PROCAINE IS EFFECTIVE FOR MINIMIZING POSTISCHEMIC VENTRICULAR-FIBRILLATION IN CARDIAC-SURGERY

Procaine hydrochloride was added to cardioplegia and studied for its e fficacy in stabilizing the postischemic rhythm after aortic declamping in cardiac surgery. Fifty-six patients scheduled for coronary artery bypass grafting (CABG), were included in a randomized, double-blind st udy. The patients were anesthetized with isoflurane, low-dose fentanyl , diazepam, and pancuronium. In the study group (28 patients), St. Tho mas' Hospital cardioplegic solution II (Plegisol(R)) was prepared with 1 mM procaine. The control group (28 patients) was given the same car dioplegia with saline. Ventricular fibrillation (VF) occurring after d eclamping was treated with direct current (DC) shock (8-12-12-20 J). T here were no significant differences with regard to demographic proper ties or anesthesiologic and surgical treatment. Two patients (7%) in t he procaine group required DC shock for VF, compared to 28 (100%) in t he control group (P < 0.001). The amount of lidocaine (mean +/- SEM) g iven for resistant dysrhythmias was 3.6 mg +/- 3.6 in the procaine gro up compared to 35.7 mg +/- 9.2 in the control group (P < 0.002). One p atient in each group required temporary pacing. The number of synchron ized DC shocks for conversion of atrial fibrillation was lower in the procaine group (P < 0.05). The enzyme release the first day after surg ery was lower in the procaine group (P < 0.05). Procaine (1 mM) in car dioplegia stabilizes the postischemic rhythm in CABG surgery in humans without any observed adverse effects.