ergoline and Cardiac-Output--Low

Hemodynamic effects of nicergoline injected by intravenous route were studied in 43 patients early after open-heart operations. A serial witnesses has been compared with 5 other groups for which the posologies were increased. Catheterisms of radial artery and pulmonary artery allows the measuring of systolic arterial pressure (SP), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP) and cardiac index (CI). The heart rate (HR) was noticed. The systemic vascular resistance (SVR), the stroke index (SI) and the left ventricular stroke work index (SWI) were calculated. The results were statistically analysed by the Student test. After injection of a bolus of 0,3 mg kg-1 by intravenous route, stable effects are obtained with a maintenance posology of 0,8 mg.kg-1.h-1. The SP diminishes by 20 p. cent (123 to 104 mm Hg; p less than 0,01). There is a loose of 16 p. cent from the RAP (9,5 to 8 mm Hg; p less than 0,05) and of 18 p. cent from the PCWP (16,5 to 13,5 mm Hg; NS). The HR decreases by 13 p. cent (97 to 81 syst. min.-1; p less than 0,05). The CI increases by 25 p. cent (2,2 to 2,75 1.min.-1m-2; p less than 0,01); the SI by 40 p. cent (35 to 35 ml beat-1m-2; p less than 0,01) and the SWI by 32 p. cent (27,5 to 36 g.m.m-2; p less than 0,05). We conclude from this investigation that nicergoline injected through intravenous route with an output of 0,8 mg.kg-1.h-1 mainly leads to afterload reduction. Thanks to its effect on the CI and on the HR as well as to its mild to moderate action, it is a clinical useful agent for primary or adjunctive therapy of postoperative low cardiac output.

Topics: Adult; Aged; Cardiac Output; Cardiac Output, Low; Cardiac Surgical Procedures; Ergolines; Female; Hemodynamics; Humans; Infusions, Parenteral; Male; Middle Aged; Neuroleptanalgesia; Nicergoline; Postoperative Complications

We investigated the potential value of vasodilating therapy in critically ill patients with inappropriately low cardiac output during acute illness. In seven patients with low flow state during septic or postoperative state, sodium nitroprusside (20-100 micrograms/min) was compared with nicergoline (NIC) (0.5 to 2.5 mg/min), a new selective alpha 1-blocking agent with negative chronotropic action. Sodium nitroprusside (NP) decreased arterial pressure (from 90 +/- 5 to 68 +/- 5 mm Hg, p less than 0.01) and pulmonary artery balloon-occluded pressure from 20.3 +/- 3.1 to 15.4 +/- 2.8 mm Hg, p less than 0.01) and increased heart rate (from 110 +/- 11 to 120 +/- 13 beats/min, p less than 0.05) but failed to increase stroke volume (from 24.7 +/- 4.8 to 23.4 +/- 4.4 ml, NS). During NIC administration, a comparable decrease in systemic vascular resistance was associated with a significant increase in stroke volume (from 21.6 +/- 3.3 to 25.6 +/- 3.2 ml/m2, p less than 0.01) and cardiac output (CO) (from 2.4 +/- 0.3 to 2.7 +/- 0.3 L/min/m2, p less than 0.025), whereas the decrease in arterial pressure was less significant (from 91 +/- 8 to 84 +/- 7 mm Hg, p less than 0.05). Because NIC has no positive inotropic action, the most likely mechanism is that a baroreceptor-mediated increase in heart rate with NP was prevented by the negative chronotropic action of NIC. Both drugs adversely affected arterial blood oxygenation. By its unique property to decrease heart rate, NIC could represent a valuable vasodilating agent, especially in acute conditions.

Topics: Cardiac Output, Low; Critical Care; Ergolines; Ferricyanides; Humans; Infections; Nicergoline; Nitroprusside; Postoperative Complications; Time Factors