Skip to main content Accessibility help
×
Home
Hostname: page-component-55597f9d44-5zjcf Total loading time: 0.442 Render date: 2022-08-17T20:55:13.964Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue false

Reply

Published online by Cambridge University Press:  01 January 2008

N. K. Chinnan*
Affiliation:
The Canberra Hospital Woden, ACT, Australia
G. D. Puri
Affiliation:
Department of Anaesthesia and Intensive CarePost Graduate Institute of Medical Education and Research (PGIMER)Chandigarh, India
S. K. S. Thingnam
Affiliation:
Department of Cardiothoracic and Vascular SurgeryPost Graduate Institute of Medical Education and Research (PGIMER)Chandigarh, India
*
Correspondence to: Nevin Kollannoor Chinnan, The Canberra Hospital, PO Box-11, Woden, ACT, Australia. E-mail: nevinkc2001@yahoo.com; Tel: +61 424486052; Fax: +61 262443300

Abstract

Type
Correspondence
Copyright
Copyright © European Society of Anaesthesiology 2007

EDITOR:

We thank Kiss and colleagues for their valuable comments. The faster onset of electromechanical arrest after administration of cardioplegia is very likely due to the coronary vasodilating properties of nicorandil [Reference Chinnan, Puri and Thingnam1]. Coronary vasodilatation could have also resulted in better distribution of the cardioplegic solution and improved myocardial preservation and, hence, fewer arrhythmias while coming off cardiopulmonary bypass (CPB) and less risk of postoperative myocardial infarction. The increased incidence of myocardial infarction in the nicorandil group coronary artery bypass grafting (CABG) patients could be multifactorial. However, it is interesting to note that three out of four patients who had a postoperative myocardial infarction in the nicorandil group, CABG patients were diabetics. Our study did not look into coronary artery spasms in the postoperative period. In this context, we would like to refer to a case report where nicorandil infusion was used to manage distal micro-vascular spasm characterized by ST segment elevation in the electrocardiogram, serially elevated cardiac enzymes (creatine kinase and creatine phosphokinase-MB) and new onset regional wall motion abnormalities in the absence of fixed or vasospastic occlusion of coronary vessels on angiography [Reference Mizogami, Shimo, Taguchi and Horita2]. With regard to reperfusion injuries and arrhythmias, intravenous and intracoronary nicorandil have been shown to be of benefit after percutaneous coronary interventions for acute myocardial infarctions [Reference Takarabe, Okazaki, Higuchi, Murayama, Natsuaki and Itoh3,Reference Ota, Nishikawa and Takeuchi4]. After prolonged cardioplegic arrest (4 h) in an isolated rabbit heart model, nicorandil was found to attenuate ischaemia–reperfusion injury of the myocardium and coronary endothelium, and ameliorate leukocyte activation [Reference Hara, Horinaka and Yabe5]. These findings by other researchers are in accordance with our observations. We would also like to clarify that we used a terminal infusion of warm blood cardiolplegia (hot shots) before coming off CPB as it is the present day standard of care and apologize for not making that clear in our study protocol. We fully agree with Kiss and colleagues that a larger multicentre randomized controlled trial is required to determine the efficacy and the role of nicorandil in certain subclasses of patients like those developing coronary artery spasms in the postoperative period, and diabetics undergoing cardiac surgery.

References

1.Chinnan, NK, Puri, GD, Thingnam, SKS. Myocardial protection by nicorandil during open heart surgery under cardiopulmonary bypass. Eur J Anaesthesiol 2007; 24: 2632.CrossRefGoogle ScholarPubMed
2.Mizogami, M, Shimo, K, Taguchi, T, Horita, Y. Stunned myocardium after hip arthroplasty. Br J Anaesth 2000; 84: 510513.CrossRefGoogle ScholarPubMed
3.Takarabe, K, Okazaki, Y, Higuchi, S, Murayama, J, Natsuaki, M, Itoh, T. Nicorandil attenuates reperfusion injury after long cardioplegic arrest. Asian Cardiovasc Thorac Ann 2007; 15: 204209.CrossRefGoogle ScholarPubMed
4.Ota, S, Nishikawa, H, Takeuchi, M et al. . Impact of nicorandil to prevent reperfusion injury in patients with acute myocardial infarction: Sigmart Multicenter Angioplasty Revascularization Trial (SMART). Circ J 2006; 70: 10991104.CrossRefGoogle Scholar
5.Hara, H, Horinaka, S, Yabe, A et al. . Suppressive effect of nicorandil in ventricular arrhythmias after reperfusion therapy in patients with acute myocardial infarction. J Cardiol 2007; 49: 135141.Google ScholarPubMed
You have Access

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Reply
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Reply
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Reply
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *