A Multicenter, Randomized, Blind Comparison of Amrinone with Milrinone After Elective Cardiac Surgery

Rathmell, James P.; Prielipp, Richard C.; Butterworth, John F.; Williams, Elliott; Villamaria, Frank J.; Testa, Lisa; Viscomi, Christopher M.; Ittleman, Frank P.; Baisden, Clinton E.; Royster, Roger L.

doi:10.1097/00000539-199804000-00001

Cited by 26 publications

(7 citation statements)

References 10 publications

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“…The inodilator clearly increased the CI secondary to an increase in HR, while SVI remained unchanged. Milrinone reduced both SVRI and PVRI (19,21), but in the present model with a fixed RV afterload, the LV afterload was primarily affected. The interventricular volume relationship seemed unchanged, as judged by a stable EDVI in both the RV and LV.…”

Section: Discussionmentioning

confidence: 50%

Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in an animal model with right ventricular failure after pulmonary artery banding

Hyldebrandt

Sivén

Agger

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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Right ventricular (RV) failure due to chronic pressure overload is a main determinant of outcome in congenital heart disease. Medical management is challenging because not only contractility but also the interventricular relationship is important for increasing cardiac output. This study evaluated the effect of milrinone alone and in combination with epinephrine or dopamine on hemodynamics, ventricular performance, and the interventricular relationship. RV failure was induced in 21 Danish landrace pigs by pulmonary artery banding. After 10 wk, animals were reexamined using biventricular pressure-volume conductance catheters. The maximum pressure in the RV increased by 113% (P < 0.0001) and end-diastolic volume by 43% (P < 0.002), while left ventricular (LV) pressure simultaneously decreased (P = 0.006). Concomitantly, mean arterial pressure (MAP; -16%, P = 0.01), cardiac index (CI; -23%, P < 0.0001), and mixed venous oxygen saturation (SvO2 ; -40%, P < 0.0001) decreased. Milrinone increased CI (11%, P = 0.008) and heart rate (HR; 21%, P < 0.0001). Stroke volume index (SVI) decreased (7%, P = 0.03), although RV contractility was improved. The addition of either epinephrine or dopamine further increased CI and HR in a dose-dependent manner but without any significant differences between the two interventions. A more pronounced increase in biventricular contractility was observed in the dopamine-treated animals. LV volume was reduced in both the dopamine and epinephrine groups with increasing doses In the failing pressure overloaded RV, milrinone improved CI and increased contractility. Albeit additional dose-dependent effects of both epinephrine and dopamine on CI and contractility, neither of the interventions improved SVI due to reduced filling of the LV.

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Section: Discussionmentioning

confidence: 50%

Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in an animal model with right ventricular failure after pulmonary artery banding

Hyldebrandt

Sivén

Agger

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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“…3 17 Intravenous milrinone has also been shown to reduce pulmonary artery pressure, pulmonary vascular resistance and increase cardiac index. 18,19 Solina and colleagues compared nitric oxide to intravenous milrinone in 45 cardiac surgical patients with pulmonary hypertension. 15 However, compared to milrinone, inhaled NO was associated with lower heart rates, higher right ventricular ejection fraction, and lower requirement for treatment with vasopressor agents.…”

Section: Studies On Intravenous Milrinone In Cardiac Surgerymentioning

confidence: 99%

Inhaled Milrinone: A New Alternative in Cardiac Surgery?

Denault

Lamarche

Couture³

et al. 2006

Semin Cardiothorac Vasc Anesth

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The administration of milrinone through inhalation has been studied in only a few animal and human studies. Compared to the intravenous administration, inhaled milrinone has been shown to reduce pulmonary artery pressure without systemic hypotension. Therefore, this approach could represent an alternative to nitric oxide. This current state of knowledge of intravenous and inhaled milrinone is presented and summarized.

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“…These agents have the unique ability to improve diastolic relaxation of the ventricle (lusitropy), which may be poor following cardiopulmonary bypass. Both amrinone and milrinone result in increased cardiac output as well as decreased systemic vascular resistance that may require volume resuscitation or an alpha agonist [10] to counteract.…”

Section: Opinion Statementmentioning

confidence: 99%

“…10. RN and RT extubate patient and administer O 2 to maintain SpO 2 ≥ 93%: If CPAP PaO 2 was ≥ 100 on FiO 2 0.5 and secretions are manageable, administer O 2 via nasal cannula.…”

mentioning

confidence: 99%

Respiratory and hemodynamic management after cardiac surgery

Liu

Gropper

2002

Curr Treat Options Cardio Med

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In this new era of managed care, the emphasis has been on the reduction of intensive-care stay after coronary artery bypass surgery. "Fast-track" or rapid weaning protocols have become increasingly popular due to evidence that shows their cost-effectiveness and safety. With new advances in surgical and anesthetic techniques, the goal is often to have patients extubated within 4 to 6 hours upon arrival in the intensive-care unit. Patients who are not candidates for the fast-track protocol are often those who either have poor respiratory function and a large A-a gradient or those who have hemodynamic instability from poor cardiac function after bypass. These patients need more intensive care and more traditional weaning from mechanical ventilation. Those that are not able to wean from the mechanical ventilator within a few weeks are candidates for tracheostomy in order to avoid complications from prolonged endotracheal intubation and to improve pulmonary toilet. The treatment of perioperative low cardiac output syndrome is another goal after bypass surgery. Poor cardiac function can be managed with a variety of vasopressor and inotropic agents based on what the suspected derangement is from clinical examination and hemodynamic measurements (eg, low preload, low cardiac index, high or low systemic vascular resistance). Another modality that has been shown to have benefit on reducing hospital stay and costs is prophylaxis for atrial fibrillation, which may occur in 40% of patients who undergo bypass surgery and in 60% of those who undergo valve replacement surgery. Beta-blockers and amiodarone have both been found to be effective as prophylaxis against postoperative atrial fibrillation.

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A Multicenter, Randomized, Blind Comparison of Amrinone with Milrinone After Elective Cardiac Surgery

Cited by 26 publications

References 10 publications

Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in an animal model with right ventricular failure after pulmonary artery banding

Effects of milrinone and epinephrine or dopamine on biventricular function and hemodynamics in an animal model with right ventricular failure after pulmonary artery banding

Inhaled Milrinone: A New Alternative in Cardiac Surgery?

Respiratory and hemodynamic management after cardiac surgery

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