Comparison of two different loading doses of milrinone for weaning from cardiopulmonary bypass
To compare the hemodynamic effects, pharmacokinetic profiles, and the need for vasoactive agents between a low (20 μg/kg during 15 minutes [group 1; n = 10]) and a high (40 μg/kg during 15 minutes [group 2; n = 10]) loading dose of milrinone. Prospective, randomized, double-blind. University hospita...
Saved in:
| Published in: | Journal of cardiothoracic and vascular anesthesia Vol. 9; no. 3; pp. 264 - 271 |
|---|---|
| Main Authors: | , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Philadelphia, PA
Elsevier Inc
01-06-1995
Elsevier |
| Subjects: | |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | To compare the hemodynamic effects, pharmacokinetic profiles, and the need for vasoactive agents between a low (20 μg/kg during 15 minutes [group 1;
n = 10]) and a high (40 μg/kg during 15 minutes [group 2;
n = 10]) loading dose of milrinone.
Prospective, randomized, double-blind.
University hospital.
Twenty patients scheduled for elective coronary artery surgery.
Weaning from CPB was achieved using a strict protocol. After atrioventricular pacing at 90 beats per minute and preload optimalization, a first weaning attempt was started with only calcium and nitroglycerin as support. If this attempt was unsuccessful (cardiac index < 2L/min/m
2), CPB was reinitiated and weaning level 2 was prepared, consisting of inotropic support with milrinone. Patients received either the low (group 1) or the high (group 2) loading dose of milrinone. After the end of the loading dose, a continuous infusion of milrinone of 0.5 μg/kg/min was started in both groups.
Both groups were comparable regarding preoperative and intraoperative data. Hemodynamic data were comparable in both groups at each time of measurement (
p = 0.941). The need for vasoactive medication (norepinephrine [NE]) in order to keep mean arterial pressure ≥50 mm Hg was significantly higher in group 2 (
p = 0.004). Need for NE during the loading infusion was 9.6 ± 4.9 μg (mean ± SEM) in group 1 and 41.6 ± 7.6 μg in group 2 (
p = 0.004). Need for NE during the immediate post-CPB period was also higher in group 2 (16.0 ± 10.4 μg in group 1 and 232.5 ± 82.8 μg in group 2 (
p = 0.002)). Plasma clearance of milrinone after CPB was less in both groups than in healthy volunteers. However, clearance of milrinone was significantly higher in group 2 (
p = 0.006), and consequently, half-life of milrinone was significantly less in group 2 (
p = 0.007).
The present results demonstrate that when milrinone is used during weaning from CPB, a loading dose of 20 μg/kg provided to similar hemodynamic support a loading dose of 40 μg/kg. The need for vasoconstrictive medication was significantly less in the group with the low loading dose. |
|---|---|
| Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23 |
| ISSN: | 1053-0770 1532-8422 |
| DOI: | 10.1016/S1053-0770(05)80319-2 |