Hemodynamic Instability Clinical Trial
This single-institution randomized controlled trial prospective will enrolled 48 patients scheduled for an aortic valve replacement. The objective of the present investigation is to determine the role of Polaramine® on reducing hemodynamic instability after separation from cardiopulmonary bypass (CPB) during cardiac surgery. Our hypothesis is that Polaramine® play an important role reducing dysfunction of the autonomic nervous system and hemodynamic stability after separation from CPB.
Vasoplegic syndrome is recognized as a common complication after CPB. Its incidence ranges
from 5% to 25% after cardiac surgery requiring CPB. Such syndrome is related to an
inflammatory reaction, which is attributed to the CPB. This syndrome is typically
characterized by a combination of different parameters with low specificity and sensitivity,
such as low systemic vascular resistance leading to a hypotension imposing perfusion of
vasopressors with high or normal cardiac outputs.
Investigators preliminary data suggest that vasoplegic syndrome might be related to heart
manipulation during surgery. Tearing maneuvers performed on the heart chambers trigger peaks
pressure stimulating, consequently, baroreceptors and finally resulting in arteriovenous
vasodilation via neurogenic and endogenous pathways. According to investigators initial
investigation, such reaction appears to be related to basophils degranulation and release of
vasoactive substances.
The hypothesis of the present trial is that a reduction of basophils degranulation and
release of vasoactive substances via an antihistaminic could lower the incidence of the
vasoplegic syndrome. This study aims to determine the effect of an antihistamine
(dexchlorpheniramine (Polaramine®)) administered intravenously before CPB, on the vasoplegic
syndrome incidence after separation from CPB.
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