Sánchez-Zurita H, Flores-Kim SI, Serrano-Valdez X

Language: Spanish
References: 11
Page: 31-35
PDF size: 63.84 Kb.

ABSTRACT

Objective: To evaluate if the prophylactic administration of milrinone improves the hemodynamic profile after heart surgery under extracorporeal circulation. Materials and methods: Twenty-five patients undergoing heart surgery with cardiopulmonary bypass were divided into two groups: Group I, milrinone (n = 15) and Group II, control (n = 10). General anesthesia was given in a similar fashion to both groups. Group I was impregnated with milrinone 50 µg/kg and received a maintenance dose of 0.5 µg/kg/min after anesthetic induction and before starting surgery. Group II was managed with no milrinone. Invasive monitoring was performed. Pulmonary artery mean pressure (PAMP), cardiac output (CO), cardiac index (CI), stroke volume (SV), systolic index (SI), and left ventricle work index (LVWI) were measured at six time points: preoperatively, milrinone impregnation, beginning of surgery, after sternotomy, end of surgery, and five hours postoperatively. Statistical analysis was performed using average, standard deviation, Student’s t test, ANOVA and Bonferroni correction. Results: Demographic data were statistically similar in both groups. A statistically significant difference, in terms of a better hemodynamic profile, was seen in Group I in CI (p ‹ 0.0001), SV (p ‹ 0.0001), SI (p ‹ 0.0001), and LVWI (p < 0.0001) compared to Group II at all time points. Conclusions: Impregnation with milrinone 50 µg/kg plus a 0.5-µg/kg/min maintenance dose since before the surgical stimulus and until the fifth postoperative hour improved the hemodynamic profile in these patients throughout surgery, reducing the need for other inotropic drugs compared to the control group.

REFERENCES

1. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology 1990;73:308-27.

2. Smiley RM, Vulliemoz Y. Cardiac surgery causes desensibilization of the b-adrenergic receptor system of human lymphocytes. Anesth Analg 1992;74:212-8.

3. Tan LB, Benjamin IJ, Clark WK. Â-adrenergic receptor desensitization may serve a cardioprotective role. Cardiovascular Res 1993;26:608-14.

4. Smiley RM, Pantuck CB, Chadburn A, Knowles DM. Down-Regulation and desensitization of the b-adrenergic receptor system of human lymphocytes after cardiac surgery. Anesth Analg 1993;77:653-61.

5. Kumar A, Haery C, Parrillo JE. Myocardial dysfunction in septic shock: Part 1. Clinical manifestation of cardiovascular dysfunction. Journal of Cardiothoracic and Vascular Anesthesia 2001;15:364-376.

6. Feneck RO and The European Milrinone Multicentre Trial Group. Intravenous milrinone following cardiac surgery: Influence of baseline hemodynamics and patient factors on therapeutic response. Journal of Cardiothoracic and Vascular Anesthesia. 1992;6:563-567.

7. Kikura, Mutsishito, Ikeda, Takehiko, Kazama, Tomiei. Preemptive use of milrinone or milrinone prior to termination of cardiopulmonary bypass is beneficial for maintaining cardiac function and transport in cardiac surgical patients. Anesthesiology 1998;89:282A.

8. Sherry KM, Locke TJ. Use of milrinone in cardiac surgical patients. Cardiovasc Drugs Ther 1993;7:671-5.

9. Benotti JR, Lesko LJ. Pharmacokinetics and pharmacodynamics of milrinone in chronic congestive heart failure. Am J Cardiol 1985;56:685-9.

10. Wright EM, Sherry KM. Clinical and haemodynamics effects of milrinone in the treatment of low cardiac output after cardiac surgery. BR J Anaesth 1991;67:585-90.

11. Mutsushito Kikura, Levy JH. The effect of milrinone on hemodynamics and left ventricular function after emergence from cardiopulmonary bypass. Anesth Analg 1997;85:16-22.