Amrinone, in combination with norepinephrine, is an effective first-line drug for difficult separation from cardiopulmonary bypass

Hardy, Jean‐François; Searle, Norman R.; Roy, Micheline; Perrault, Jean

doi:10.1007/bf03009729

Cited by 44 publications

(10 citation statements)

References 28 publications

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“…Patients were included if they experienced difficult weaning from bypass and required vasoactive medications to leave the operating room. Difficult separation from bypass was defined as a systolic blood pressure Ͻ80 mm Hg confirmed with central measurement (femoral or aortic), diastolic pulmonary artery pressure, or pulmonary artery capillary wedge pressure Ͼ15 mm Hg during progressive weaning from cardiopulmonary bypass and the use of inotropic or vasopressive support (norepinephrine Ͼ4 g/min, epinephrine Ͼ2g/min, dobutamine Ͼ2 g/kg/min, milrinone, or amrinone) or mechanical support (5,9,10).…”

Section: Methodsmentioning

confidence: 99%

Poor correlation between hemodynamic and echocardiographic indexes of left ventricular performance in the operating room and intensive care unit

Bouchard

Denault²,

Couture³

et al. 2004

Critical Care Medicine

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Section: Methodsmentioning

confidence: 99%

Poor correlation between hemodynamic and echocardiographic indexes of left ventricular performance in the operating room and intensive care unit

Bouchard

Denault²,

Couture³

et al. 2004

Critical Care Medicine

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“…[6][7][8][9][10][11][12][13] In addition, milrinone has been shown to improve diastolic performance in patients with congestive heart failure.…”

Section: Méthode : Cinquante Patients Subissant Un Pac Ont éTé Randommentioning

confidence: 99%

Milrinone enhances systolic, but not diastolic function during coronary artery bypass grafting surgery

Couture

Denault

Pellerin

et al. 2007

Can J Anesth/J Can Anesth

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Purpose:To evaluate the effect of milrinone on diastolic function during coronary artery bypass grafting surgery (CABG). Methods:Fifty patients undergoing CABG were randomized to receive a bolus and infusion of milrinone or placebo before cardiopulmonary bypass (CPB) until skin closure. Hemodynamic and transesophageal echocardiographic measurements of systolic and diastolic function were obtained. Pulsed wave Doppler measurements of the early (E wave) and atrial components (A wave) of the transmitral (TMF) and transtricuspid (TTF) flows, and systolic (S wave), diastolic (D wave) and atrial components (Ar) of the pulmonary (PVF) and hepatic venous blood flow (HVF) velocities were performed. Early and atrial components of the mitral (Em and Am waves) and tricuspid annulus velocities (Et and At waves) were assessed by tissue Doppler imaging (TDI). Assessment of diastolic dysfunction was graded from normal to severe using a scale score.Results: Cardiac index and heart rate were higher in the milrinone group compared to placebo after the administration of study drug (2.8 ± 0.6 vs 2.1 ± 0.5 L·min -1 m -2 ) (P < 0.0001) and (67 ± 8 vs 60 ± 12 beats·min -1 ) (P < 0.05) respectively. There were no changes in left and right ventricular diastolic dysfunction scores between study groups. Higher PVF S wave, HVF S wave, TTF A wave and At measured by TDI in the milrinone group compared with placebo suggested an improvement in ventricular systolic and atrial contraction. Conclusion:Distinct from its effects on systolic function, milrinone administered before CPB is not with associated improved biventricular diastolic function in patients undergoing CABG. Objectif : Evaluer l'effet de la milrinone sur la fonction diastolique durant un pontage aortocoronarien (PAC). Méthode : Cinquante patients subissant un PAC ont été randomisés à recevoir soit une dose bolus et une perfusion de milrinone, soit un placebo avant la circulation extracorporelle (CEC) jusqu'à fermeture de la peau. Les mesures hémodynamiques et échocardiographiques transoesophagiennes des fonctions systolique et diastolique ont été obtenues. Les mesures Doppler pulsées des composantes précoces (onde E) et auriculaires (onde A) des débits transmitral (TMF) et transtricuspide (TTF), et les composantes systolique (onde S) diastolique (onde D) et auriculaires (Ar) des vélocités du débit sanguin veineux pulmonaire (PVF) et hépatique (HVF) ont été prises. Les composantes précoces et auriculaires des vélocités de l'anneau mitral (ondes Em et Am) et de l'anneau tricuspide (ondes Et et At) ont été mesurées par Doppler tissulaire (TDI

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“…In patients with heart failure, 9,10 the combination of milrinone and dobutamine causes an increase in HR and a fall in PCWP and SVR, which is consistent with our results. During weaning from cardiopulmonary bypass, 11 amrinone combined with norepinephrine maintains an adequate blood pressure. Because a higher dose of dopamine induces vasoconstriction through activating vascular α 1 -adrenergic receptors, 13 it is not unexpected that compared with two afterload reducers given simultaneously (milrinone + dobutamine), the combination of an afterload reducer and enhancer (milrinone and dopamine particularly in α-range) may work better, because of an unacceptable low blood pressure with the former combination.…”

Section: Discussionmentioning

confidence: 99%

Dopamine may preserve the myocardial oxygen balance better than dobutamine when administered with milrinone

Takamatsu

Karasawa

Okuda

2002

Can J Anesth/J Can Anesth

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Amrinone, in combination with norepinephrine, is an effective first-line drug for difficult separation from cardiopulmonary bypass

Cited by 44 publications

References 28 publications

Poor correlation between hemodynamic and echocardiographic indexes of left ventricular performance in the operating room and intensive care unit

Poor correlation between hemodynamic and echocardiographic indexes of left ventricular performance in the operating room and intensive care unit

Milrinone enhances systolic, but not diastolic function during coronary artery bypass grafting surgery

Dopamine may preserve the myocardial oxygen balance better than dobutamine when administered with milrinone

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