[HSF] Inotropes, ventricular fibrillation and myocardial protection

[Prasanna Simha M]

I am not saying that the procaine or lignocaine is still acting. What I
meant is that since the fibrillation is occurring with the hotshot delivery
with high local lignocaine changing the drug class may be beneficial.
Prasanna

On 8/1/07, Ben Bidstrup <benjamin.bidstrup at bigpond.com> wrote:
>
> I beg respectfully to differ. The lidocaine (a fast Na channel
> blocker) is all but gone after a short while in the cardioplegia
> scenario. Getting a suitable level back into the circulation and thus
> the heart at release of the clamp is what is needed.
>
> Perhaps a randomised study is in the offing.
>
> http://circ.ahajournals.org/cgi/content/abstract/79/5/1106
>
> This reference relates to defib energy levels but i think you will
> see where I am coming from.
>
> At James Cook, I was involved in the development of a non
> depolarising cardioplegia solution, which is slowly working its way
> up the development path. The main components are lidocaine and
> adenosine.
>
>
>
>
> >Ben,
> >I use Amiadorone in the pump for all emazes (and postop) and
> >Amiadorone in the pump for all aortic valves. Since the St Thomas
> >Cardioplegia (which we mix in blood) already has procaine adding
> >Lignocaine would be redundant.(Incidentally Amiadorone is very cheap
> >in India !!)
> >Prasanna
> >Ben Bidstrup wrote:
> >>Why the amiodarone. Surely with some perfusion, the electrolyte
> >>imbalances within the myocardium would correct and SR ensue. If
> >>anything use lidocaine. Less toxic and cheaper, not a negative
> >>inotrope. It is what Yacoub taught me many years ago, and I have
> >>used it to good effect (infrequently I might add).
> >>
> >>>Tohru,
> >>>   I did an AVR on an 87 yo man as a 2nd case just a couple of
> >>>hours  ago. Again, no LV vent, only a sump.  While closing the
> >>>aortotomy, I  began the
> >>>continuous warm retrograde blood.  The heart began fibrillating
> >>>after a couple of
> >>>minutes.  I gave amio and then cardioverted.  The  heart had a
> >>>slow junctional
> >>>rhythm until the clamp was released.  A sinus  rhythm developed shortly
> >>>afterwards.  He came off with no inotropes.   It's much easier on
> >>>the heart and
> >>>your nerves to cardiovert a clamped, flaccid  heart rather than
> >>>trying to do it
> >>>after the clamp has been released.
> >>>   I look forward to your visit at the STS.  As I said before,  I'll
> try to
> >>>have a couple of interesting cases for you and other interested
> >>>members of HSF
> >>>to watch and criticize to your heart's content.
> >>>
> >>>Hal
> >>>
> >>>
> >>>
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>
> Two things are infinite; the universe and human stupidity; and I am
> not sure about the universe.
> Albert Einstein
>
> The greatest obstacle to discovery is not ignorance --- it is the
> illusion of knowledge.
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>
> Ben Bidstrup FRACS FRCSEd FEBCTS
> Consultant Cardiothoracic Surgeon
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-- 
Prasanna Simha M