Effects of Milrinone continuous intravenous infusion on global cerebral oxygenation and cerebral vasospasm after cerebral aneurysm surgical clipping

Ghanem, Mohamed; Shabana, Amir M.

doi:10.1016/j.egja.2013.07.006

Cited by 11 publications

(10 citation statements)

References 17 publications

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“…, 35 In 7 studies only data on immediate results were available, 14 , 15 , 17 , 19 , 23 , 34 , 35 and in one publication the follow-up time was not specified 24 . All reviewed articles except for 7 17 , 19 , 20 , 23 - 25 , 35 reported information on the occurrence of adverse effects associated with milrinone: 12 of the 17 studies reported that no adverse hemodynamic changes were observed 13 , 14 , 21 , 22 , 26 , 27 , 29 - 34 while the other 5 12 , 15 , 16 , 18 , 28 reported only mild increases in heart rate and a decreased blood pressure that in some cases required institution of vasopressors or an increase in the dose of preexisting vasopressors. No instances of severe hypotension requiring discontinuation of therapy or severe arrhythmias or other significant side effects were described.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining citations consisted of 6 case reports, one prospective case series with a comparison group built with historical controls, 23 and one prospective non-randomized unblinded comparative study. 12 In this latter study there is no mention of how the control group was selected and it is unclear whether allocation concealment was maintained. The primary outcome in this one study was the non-invasive measurement of transcranial mixed venous oxygen saturation during therapy.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

Lannes

Zeiler

Guichon

et al. 2016

Can. J. Neurol. Sci.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

Lannes

Zeiler

Guichon

et al. 2016

Can. J. Neurol. Sci.

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“…Results of a recent meta-analysis demonstrated that cilostazol is effective in decreasing the incidence of symptomatic cerebral vasospasm, severe cerebral vasospasm, and cerebral vasospasm-related new cerebral infarctions after SAH [19 ▪▪ ]. Similarly, continuous infusion of milrinone significantly improved global cerebral oxygenation, and reduced the incidence of cerebral vasospasm during the critical 4 to 11 day postoperative period following cerebral aneurysm clipping surgery [20]. …”

Section: Improving Neurological Outcomes After Subarachnoid Hemorrhagementioning

confidence: 99%

Postoperative ICU management of patients after subarachnoid hemorrhage

Gruenbaum

Bilotta²

2014

Current Opinion in Anaesthesiology

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Purpose of review This article reviews recent advances in the postoperative ICU management of patients after subarachnoid hemorrhage (SAH), especially with regards to hemodynamic management, methods of improving neurological outcomes, and management of cardiac and pulmonary complications. Recent findings Several hemodynamic monitors and parameters may be useful for guiding volume therapy, including cardiac output, stroke volume variation monitoring, and global end-diastolic volume index. Early goal-directed hemodynamic therapy after SAH has recently been shown to improve clinical outcomes in patients with a poor clinical grade or coexisting cardiopulmonary complications. Recent laboratory and imaging modalities are being developed to identify patients at risk for developing vasospasm after SAH. Evidence for the use of various prophylactic adjuvant therapies to prevent vasospasm, including magnesium, phosphodiesterase 3 inhibitors, and therapeutic hypothermia, is emerging. Intrathecal administration of vasodilators or fibrinolytics may have offered advantages over systemic drug administration in the treatment of vasospasm. Pulmonary and cardiac complications are common after SAH, and are associated with an increased risk of mortality. Summary The postoperative ICU period after SAH is associated with a significant morbidity and mortality risk, and recent studies have greatly contributed to our understanding of how to optimally manage these patients.

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“…Furthermore, studies have documented a significant increase in cerebral perfusion pressure and improvement in global cerebral oxygenation using milrinone infusion in post-aneurysm clipping patients. [8] It is one of the standard drugs used for the management of vasospasm following aneurysmal SAH.…”

Section: Discussionmentioning

confidence: 99%

Successful management of diastolic heart failure in a patient with restrictive cardiomyopathy following an anterior communicating artery aneurysm clipping

Arumugam

Singh

Raju

et al. 2017

Journal of Neuroanaesthesiology and Critical Care

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Perioperative management of neurosurgical patients with an underlying myocardial dysfunction poses a unique challenge to the neuroanaesthesiologist and the neurointensivist. Sudden catecholamine surge during the aneurysmal subarachnoid haemorrhage (SAH) can cause severe cardiac dysfunction such as myocardial ischaemia and cardiomyopathy. SAH in a patient with restrictive cardiomyopathy could be hazardous to the myocardium leading to severe cardiac morbidity. We report the successful management of an acute post-operative diastolic heart failure with a milrinone infusion in a patient with restrictive cardiomyopathy, following anterior communicating artery aneurysm clipping. We have discussed the ‘dual beneficial’ role of milrinone on the heart and the brain in this clinical setting. In addition, the importance of peri-operative utilisation of transoesophageal echocardiography and transthoracic echocardiography for the successful management of diastolic heart failure is highlighted.

show abstract

Effects of Milrinone continuous intravenous infusion on global cerebral oxygenation and cerebral vasospasm after cerebral aneurysm surgical clipping

Cited by 11 publications

References 17 publications

The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

The Use of Milrinone in Patients with Delayed Cerebral Ischemia Following Subarachnoid Hemorrhage: A Systematic Review

Postoperative ICU management of patients after subarachnoid hemorrhage

Successful management of diastolic heart failure in a patient with restrictive cardiomyopathy following an anterior communicating artery aneurysm clipping

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