Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery
Abstract Background Postoperative atrial fibrillation (POAF) is commonplace after cardiothoracic surgery. A rate control strategy using short-acting beta blockers is recommended as a first-line therapy in patients without hemodynamic instability. Microcirculatory effects of POAF and esmolol have not...
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doaj-cf30dc6fcfdb4433a98e604b62cea5682020-11-24T21:42:07ZengBMCCritical Care1364-85352017-12-012111810.1186/s13054-017-1889-5Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgeryWilliam Fornier0Matthias Jacquet-Lagrèze1Thomas Collenot2Priscilla Teixeira3Philippe Portran4Rémi Schweizer5Michel Ovize6Jean-Luc Fellahi7Department of Anesthesiology and Intensive Care Medicine, University Hospital Louis PradelDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Louis PradelDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Louis PradelDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Louis PradelDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Louis PradelDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Louis PradelInserm U1060, IHU OPERA, Faculty of Medicine, Claude Bernard Lyon 1 UniversityDepartment of Anesthesiology and Intensive Care Medicine, University Hospital Louis PradelAbstract Background Postoperative atrial fibrillation (POAF) is commonplace after cardiothoracic surgery. A rate control strategy using short-acting beta blockers is recommended as a first-line therapy in patients without hemodynamic instability. Microcirculatory effects of POAF and esmolol have not yet been investigated. We hypothesized that POAF without hemodynamic instability would induce microvascular dysfunction which could be reversed by intravenous esmolol. Methods Twenty-five cardiothoracic surgical patients with POAF were included in the study. Microcirculation was assessed by peripheral near-infrared spectroscopy (NIRS) in association with a vascular occlusion test (VOT) before esmolol infusion, during incremental doses of esmolol (25, 50, 100, and 200 μg/kg/min), and after a return to sinus rhythm. Esmolol was given to control heart rate to between 60 and 90 beats/min. Regional tissue oxygen saturation variables (StO2, StO2 min, StO2 max, and ∆StO2) and desaturation/resaturation speeds during VOT were recorded to evaluate the microcirculation. Results StO2 and resaturation speed were significantly improved when POAF returned to sinus rhythm (StO2 64% ± 6 versus 67% ± 6, P < 0.01; resaturation speed 0.53%/s (0.42–0.97) versus 0.66%/s (0.51–1.04), P = 0.020). ∆StO2 was significantly decreased after a return to sinus rhythm (7.9% ± 4.8 versus 6.1% ± 4.7, P = 0.026). During esmolol infusion, we found a significant decrease in both heart rate (P < 0.001) and blood pressure (P < 0.001), and a non-significant dose-dependent increase in StO2 (P = 0.081) and resaturation speed (P = 0.087). Conclusion POAF without hemodynamic instability is associated with significant impairment in the microcirculation which could be partially reversed by intravenous esmolol.http://link.springer.com/article/10.1186/s13054-017-1889-5Regional oxygen saturationPostoperative atrial fibrillationMicrocirculationNear-infrared spectroscopyEsmololBeta blocker |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
William Fornier Matthias Jacquet-Lagrèze Thomas Collenot Priscilla Teixeira Philippe Portran Rémi Schweizer Michel Ovize Jean-Luc Fellahi |
spellingShingle |
William Fornier Matthias Jacquet-Lagrèze Thomas Collenot Priscilla Teixeira Philippe Portran Rémi Schweizer Michel Ovize Jean-Luc Fellahi Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery Critical Care Regional oxygen saturation Postoperative atrial fibrillation Microcirculation Near-infrared spectroscopy Esmolol Beta blocker |
author_facet |
William Fornier Matthias Jacquet-Lagrèze Thomas Collenot Priscilla Teixeira Philippe Portran Rémi Schweizer Michel Ovize Jean-Luc Fellahi |
author_sort |
William Fornier |
title |
Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery |
title_short |
Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery |
title_full |
Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery |
title_fullStr |
Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery |
title_full_unstemmed |
Microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery |
title_sort |
microvascular effects of intravenous esmolol in patients with normal cardiac function undergoing postoperative atrial fibrillation: a prospective pilot study in cardiothoracic surgery |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2017-12-01 |
description |
Abstract Background Postoperative atrial fibrillation (POAF) is commonplace after cardiothoracic surgery. A rate control strategy using short-acting beta blockers is recommended as a first-line therapy in patients without hemodynamic instability. Microcirculatory effects of POAF and esmolol have not yet been investigated. We hypothesized that POAF without hemodynamic instability would induce microvascular dysfunction which could be reversed by intravenous esmolol. Methods Twenty-five cardiothoracic surgical patients with POAF were included in the study. Microcirculation was assessed by peripheral near-infrared spectroscopy (NIRS) in association with a vascular occlusion test (VOT) before esmolol infusion, during incremental doses of esmolol (25, 50, 100, and 200 μg/kg/min), and after a return to sinus rhythm. Esmolol was given to control heart rate to between 60 and 90 beats/min. Regional tissue oxygen saturation variables (StO2, StO2 min, StO2 max, and ∆StO2) and desaturation/resaturation speeds during VOT were recorded to evaluate the microcirculation. Results StO2 and resaturation speed were significantly improved when POAF returned to sinus rhythm (StO2 64% ± 6 versus 67% ± 6, P < 0.01; resaturation speed 0.53%/s (0.42–0.97) versus 0.66%/s (0.51–1.04), P = 0.020). ∆StO2 was significantly decreased after a return to sinus rhythm (7.9% ± 4.8 versus 6.1% ± 4.7, P = 0.026). During esmolol infusion, we found a significant decrease in both heart rate (P < 0.001) and blood pressure (P < 0.001), and a non-significant dose-dependent increase in StO2 (P = 0.081) and resaturation speed (P = 0.087). Conclusion POAF without hemodynamic instability is associated with significant impairment in the microcirculation which could be partially reversed by intravenous esmolol. |
topic |
Regional oxygen saturation Postoperative atrial fibrillation Microcirculation Near-infrared spectroscopy Esmolol Beta blocker |
url |
http://link.springer.com/article/10.1186/s13054-017-1889-5 |
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