[HSF] Inotropes, ventricular fibrillation and myocardial protection

Wed Aug 1 21:15:53 EDT 2007

Ani,
Having graduated from voodoo homemade cocktails to blood and its 
variants, you would easily be able to see that the bad cardioplegia's 
did have a higher (more accurately uniform) incidence of fibrillation 
which came down with better modifications of  cardioplegia's. That does 
make us wary and anyway fibrillation is not something by any stretch 
normal.Transient defibrillation may appear innocuous but then it has 
been shown that such hearts have indeed been improperly preserved (from 
works of Buckberg and Kirklin).Remember that sometimes speed etc etc may 
compensate but this may become an issue in  longer case.
Prasanna
Ani Anyanwu wrote:
> 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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