Comparison of early and late intravenous infusion of milrinone in pediatric patients undergoing cardiac surgery

Abstract

Objective: This study was done to compare the effects of early and late use of milrinone in pediatric patients undergoing complex cardiac surgery. Design:The study was a prospective randomized study. Setting: Prince Sultan cardiac center, Saudi Arabia. Methods:A prospective study involved 40 pediatric patients undergoing congenital corrective cardiac surgery, classified randomly into two groups (N=20). Group A: Milrinone infusion was started without loading dose, at 0.5mcg/kg/min at the beginning of CPB and continued postoperatively (0.5-0.75 mcg/kg/min) in the PCICU. Group B: Milrinone was started as a loading dose 50mcg/kg over 10 min after aortic declamping and continued as infusion (0.5-0.75 mcg/kg/min) postoperatively in the PCICU. Data were collected at baseline, 1 st , 6 th , 12 th , and 24 th postoperative hours in the ICU. Results:The inotropic supports and mechanical supports were needed more in group B than group A. The comparison of heart rate, CVP, temperature, hemoglobin, SpO2 and PaCO2, were insignificant between the two groups (P>0.05). The mean arterial blood pressure through the first 6 hours postoperatively was higher in group A than group B (P<0.05), but became insignificant through other timepoints. The urine output and central venous oxygen saturation were higher in group A than group B (P<0.05).The serum lactate levels were significantly higher in group B more than group A (P<0.05).Conclusion: early use of milrinone, lead to easy weaning from CPB , decreased requirement of pharmacological and mechanical support and decreased the incidence of low cardiac output syndrome after pediatric cardiac surgery and there was no complications related to milrinone in our study patients.

Milrinone: is bolus bad?

“…Similar studies in children undergoing various congenital heart surgeries[ 8 ] and in adults with pulmonary hypertension undergoing coronary artery bypass graft[ 9 ] and and/or valve surgeries on CPB were published with very similar results. However, this study is different from those studies that it is done in Fontan circulation and has shown the benefits of initiating the infusion at the beginning of the CPB.…”

Assessment of the effect of two regimens of milrinone infusion in pediatric patients undergoing fontan procedure: A randomized study

“…A similar study in pediatric patients undergoing congenital corrective cardiac surgery showed that early milrinone increased the mean arterial blood pressure, central venous oxygen saturation, urine output and associated with decreased serum lactate level. [ 15 ] The good results with early uses of milrinone at the beginning of CPB may be related to the increased level of milrinone in the blood and its effect on the tissue perfusion during and after CPB[ 16 ] and other studies showed the same results. [ 6 7 ]…”