PMID- 37470523
OWN - NLM
STAT- MEDLINE
DCOM- 20231102
LR  - 20231103
IS  - 0974-5181 (Electronic)
IS  - 0971-9784 (Print)
IS  - 0971-9784 (Linking)
VI  - 26
IP  - 3
DP  - 2023 Jul-Sep
TI  - Effect of preoperative ivabradine on hemodynamics during elective off-pump CABG.
PG  - 260-267
LID - 10.4103/aca.aca_97_22 [doi]
AB  - BACKGROUND: Ivabradine is a specific heart rate (HR)-lowering agent which blocks 
      the cardiac pacemaker I(f) channels. It reduces the HR without causing a negative 
      inotropic or lusitropic effect, thus preserving ventricular contractility. The 
      authors hypothesized that its usefulness in lowering HR can be utilized in 
      patients undergoing off-pump coronary artery bypass (OPCAB) surgery. OBJECTIVE: 
      To study the effects of preoperative ivabradine on hemodynamics (during surgery) 
      in patients undergoing elective OPCAB surgery. METHODS: Fifty patients, New York 
      Heart Association (NYHA) class I and II, were randomized into group I (control, n 
      = 25) and group II (ivabradine group, n = 25). In group I, patients received the 
      usual anti-anginal medications in the preoperative period, as per the 
      institutional protocol. In group II, patients received ivabradine 5 mg twice 
      daily for 3 days before surgery, in addition to the usual anti-anginal 
      medications. Anesthesia was induced with fentanyl, thiopentone sodium, and 
      pancuronium bromide as a muscle relaxant and maintained with fentanyl, midazolam, 
      pancuronium bromide, and isoflurane. The hemodynamic parameters [HR and mean 
      arterial pressure (MAP)] and pulmonary artery (PA) catheter-derived data were 
      recorded at the baseline (before induction), 3 min after the induction of 
      anesthesia at 1 min and 3 min after intubation and at 5 min and 30 min after 
      protamine administration. Intraoperatively, hemodynamic data (HR and MAP) were 
      recorded every 10 min, except during distal anastomosis of the coronary arteries 
      when it was recorded every 5 min. Post-operatively, at 24 hours, the levels of 
      troponin T and brain natriuretic peptide (BNP) were measured. This trial's CTRI 
      registration number is CTRI/005858. RESULTS: The HR in group II was lower when 
      compared to group I (range 59.6-72.4 beats/min and 65.8-80.2 beats/min, 
      respectively) throughout the study period. MAP was comparable [range (78.5-87.8 
      mm Hg) vs. (78.9-88.5 mm Hg) in group II vs. group I, respectively] throughout 
      the study period. Intraoperatively, 5 patients received metoprolol in group I to 
      control the HR, whereas none of the patients in group II required metoprolol. The 
      incidence of preoperative bradycardia (HR <60 beats/min) was higher in group II 
      (20%) vs. group I (8%). There was no difference in both the groups in terms of 
      troponin T and BNP level after 24 hours, time to extubation, requirement of 
      inotropes, incidence of arrhythmias, in-hospital morbidity, and 30-day mortality. 
      CONCLUSION: Ivabradine can be safely used along with other anti-anginal agents 
      during the preoperative period in patients undergoing OPCAB surgery. It helps to 
      maintain a lower HR during surgery and reduces the need for beta-blockers in the 
      intraoperative period, a desirable and beneficial effect in situations where the 
      use of beta-blockers may be potentially harmful. Further studies are needed to 
      evaluate the beneficial effects of perioperative Ivabradine in patients with 
      moderate-to-severe left ventricular dysfunction.
FAU - Virmani, Sanjula
AU  - Virmani S
AD  - Department of Anaesthesiology and Intensive Care, G B Pant Institute of 
      Postgraduate Medical Education and Research, J L Nehru Marg, New Delhi, India.
FAU - Mallik, Indira
AU  - Mallik I
AD  - Department of Cardiac Anaesthesia, PGIMS Rohtak, Haryana, India.
FAU - Mohire, Vishwanath B
AU  - Mohire VB
AD  - Department of Cardiac Anaesthesia, Superspeciality Hospital, NSCB Medical 
      College, Jabalpur, MP, India.
FAU - Geelani, Muhammad Abid
AU  - Geelani MA
AD  - Department of Cardiothoracic Surgery, G B Pant Institute of Postgraduate Medical 
      Education and Research, J L Nehru Marg, New Delhi, India.
FAU - Minhas, Harpreet Singh
AU  - Minhas HS
AD  - Department of Cardiothoracic Surgery, G B Pant Institute of Postgraduate Medical 
      Education and Research, J L Nehru Marg, New Delhi, India.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - India
TA  - Ann Card Anaesth
JT  - Annals of cardiac anaesthesia
JID - 9815987
RN  - 3H48L0LPZQ (Ivabradine)
RN  - GEB06NHM23 (Metoprolol)
RN  - J76UF062FS (Pancuronium)
RN  - 0 (Troponin T)
RN  - UF599785JZ (Fentanyl)
SB  - IM
MH  - Humans
MH  - Ivabradine/therapeutic use/pharmacology
MH  - *Metoprolol/pharmacology
MH  - Pancuronium/pharmacology
MH  - Troponin T/pharmacology
MH  - Hemodynamics
MH  - *Coronary Artery Bypass, Off-Pump/methods
MH  - Fentanyl
PMC - PMC10451143
OTO - NOTNLM
OT  - Heart rate
OT  - ivabradine
OT  - off-pump coronary artery bypass grafting
COIS- There are no conflicts of interest.
EDAT- 2023/07/20 13:06
MHDA- 2023/07/20 13:07
PMCR- 2023/07/01
CRDT- 2023/07/20 09:28
PHST- 2023/07/20 13:07 [medline]
PHST- 2023/07/20 13:06 [pubmed]
PHST- 2023/07/20 09:28 [entrez]
PHST- 2023/07/01 00:00 [pmc-release]
AID - AnnCardAnaesth_2023_26_3_260_381822 [pii]
AID - ACA-26-260 [pii]
AID - 10.4103/aca.aca_97_22 [doi]
PST - ppublish
SO  - Ann Card Anaesth. 2023 Jul-Sep;26(3):260-267. doi: 10.4103/aca.aca_97_22.