Looking for Protocols… The Potential Benefits of del Nido Cardioplegia :

Frank,

“I wanted to post a question on your site asking if anyone has experience, protocols or literature supporting the use of Del Nido cardioplegia in adults.  Love the site, great first year.

Thank you.

Patrick Grady

Hi Patrick,

I’m not the guy with the answers, but I am sure there are a lot of people out there that could interject and give you an informed answer regarding Del Nido cardioplegia in adults.

I did a google search- but can’t say it was all THAT enlightening…

=

Anybody out there…

From Jorge Molina, CCP

Plasmalyte-A based cardioplegias made possible by Toronto Sick Children’s cardioplegia master, Dr. Ivan Rebeyka which was put into the formulary there in March of 1993.

It was originally a 2:1 ratio by Dr. Rebeyka and still in use there. Dr. Rebeyka, now in Edmonton utilizes a 1:4 ratio. There have been various Lidocaine formulas with different dosages as well as different potassium dosages in the clinical arena and well established.

The most popular is the Boston/del Nido formula which utilizes higher lidocaine/KCL for longer cross-clamps. It has been discussed that the current Rebeyka formula may be the best choice for short cross-clamps under 60 minutes.

Rebeyka uses 20 mEq of KCL and 100 mg Lidocaine.

The Morell uses 75 mgs Lidocaine and about 26 mEq of KCL.

My choice for shorter cross-clamps is the Rebeyka 20 & 100 doses. Otherwise some colleagues say that the heart is sluggish for a while before it wakes up.

The other thought by Boston is to simply give half the dose. Because myocardial preservation requires hypothermia as a principle goal in addition to drugs, it is the opinion of this perfusionist to simply give the full dose of 20ml/kg but with the other two established formulas for projected short cross-clamps times.

Food for thought from this hombre.

Jorge :)

Space 1

Some Literature:

J Thorac Cardiovasc Surg. 2011 Mar;141(3):762-70. Epub 2010 Jul 24.

Protecting the aged heart during cardiac surgery: the potential benefits of del Nido cardioplegia.

O’Blenes SB, Friesen CH, Ali A, Howlett S.

Source

IWK Health Centre, Halifax, Nova Scotia, Canada. stacy.oblenes@iwk.nshealth.ca

Abstract

OBJECTIVE:

Aged hearts are more vulnerable than mature hearts to reperfusion injury during cardiac surgery because of altered cardiomyocyte Ca(2+) homeostasis. Inasmuch as immature cardiomyocytes have similar properties, a specialized cardioplegic solution (del Nido cardioplegia) designed to protect children’s hearts may also be beneficial for elderly patients. Our objective was to evaluate the ability of del Nido cardioplegic solution, containing lidocaine and less Ca(2+) than our standard cardioplegic solution, to protect aged cardiomyocytes during cardioplegic arrest and reperfusion.

METHODS:

We used our novel isolated cell model of cardioplegic arrest and reperfusion to compare the effect of del Nido cardioplegic solution with that of our standard cardioplegic solution on intracellular Ca(2+) concentration, contractions, and membrane potential in cardiomyocytes from senescent rat hearts.

RESULTS:

The incidence of spontaneous contractions during cardioplegic arrest was lower with del Nido cardioplegia (3/11 vs 9/11 cells; P < .05) than with standard cardioplegia, and contractions could not be induced by field stimulation of cardiomyocytes arrested with del Nido cardioplegia (0/11 vs 9/11 cells; P < .05). Intracellular diastolic Ca(2+) levels were lower during arrest with del Nido cardioplegia (57.10 ± 3.06 vs 76.19 ± 3.45 nmol/L; P < .05). During early reperfusion, a potentially injurious rapid recovery of intracellular Ca(2+) associated with hypercontraction in cardiomyocytes arrested with standard cardioplegic solution was avoided in cells treated with del Nido cardioplegia (81.42 ± 2.99 vs 103.15 ± 4.25 nM; P < .05).

CONCLUSIONS:

Del Nido cardioplegic solution has the potential to provide superior myocardial protection in senescent hearts by preventing electromechanical activity during cardioplegic arrest and Ca(2+)-induced hypercontraction during early reperfusion.Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

PMID:

20656301

[PubMed – indexed for MEDLINE]