Abstract
Purpose
This study evaluated the effect of neostigmine on heart rate in cardiac transplant patients.
Methods
Neostigmine (2.5–50 μg · kg−1) was administered to ASA 1 or 2 patients with normally innervated hearts (controls), and to patients who had undergone recent (<six months before study) or remote (> six months before study) cardiac transplantation.
Results
Baseline heart rate was 66 ± 3 beats · min−1 in controls (n = 10, mean ± SEM), which was slower than that observed in recently (95 ± 4 beats · min−1, n = 15, P < 0.001) and in remotely (88 ± 3 beats · min−1, n = 16, P < 0.001) transplanted patients. Neostigmine produced a dose-dependent decrease in heart rate in all patients. Controls were the most sensitive to neostigmine, with a 10% decrease in heart rate produced by an estimated dose of 5.0 ± 1.0 μg · kg−1. The recently transplanted group was the least sensitive, with the maximum dose producing only an 8.3 ± 0.9% reduction. The response to neostigmine of the remotely transplanted patients was variable. The estimated dose to produce a 10% decrease in heart rate in this group was 24 ± 6 μg · kg−1 which was greater than that for controls (P = 0.008). Administration of atropine (1.2 mg) reversed the neostigmine-induced bradycardia in all three groups. Reversal of the bradycardia consisted of a transient peak increase in heart rate in controls to 145 ± 6% of baseline, a value which was greater than that observed in recent (103 ± 1%, P < 0.001) and in remote (109 ± 3%, P < 0.001) transplants.
Conclusions
Neostigmine produces a dose-dependent brady-cardia in heart transplant patients. Some remotely transplanted patients may be particularly sensitive to the bradycardic effects of neostigmine.
Résumé
Objectif
Evaluer les effets de la néostigmine sur les transplantés cardiaques.
Méthodes
De la néostigmine (2,5–50 μg · kg−1) a été administrée à des patients ASA 1 ou 2 dont le coeur était innervé normalement (contrôles) et à des patients qui avaient subi une transplantation cardiaque récente (<six mois) ou plus ancienne.
Résultats
La fréquence cardiaque de base était de 66 ± 3 b · min−1 (n = 10, moyenne ± SEM) laquelle était inférieure à celle des transplantés récents (95 ± 4 b · min−1, n = 15, P < 0,001). La néostigmine a produit une baisse de la fréquence proportionnelle à la dose chez tous les patients. Les contrôles ont été plus sensibles à la néostigmine, avec une baisse de 10% produite par une dose estimée de 5,0 ± 1,0 μg · kg−1. Les transplantés récents ont été les moins sensibles, alors que la dose maximale ne produisait qu’une baisse de 8,3 ± 0,9%. La réponse à la néostigmine des transplantés plus anciens a été variable. La dose estimée, pour produire une baisse de 10% de la fréquence cardiaque, plus élevée que pour les contrôles, était de 24 ± 6 μg · kg−1 (P = 0,008). L’administration d’atropine a neutralisé la bradycardie induite par le néostigmine chez les trois groupes. L’antagonisme de la bradycardie a été caractérisé par une augmentation transitoire de la fréquence cardiaque à 145 ± 6% de la valeur initiale dans le groupe contrôle, valeur plus importante que chez les transplantés récents (103 ± 1%, P < 0,001) et anciens (108 ± 3%, P < 0,001).
Conclusions
Le néostigmine produit une bradycardie proportionnelle à la dose chez le transplanté cardiaque. Quelques uns des transplantés plus anciens peuvent être plus particulièrement sensibles aux effets bradycardisants de la néostigmine.
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Financial support for this study was provided by the Royal Victoria Hospital Research Institute.
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Backman, S.B., Fox, G.S., Stein, R.D. et al. Neostigmine decreases heart rate in heart transplant patients. Can J Anaesth 43, 373–378 (1996). https://doi.org/10.1007/BF03011717
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DOI: https://doi.org/10.1007/BF03011717