1].

Conclusions: Inotropic therapy with the PDE III inhibitor enoximone combined with tight HR control by a continuous infusion of esmolol improved cardiac function and reduced myocardial ischaemia in high-risk vascular surgery patients.

Clinical trial registration information—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00348101 [ClinicalTrials.gov] .

Keywords: complications, myocardial infarction; heart, esmolol; heart, enoximone; hormones, B-type natriuretic peptides; surgery, vascular


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