Transitional programming.
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Community Mental Health Centers↗
Biomedical subjects
C Conklin
Publications and source records attributed to C Conklin.
Comparison of esmolol and nitroprusside for acute post-cardiac surgical hypertension.
Because acute systemic hypertension early after cardiac surgery has been linked to catecholamine elevation, an open-label, randomized, crossover study was performed to compare the efficacy of esmolol, a new ultra-short-acting intravenous beta-blocking agent, to nitroprusside, the standard therapy. Controlled drug infusions to maximal dosage (esmolol, 300 micrograms/kg/min, and nitroprusside, 10 micrograms/kg/min) were titrated to achieve at least a 15% reduction in systolic pressure. The blood pressure (BP) endpoint was achieved with esmolol (within 29 +/- 14 minutes) in 18 of 20 patients (90%), compared with 19 of 20 (95%) with nitroprusside infusion (within 21 +/- 15 minutes, difference not significant [NS]). Systolic BP decreased from 170 +/- 13 to 136 +/- 12 mm Hg (mean +/- standard deviation) with esmolol and from 170 +/- 13 to 141 +/- 13 mm Hg with nitroprusside infusion (both p less than 0.05). Diastolic BP was reduced from 71 +/- 12 to 64 +/- 11 mm Hg with esmolol and from 71 +/- 12 to 52 +/- 13 mm Hg with nitroprusside infusion (both p less than 0.05). Esmolol infusion resulted in decreased heart rate, cardiac index and stroke volume index and increased right atrial pressure (all p less than 0.05), whereas nitroprusside infusion resulted in increased heart rate and cardiac index and decreased right atrial pressure, pulmonary arterial wedge pressure and systemic vascular resistance (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenergic beta-Antagonists↗
The neonatal status score: a predictor of mortality.
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Female↗
Use of esmolol in hypertension after cardiac surgery.
Systolic hypertension, which is common soon after cardiac surgery, increases cardiac work and may threaten fresh vascular anastomoses. Because postoperative hypertension is often associated with elevated catecholamines and preoperative use of beta-blocking agents, esmolol, an ultrashort-acting beta-blocking agent, was compared with nitroprusside in a crossover study in this setting. Twelve patients, 18 to 28 hours after cardiac surgery (coronary artery bypass graft in 9, aortic valve replacement in 2 and valved aortic conduit with reimplantation of coronary arteries in 1 patient) received controlled infusions of esmolol (mean dosage 142 +/- 100 micrograms/kg/min, range 50 to 300 micrograms/kg/min) and nitroprusside (mean dose 1.6 +/- 1.3 micrograms/kg/min, range 0.5 to 2.75 micrograms/kg/min). In this open-label study, choice of the first drug was randomized, after which patients were then crossed over to the other study drug. Therapeutic response (greater than or equal to 15% systolic blood pressure reduction) was achieved in 11 of 12 esmolol patients and 12 of 12 nitroprusside patients. Both drugs significantly lowered systolic and diastolic blood pressure, as well as left ventricular stroke work index. While the cardiac index was decreased by esmolol and increased by nitroprusside, neither drug significantly changed stroke volume index. Systemic vascular resistance, unchanged by esmolol, was decreased significantly by nitroprusside. Oxygen saturation and Pao2, unchanged with esmolol, were both significantly reduced with nitroprusside. Thus, for hypertension early after cardiac surgery, esmolol is safe, effective and rapid and, compared with nitroprusside, results in less unwanted decrease in diastolic blood pressure and oxygen saturation, but there is more decrease in heart rate and cardiac index.
Adrenergic beta-Antagonists↗