PDF(Pubmed)
Abstract：
Ivabradine is a specific heart rate (HR)-lowering agent which blocks the cardiac pacemaker If channels. It reduces the HR without causing a negative inotropic or lusitropic effect, thus preserving ventricular contractility. The authors hypothesized that its usefulness in lowering HR can be utilized in patients undergoing off-pump coronary artery bypass (OPCAB) surgery.
To study the effects of preoperative ivabradine on hemodynamics (during surgery) in patients undergoing elective OPCAB surgery.
Fifty patients, New York Heart Association (NYHA) class I and II, were randomized into group I (control, n = 25) and group II (ivabradine group, n = 25). In group I, patients received the usual anti-anginal medications in the preoperative period, as per the institutional protocol. In group II, patients received ivabradine 5 mg twice daily for 3 days before surgery, in addition to the usual anti-anginal medications. Anesthesia was induced with fentanyl, thiopentone sodium, and pancuronium bromide as a muscle relaxant and maintained with fentanyl, midazolam, pancuronium bromide, and isoflurane. The hemodynamic parameters [HR and mean arterial pressure (MAP)] and pulmonary artery (PA) catheter-derived data were recorded at the baseline (before induction), 3 min after the induction of anesthesia at 1 min and 3 min after intubation and at 5 min and 30 min after protamine administration. Intraoperatively, hemodynamic data (HR and MAP) were recorded every 10 min, except during distal anastomosis of the coronary arteries when it was recorded every 5 min. Post-operatively, at 24 hours, the levels of troponin T and brain natriuretic peptide (BNP) were measured. This trial\'s CTRI registration number is CTRI/005858.
The HR in group II was lower when compared to group I (range 59.6-72.4 beats/min and 65.8-80.2 beats/min, respectively) throughout the study period. MAP was comparable [range (78.5-87.8 mm Hg) vs. (78.9-88.5 mm Hg) in group II vs. group I, respectively] throughout the study period. Intraoperatively, 5 patients received metoprolol in group I to control the HR, whereas none of the patients in group II required metoprolol. The incidence of preoperative bradycardia (HR <60 beats/min) was higher in group II (20%) vs. group I (8%). There was no difference in both the groups in terms of troponin T and BNP level after 24 hours, time to extubation, requirement of inotropes, incidence of arrhythmias, in-hospital morbidity, and 30-day mortality.
Ivabradine can be safely used along with other anti-anginal agents during the preoperative period in patients undergoing OPCAB surgery. It helps to maintain a lower HR during surgery and reduces the need for beta-blockers in the intraoperative period, a desirable and beneficial effect in situations where the use of beta-blockers may be potentially harmful. Further studies are needed to evaluate the beneficial effects of perioperative Ivabradine in patients with moderate-to-severe left ventricular dysfunction.
To study the effects of preoperative ivabradine on hemodynamics (during surgery) in patients undergoing elective OPCAB surgery.
Fifty patients, New York Heart Association (NYHA) class I and II, were randomized into group I (control, n = 25) and group II (ivabradine group, n = 25). In group I, patients received the usual anti-anginal medications in the preoperative period, as per the institutional protocol. In group II, patients received ivabradine 5 mg twice daily for 3 days before surgery, in addition to the usual anti-anginal medications. Anesthesia was induced with fentanyl, thiopentone sodium, and pancuronium bromide as a muscle relaxant and maintained with fentanyl, midazolam, pancuronium bromide, and isoflurane. The hemodynamic parameters [HR and mean arterial pressure (MAP)] and pulmonary artery (PA) catheter-derived data were recorded at the baseline (before induction), 3 min after the induction of anesthesia at 1 min and 3 min after intubation and at 5 min and 30 min after protamine administration. Intraoperatively, hemodynamic data (HR and MAP) were recorded every 10 min, except during distal anastomosis of the coronary arteries when it was recorded every 5 min. Post-operatively, at 24 hours, the levels of troponin T and brain natriuretic peptide (BNP) were measured. This trial\'s CTRI registration number is CTRI/005858.
The HR in group II was lower when compared to group I (range 59.6-72.4 beats/min and 65.8-80.2 beats/min, respectively) throughout the study period. MAP was comparable [range (78.5-87.8 mm Hg) vs. (78.9-88.5 mm Hg) in group II vs. group I, respectively] throughout the study period. Intraoperatively, 5 patients received metoprolol in group I to control the HR, whereas none of the patients in group II required metoprolol. The incidence of preoperative bradycardia (HR <60 beats/min) was higher in group II (20%) vs. group I (8%). There was no difference in both the groups in terms of troponin T and BNP level after 24 hours, time to extubation, requirement of inotropes, incidence of arrhythmias, in-hospital morbidity, and 30-day mortality.
Ivabradine can be safely used along with other anti-anginal agents during the preoperative period in patients undergoing OPCAB surgery. It helps to maintain a lower HR during surgery and reduces the need for beta-blockers in the intraoperative period, a desirable and beneficial effect in situations where the use of beta-blockers may be potentially harmful. Further studies are needed to evaluate the beneficial effects of perioperative Ivabradine in patients with moderate-to-severe left ventricular dysfunction.
摘要：
■伊伐布雷定是一种特定的心率（HR）降低剂，可阻断心脏起搏器If通道。它会降低HR而不会引起负性肌力或脂性作用，从而保持心室收缩力。作者假设其降低HR的有效性可用于接受非体外循环冠状动脉搭桥术（OPCAB）手术的患者。
■目的研究术前伊伐布雷定对择期OPCAB手术患者血流动力学（手术期间）的影响。
■50名患者，纽约心脏协会（NYHA）一级和二级，随机分为I组(对照组，n=25）和II组（伊伐布雷定组，n=25)。在第一组中,患者在术前接受常规的抗心绞痛药物治疗，根据机构协议。在第二组中，患者在手术前接受伊伐布雷定5毫克，每天2次，持续3天，除了通常的抗心绞痛药物。用芬太尼诱导麻醉，硫喷酮钠,和潘库溴铵作为肌肉松弛剂并用芬太尼维持，咪达唑仑,潘库溴铵,和异氟烷.在基线（诱导前）记录血流动力学参数[HR和平均动脉压（MAP）]和肺动脉（PA）导管数据，麻醉诱导后3min，插管后1min和3min，鱼精蛋白给药后5min和30min。术中,每10分钟记录一次血流动力学数据（HR和MAP），除了在冠状动脉远端吻合期间，每5分钟记录一次。术后,24小时后,测定肌钙蛋白T和脑钠肽(BNP)水平。该试验的CTRI注册号是CTRI/005858。
■与I组相比，II组的HR较低（范围为59.6-72.4次/分钟和65.8-80.2次/分钟，分别)在整个研究期间。MAP具有可比性[范围（78.5-87.8mmHg）与II组（78.9-88.5mmHg）与I组,分别]在整个研究期间。术中,1组5例患者接受美托洛尔控制HR,而II组患者均不需要美托洛尔。术前心动过缓（HR<60次/分钟）的发生率在II组（20％）较高。第一组（8%）。两组24小时后肌钙蛋白T和BNP水平无差异，拔管时间，同向异构体的要求，心律失常的发生率，住院发病率，30天死亡率
■在进行OPCAB手术的患者术前期间，伊伐布雷定可以安全地与其他抗心绞痛药一起使用。它有助于在手术过程中保持较低的HR，并减少术中对β受体阻滞剂的需求，在使用β受体阻滞剂可能是潜在有害的情况下，这是理想的和有益的效果。需要进一步的研究来评估围手术期伊伐布雷定对中度至重度左心室功能障碍患者的有益作用。
■目的研究术前伊伐布雷定对择期OPCAB手术患者血流动力学（手术期间）的影响。
■50名患者，纽约心脏协会（NYHA）一级和二级，随机分为I组(对照组，n=25）和II组（伊伐布雷定组，n=25)。在第一组中,患者在术前接受常规的抗心绞痛药物治疗，根据机构协议。在第二组中，患者在手术前接受伊伐布雷定5毫克，每天2次，持续3天，除了通常的抗心绞痛药物。用芬太尼诱导麻醉，硫喷酮钠,和潘库溴铵作为肌肉松弛剂并用芬太尼维持，咪达唑仑,潘库溴铵,和异氟烷.在基线（诱导前）记录血流动力学参数[HR和平均动脉压（MAP）]和肺动脉（PA）导管数据，麻醉诱导后3min，插管后1min和3min，鱼精蛋白给药后5min和30min。术中,每10分钟记录一次血流动力学数据（HR和MAP），除了在冠状动脉远端吻合期间，每5分钟记录一次。术后,24小时后,测定肌钙蛋白T和脑钠肽(BNP)水平。该试验的CTRI注册号是CTRI/005858。
■与I组相比，II组的HR较低（范围为59.6-72.4次/分钟和65.8-80.2次/分钟，分别)在整个研究期间。MAP具有可比性[范围（78.5-87.8mmHg）与II组（78.9-88.5mmHg）与I组,分别]在整个研究期间。术中,1组5例患者接受美托洛尔控制HR,而II组患者均不需要美托洛尔。术前心动过缓（HR<60次/分钟）的发生率在II组（20％）较高。第一组（8%）。两组24小时后肌钙蛋白T和BNP水平无差异，拔管时间，同向异构体的要求，心律失常的发生率，住院发病率，30天死亡率
■在进行OPCAB手术的患者术前期间，伊伐布雷定可以安全地与其他抗心绞痛药一起使用。它有助于在手术过程中保持较低的HR，并减少术中对β受体阻滞剂的需求，在使用β受体阻滞剂可能是潜在有害的情况下，这是理想的和有益的效果。需要进一步的研究来评估围手术期伊伐布雷定对中度至重度左心室功能障碍患者的有益作用。
