Does intravenous landiolol, a β1-adrenergic blocker, affect stroke volume variation?

• Published in: Journal of anesthesia 2013-12, Vol.27 (6), p.890-894
• Main Authors: Wajima, Zen’ichiro, Shiga, Toshiya, Imanaga, Kazuyuki, Inoue, Tetsuo
• Format: Article
• Language: English
• Subjects: Adrenergic beta-1 Receptor Antagonists - pharmacology; Adult; Aged; Anesthesiology; Blood Pressure - drug effects; Bradycardia - drug therapy; Bradycardia - metabolism; Carbon Dioxide - metabolism; Cardiac Output - drug effects; Critical Care Medicine; Emergency Medicine; Female; Heart Rate - drug effects; Humans; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; Morpholines - pharmacology; Original Article; Pain Medicine; Prospective Studies; Stroke Volume - drug effects; Urea - analogs & derivatives; Urea - pharmacology; Vascular Resistance - drug effects
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-013-1622-8

Purpose There are no reports about the effect of bradycardia on stroke volume variation (SVV), and we hypothesized that induced bradycardia alters the value of SVV. Landiolol, an ultra-short-acting adrenergic β 1 -receptor blocking agent, was reported to induce bradycardia without decreasing blood pressure. The initial aim of this prospective study was to investigate changes in SVV values by induced bradycardia in patients with good cardiac function. Methods At 30 min after anesthesia induction, if heart rate (HR) was >80 bpm, the patient was chosen as a subject. Ten ASA physical status I–II patients aged 38–75 years who were scheduled for elective abdominal surgery were included in this study. Baseline values were recorded, and then administration of landiolol was started at 125 μg/kg/min for 1 min and then continued at 40 μg/kg/min. SVV and other parameters were recorded at baseline and 3 min after continuous landiolol injection. Results Landiolol significantly decreased systolic arterial pressure, and diastolic arterial pressure, contrary to our expectations, and also HR, SVV, cardiac output, stroke volume index, and pressure of end-tidal CO 2 , whereas systemic vascular resistance values increased significantly. Conclusions SVV decreased after continuous administration of a β 1 -adrenergic blocker, probably because of a decrease in the difference of maximum stroke volume (SV) and minimum SV, or the downward shift of the Frank–Starling curve that occurred after landiolol administration. We believe that SVV values might be overestimated or misinterpreted when HR is decreased by landiolol and might not necessarily indicate that the patient is hypervolemic or normovolemic.