Evaluation of the Preventive Effect of Midodrine Administration on Vasoplegia during Cardiac Surgery, Compared with the Control Group

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, School of Medicine AND Students Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

3 Assistant Professor, Department of Epidemiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

AbstractBackground: Cardiac vasoplegic syndrome is vasodilatory shock that occurs in half of the patients after cardiopulmonary bypass surgery and increases mortality and morbidity rates in these patients. The aim of this study was to evaluate the preventive effect of midodrine administration on vasoplegia during cardiac surgery.Methods: The study included 71 patients undergone cardiac surgery. The patients were randomly divided into two groups and the intervention group received a tablet of 5 mg midodrine and control group received placebo one hour before the surgery. Vital signs in both groups during different levels of surgery were studied. The data were compared using t, chi-square and Mann-Whitney tests.Findings: According to mean differences in patients’ vital signs in both groups before induction of anesthesia, we found that the mean difference in diastolic blood pressure after anesthesia (P = 0.004) and after pump (P = 0.009), dropped in the control group for 0.49 and 5.5 mmHg, respectively; while in the intervention group it was stable. Administered ephedrine was lower in intervention group (20.71 mg) than the control group (41.56 mg) (P = 0.001).Conclusion: This study showed that systolic and diastolic blood pressures in patients receiving midodrine were greater than the control group during cardiac surgery. Midodrine stabilizes vital signs and reduces the risk of cardiac vasoplegic syndrome.

Keywords

References

  1. Byrne JG, Leacche M, Paul S, Mihaljevic T, Rawn JD, Shernan SK, et al. Risk factors and outcomes for 'vasoplegia syndrome' following cardiac transplantation. Eur J Cardiothorac Surg 2004; 25(3): 327-32.
  2. Gomes WJ, Carvalho AC, Palma JH, Teles CA, Branco JN, Silas MG, et al. Vasoplegic syndrome after open heart surgery. J Cardiovasc Surg (Torino) 1998; 39(5): 619-23.
  3. Leyh RG, Kofidis T, Struber M, Fischer S, Knobloch K, Wachsmann B, et al. Methylene blue: the drug of choice for catecholamine-refractory vasoplegia after cardiopulmonary bypass? J Thorac Cardiovasc Surg 2003; 125(6): 1426-31.
  4. Ozal E, Kuralay E, Yildirim V, Kilic S, Bolcal C, Kucukarslan N, et al. Preoperative methylene blue administration in patients at high risk for vasoplegic syndrome during cardiac surgery. Ann Thorac Surg 2005; 79(5): 1615-9.
  5. Blackstone EH, Kirklin JW, Stewart RW, Chenoweth DE. The damaging effects of cardiopulmonary bypass. In: Wu KK, Rossi EC, Editors. Prostaglandins in Clinical Medicine: Cardiovascular and Thrombotic Disorders. Chicago, IL: Year Book Medical Publishers; 1982. p. 355.
  6. Levin RL, Degrange MA, Bruno GF, Del Mazo CD, Taborda DJ, Griotti JJ, et al. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery. Ann Thorac Surg 2004; 77(2): 496-9.
  7. Argenziano M, Chen JM, Choudhri AF, Cullinane S, Garfein E, Weinberg AD, et al. Management of vasodilatory shock after cardiac surgery: identification of predisposing factors and use of a novel pressor agent. J Thorac Cardiovasc Surg 1998; 116(6): 973-80. Egi M, Bellomo R, Langenberg C, Haase M, Haase A, Doolan L, et al. Selecting a vasopressor drug for vasoplegic shock after adult cardiac surgery: a systematic literature review. Ann Thorac Surg 2007; 83(2): 715-23.
  8. Papadopoulos G, Sintou E, Siminelakis S, Koletsis E, Baikoussis NG, Apostolakis E. Perioperative infusion of low-dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study. J Cardiothorac Surg 2010; 5: 17.
  9. Weiner MM, Lin HM, Danforth D, Rao S, Hosseinian L, Fischer GW. Methylene blue is associated with poor outcomes in vasoplegic shock. J Cardiothorac Vasc Anesth 2013; 27(6): 1233-8.
  10. Parsaik AK, Singh B, Altayar O, Mascarenhas SS, Singh SK, Erwin PJ, et al. Midodrine for orthostatic hypotension: a systematic review and meta-analysis of clinical trials. J Gen Intern Med 2013; 28(11): 1496-503.
  11. Izcovich A, Gonzalez Malla C, Manzotti M, Catalano HN, Guyatt G. Midodrine for orthostatic hypotension and recurrent reflex syncope: A systematic review. Neurology 2014; 83(13): 1170-7.
  12. Ramirez CE, Okamoto LE, Arnold AC, Gamboa A, Diedrich A, Choi L, et al. Efficacy of atomoxetine versus midodrine for the treatment of orthostatic hypotension in autonomic failure. Hypertension 2014; 64(6): 1235-40.
Journal of Isfahan Medical School
Volume 34, Issue 392 - Serial Number 392
May and June 2016
Pages 857-864

Files

History

  • Receive Date: 16 December 2015
  • Revise Date: 30 April 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics