Bolus administration of landiolol, a short-acting, selective beta1-blocker, to treat tachycardia during anesthesia: a dose-dependent study.

OBJECTIVES: The purpose of this study was to clarify the clinical efficacy of landiolol, a selective beta(1)-blocker, in patients developing tachycardia during anesthesia. DESIGN: A prospective, randomized, and placebo-controlled study. SETTING: A single university hospital. PARTICIPANTS: Patients undergoing resection of intracranial or maxillofacial tumors under general anesthesia. INTERVENTIONS: Intravenous bolus administration of landiolol. MEASUREMENTS AND MAIN RESULTS: Patients with heart rates exceeding 90 beats/min for more than 5 minutes received an intravenous bolus dose of landiolol. These patients who developed tachycardia were randomized into 4 groups receiving landiolol in the dose of 0, 0.1, 0.2, or 0.3 mg/kg. Heart rate and blood pressure were recorded before drug injection and 1, 3, 5, 7, 10, 15, 20, 25, and 30 minutes after the injection. Heart rate was significantly reduced with each dose of landiolol compared with the placebo group between 3 and 20 minutes after drug injection. The lowest heart rate was 93 +/- 4, 80 +/- 8, 79 +/- 8, and 77 +/- 6 beats/min (mean +/- standard deviation) in the landiolol 0, 0.1, 0.2, and 0.3 mg/kg groups, respectively. On the other hand, reduction of blood pressure was not as remarkable as that of heart rate. Landiolol, 0.1 and 0.2 mg/kg, did not significantly reduce systolic or diastolic blood pressure during the study period, although significant reduction of blood pressure was observed in the landiolol 0.3-mg/kg group between 5 and 10 minutes after drug injection. CONCLUSION: The results showed that bolus administration of landiolol was effective in the treatment of tachycardia during anesthesia in surgical patients. Landiolol was more efficacious in reducing heart rate than blood pressure.

[An experience of intraoperative blood salvage in emergency laparotomy for severe abdominal injury].

A 34-year-old male patient, who had fallen from a balcony suffering liver injury, underwent emergency laparotomy for right liver lobectomy and portal vein repair. For the first two hours of operation, the blood loss exceeded 12,000 ml, and his hemoglobin level dropped to 2.6 g x dl(-1) despite administration of 30 units of packed red cells (MAP). At this point, no more MAP was available in our hospital. Then we decided to initiate intraoperative blood salvage in order to minimize the further loss of hemoglobin. For 26,200 ml of the total blood loss, 1160 ml of packed red cells were restored from 7600 ml of salvaged blood, and 46 units of MAP, 40 units of fresh frozen plasma and 20 units of platelets were administered. His postoperative course was not complicated by systemic infection. Although intraoperative blood salvage is proved to be useful for reducing allogenic transfusion, it is not recommended to be used in surgery for trauma because of a potential risk of serious systemic infection. Our experience, however, suggests that intraoperative blood salvage could be utilized as a life-saving means even in trauma surgery.