Protective effects of a magnesium magnetic isotope (Mg25)‐exchanging nanoparticle (25MgPMC16) on mitochondrial functional disorders in esmolol‐induced cardiac arrest in rats

1 In cardiac surgery, agents are needed to produce temporary cardiac arrest (cardioplegia). One of these agents is esmolol (ESM) which is a short‐acting selective beta‐1 adrenergic receptor antagonist and its overdose causes diastolic ventricular arrest. 2 The ²⁵MgPMC₁₆ (porphyrin adducts of cyclohexil fullerene‐C60) is known as a nanoparticle which has a cardioprotective effect when the heart is subjected to stressful conditions. 3 In this study, we aimed to confirm the deleterious effects of ESM overdose on cardiac mitochondria and identify any protective effects of ²⁵MgPMC₁₆ in male Wistar rats. Esmolol 100 mg kg^?1 (LD50 = 71 mg kg^?1) was injected intravenously (i.v.) into tail vein to induce cardiac arrest. This dose was obtained from an ESM dose–response curve which induces at least 80% arrest in rats. 4 ²⁵MgPMC₁₆ at three different doses (45, 90 and 224 mg kg^?1) was injected i.v. as pretreatment, eight hours before ESM injection. ²⁵MgCl₂ or ²⁴MgPMC₁₆ were used as controls. Following cardiac arrest, the heart was removed and the mitochondria extracted. Mitochondrial viability and the adenosine 5′‐diphosphate sodium salt hydrate/Adenosine 5′‐triphosphate disodium salt hydrate (ADP/ATP) ratio were measured as biomarkers of mitochondrial function. 5 Results indicate that ²⁵MgPMC₁₆ caused a significant increase in mitochondrial viability and decrease in ADP/ATP ratio. No significant changes were seen with ²⁴MgPMC₁₆ or ²⁵MgCl₂. It is concluded that cardiac arrest induced by ESM overdose leads to a significant decrease in mitochondrial viability and their ATP levels, whereas pretreatment by ²⁵MgPMC₁₆ can protect mitochondria by increasing ATP level through liberation of Mg into cells and the improvement of hypoxia.     

不同剂量艾司洛尔对老年患者全麻气管拔管时心血管反应的作用

目的观察不同剂量艾司洛尔对老年患者气管拔管时心血管反应的作用。方法将80例择期手术病人随机分为A(对照组),B(艾司洛尔0.5mg/kg组),C(艾司洛尔1.0mg/kg组),D(艾司洛尔1.5mg/kg组)。4组拔管前分别静注生理盐水20mL、艾司洛尔0.5、1.0和1.5mg/kg(将艾司洛尔稀释至20mL),记录病人给药前、拔管时、拔管后1、3、5min时收缩压(SBP)、舒张压(DBP)、心率(HR),并计算心率和收缩压乘积(RPP)。结果A组拔管时及拔管后1minSBP、DBP、HR和RPP显著高于给药前(P<0.01);B组拔管时SBP、DBP、HR和RPP显著高于给药前(P<0.01),拔管后1minSBP、DBP、HR和RPP显著低于A组(P<0.05);C、D两组拔管时SBP、DBP、HR和RPP显著低于A、B两组(P<0.05),拔管后1minSBP、DBP、HR和RPP显著低于A组(P<0.01);C、D组拔管后5minSBP、RPP显著低于给药前(P<0.05),但D组有2例用药后发生严重心动过缓。结论静注艾司洛尔1.0mg/kg对老年患者气管拔管时的心血管反应作用效果较好且安全性更大。     

Changes in onset time of rocuronium in patients pretreated with ephedrine and esmolol--the role of cardiac output

BACKGROUND: We investigated the hypothesis that manipulation of cardiac output (CO) with esmolol (Es) or ephedrine (E) affects the onset time of rocuronium. METHODS: Following anesthesia induction, 33 patients received E (70 micro g kg-1), Es (500 micro g kg-1) or placebo (P) 30 s before rocuronium (0.6 mg kg-1) administration. Cardiac output was measured non-invasively after intubation every 3 min. The interval from the end of rocuronium administration to the disappearance of all twitches was considered to be the onset time. RESULTS: Onset time was shorter after E (52.2 +/- 16.5 s) and longer after Es (114.3 +/- 11.1 s) compared with P (87.4 +/- 7.3 s) (P < 0.0001). Cardiac output increased (P < 0.05) in group E for 15 min after rocuronium. In group Es, CO decreased (P < 0.05) at 3 and 6 min. Cardiac output was higher in group E vs. group Es, 3-6 min post administration of rocuronium (P=0.015). CONCLUSION: Pretreatment with E or Es appears to affect the onset time of rocuronium by altering CO as measured with the NICO (Non-Invasive Cardiac Output) monitor (Novametrix Medical Systems Inc., Willingford, CO).     

硝酸甘油复合艾司洛尔用于维持腹腔镜胆囊切除术中循环功能稳定的研究

目的观察硝酸甘油复合艾司洛尔用于维持腹腔镜胆囊切除术(LC)中循环功能稳定的可行性。方法选择90例LC的患者,随机分为3组:A组为对照组,B组为硝酸甘油组,C组为硝酸甘油复合艾司洛尔组,每组各30例。3组均选用全麻。在二氧化碳充气前5min,B组开始硝酸甘油静脉泵注,C组除硝酸甘油外同时复合艾司洛尔0.1mg/(kg·min)持续静脉泵注,并根据MAP的波动调节硝酸甘油的泵注速度,手术结束时停用硝酸甘油和艾司洛尔。观察并记录气腹前(T0)、气腹后15min(T1)、气腹后30min(T2)及术毕10min(T3)的MAP、HR、SpO2、ECG、PETCO2的情况,并计算HR与收缩压(SBP)的乘积(RPP)及B、C两组硝酸甘油的用药量。结果T1、T2、T3与T0比较,A组MAP、HR、RPP明显增加(P<0.05),B组HR和RPP明显增加(P<0.05);T3与T2、T0比较,B组MAP、HR、RPP明显增加(P<0.05);T1、T2、T3时,B组与A组比较,MAP明显降低(P<0.05),C组与A组比较,MAP、HR、RPP明显降低(P<0.05);C组硝酸甘油的用量明显低于B组(P<0.05)。结论硝酸甘油复合艾司洛尔可有效地维持腹腔镜胆囊切除术中循环功能稳定。     

Administration of milrinone before ischemia, in the presence of beta-blockade, to treat metabolic impairment and myocardial stunning in pigs

Background: We examined effects of phosphodiesterase type III inhibition on regional myocardial metabolism and global left ventricular function, during ischemia, in the presence of β-blockade.
Methods: Twenty-three pigs were randomized and studied to completion in four groups: C, did not receive drugs; M, received 50 μg/kg milrinone; E, received esmolol (150 μg/kg/min); E+M, received both. The left anterior descending artery (LADa) was then occluded for 15 min, followed by a 60-min reperfusion. Left ventricular (LV) function data obtained included LV pressures, cardiac output (CO), slope of end-systolic pressure–volume relationship (Emax), and dP/dT. Blood lactate concentrations were obtained from the aorta, LADa, and vein at baseline, end of occlusion, and during early (5 min) and late (1 h) reperfusion.
Results: During ischemia, occlusion produced significant depression in LV dP/dT, Emax and concomitant elevation of LVEDP that persisted over early reperfusion in groups not treated with milrinone. After ischemia, measurements of CO were higher, with lower LVEDP and SVR; LV dP/dT and the Emax were higher, with lower LVEDP in the E+M group vs. the E group. Ischemic region lactate extraction during ischemia was better with E group vs. C group. Esmolol without or with milrinone was associated with nonsignificant lactate ischemic production during early reperfusion from baseline values.
Conclusion: We demonstrated that the pre-emptive administration of milrinone before ischemia was associated with less ischemic hemodynamic effects, without worsening the ischemic metabolic process. The combination E+M diminished ischemic metabolic impairment, and preserved left ventricular function and baseline hemodynamics.     

艾司洛尔在控制性降压中对氧供需平衡的影响

目的:探讨艾司洛尔在控制性降压中对机体血流动力学及氧供需平衡的影响。方法:42例ASAⅠ-Ⅱ级择期脊椎手术患者,随机分为两组,硝普钠联合应用艾司洛尔行控制性降压组(ESNP组)及单纯应用硝普钠行控制性降压组(SNP组),ESNP组用微量泵分别按0.3-6.0 μg·kg-1·min-1输注硝普钠及250-300μg·kg-1·min-1输注艾司洛尔,控制心率至60-80次/min水平,SNP组用微量泵按0.3-6.0μg·kg-1min-1输注硝普钠。持续监测两组患者降压前后的每搏输出量(SVI)、心输出量(CO)、外周血管阻力(SVR)等血流动力学参数的变化,测定动脉血氧饱和度(SaO2)、静脉血氧饱和度(SvO2)、动脉血氧分压(PaO2)、静脉血氧分压(PvO2)等血气指标的动态变化,计算各时段的氧供、氧耗。结果:降压后ESNP组与SNP组相比较,SVI、CO、SvO2、PvO2明显升高,氧耗(VO2)显著降低,差异有显著性,而两组的氧供差异无显著性。结论:艾司洛尔具有促使心率减慢、心室舒张期延长、心排血量增加,从而导致心脏作功下降、氧耗降低的作用。     

爱司洛尔在心血管疾病急症治疗中的临床应用(摘要)

目的　评价爱司洛尔在心血管疾病急症治疗中应用的安全性和疗效。方法　 2 2 5例心血管急症患者 ,其中CABG术后及普通外科术后房扑 房颤分别为 60例及 10 0例 ;不稳定性心绞痛及急性心肌梗死分别为 5 0例及15例。爱司洛尔静脉负荷量 0 .5mg kg,l分钟内静注 ,继以 0 .0 5mg kg min ,持续静脉输注 ,若无效 ,4分钟后静脉负荷量不变 ,维持量递增 ,直至 0 .2mg kg min。结果　CABG术后及外科术后房扑 房颤 2 4小时内的转复率分别为 75 %及83 %。房扑 房颤的快速心室率由用药前 198± 2 7 分下降至 12 9± 16 分 (p <0 .0 5 )。心绞痛和急性心肌梗死患者用药后平均心率由用药前 10 1± 13 (79-12 3 ) 分下降至 77± 14 分 (p <0 .0 5 ) ;平均血压由 12 6± 19 71± 12mmHg下降至10 7± 2 0 62± 8mmHg (p <0 .0 5 )。 3 7恶化劳力性心绞痛的缓解率为 79%。所有患者均未出现严重不良反应。结论　爱司洛尔是用于心血管急症治疗的一种用法安全、疗效确切的较为理想的药物。     

The use of cardioselective β-blockers in a patient with idiopathic hypertrophic subaortic stenosis and chronic obstructive pulmonary disease

The β-adrenergic receptor blocking drugs are commonly used in the treatment of patients with idiopathic hypertropic subaortic stenosis (IHSS). These drugs, however, are contraindicated in patients with chronic obstructive pulmonary disease (COPD). We report the anesthetic management of a patient with IHSS complicated by severe COPD. We concluded that the β₁ selective, ultra-short acting β-blocker, esmolol, can be used intraoperatively when both conditions are present. The pathophysiology and the commonly used anesthetic drugs and practices for treatment of patients with IHSS are reviewed.     

艾司洛尔对老年患者非心脏手术围麻醉期应激反应的抑制作用

目的观察静脉持续输注艾司洛尔对老年患者非心脏手术围麻醉期应激反应的抑制作用。方法65岁以上择期全麻气管插管下行非心脏手术的患者40例，随机分为艾司洛尔组（n=20）与对照组（n=20）。艾司洛尔组麻醉前先静脉注射艾司洛尔0．25mg／kg，然后以20～50μg／（kg·min）的速度用输液泵持续输注，直到气管拔管后5min；对照组以生理盐水替代。记录入室、气管插管前、气管插管后即刻、切皮、手术结束、患者睁眼及拔管后即刻HR、MBP、RPP，以及入室、插管后即刻、切皮、手术结束及拔管后血糖、血香草扁桃酸（BVMA）及血皮质醇水平。结果与对照组比较，艾司洛尔组的HR、RPP在插管后即刻、患者睁眼以及气管拔管后即刻，MBP在气管插管后及睁眼时显著降低（P〈0．05），血糖值在手术结束及拔管后显著降低（P〈0．05或P〈0．01）。艾司洛尔组的芬太尼与异丙酚总量分别为（0．4±0．1）mg和（450．8±98．2）mg，显著少于对照组的（0．5±0．1）mg与（580．3±125．7）mg（P〈0．05）。结论艾司洛尔围麻醉期持续静脉输注可以很好地控制老年患者非心脏手术的应激反应，抑制围麻醉期患者血糖的升高，减少老年患者的麻醉药用量。