[HSF] Inotropes, ventricular fibrillation and myocardial protection

[Ani Anyanwu]

I still do not understand why we are alarmed about transient ventricular fibrillation on reperfusion and why using drugs to suppress it will have any impact on outcome.
 
Ani



> Date: Wed, 1 Aug 2007 11:51:47 +0530> From: prasannasimha at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Inotropes, ventricular fibrillation and myocardial protection> CC: > > 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> > >>>> > >>>> > >>>> > >>>************************************** Get a sneak peek of the> > >>>all-new AOL at> > >>>http://discover.aol.com/memed/aolcom30tour> > >>>_______________________________________________> > >>>OpenHeart-L mailing list> > >>>> > >>>Send postings to:> > >>> OpenHeart-L at lists.hsforum.com> > >>>> > >>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > >>>http://mmp.cjp.com/mailman/listinfo/openheart-l> > >>>> > >>>All messages transmitted by the OpenHeart-L are subject to the policies> > and> > >>>disclaimers posted at:> > >>>http://www.hsforum.com/listdisclaim> > >>>-----------------------------------------> > >>> > >>> > >> > >_______________________________________________> > >OpenHeart-L mailing list> > >> > >Send postings to:> > >OpenHeart-L at lists.hsforum.com> > >> > >To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > >http://mmp.cjp.com/mailman/listinfo/openheart-l> > >> > >All messages transmitted by the OpenHeart-L are subject to the> > >policies and disclaimers posted at:> > >http://www.hsforum.com/listdisclaim> > >-----------------------------------------> >> >> > --> >> >> > 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.> > Daniel J Boorstin> >> > Ben Bidstrup FRACS FRCSEd FEBCTS> > Consultant Cardiothoracic Surgeon> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> > > > -- > Prasanna Simha M> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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