Preoperative Inhalation of Milrinone Attenuates Inflammation in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Abstract

Objectives: The purpose of this study was to evaluate the effect of preoperative inhalation of milrinone on cardiopulmonary bypass (CPB)-related inflammation. Subjects and Methods: A total of 30 patients undergoing cardiac surgery were recruited and randomized for preoperative inhalation of milrinone (Mil group) or normal saline (NS group), respectively. Each group had 15 patients. Their hemodynamic parameters were measured and blood samples were obtained longitudinally. The levels of serum interleukin (IL-6), tumor necrosis factor-α (TNF-α), and matrix metalloproteinase (MMP)-9 were determined by ELISA. Results: The levels of serum IL-6, TNF-α, and MMP-9 significantly increased at the end of cardiac surgery and remained high for 24 h in both groups of patients. However, the levels of proinflammatory cytokines at the end of cardiac surgery in the Mil group of patients were significantly lower than those of the NS group of patients. Conclusions: Our data indicated that preoperative inhalation of milrinone significantly mitigated CPB-related inflammation.

A multicentre randomized-controlled trial of inhaled milrinone in high-risk cardiac surgical patients

“…Exposure to iMil has been reported in 279 patients in small unblinded trials, 10,11,[13][14][15][16] retrospective analyses, 12,19 in combination with iPGI 2 , 18 and in case reports. [20][21][22][23][24][25][26] One trial involving 21 patients compared iMil (n = 11) with placebo.…”

“…7 The use of inhaled milrinone (iMil) has been described in several animal 8,9 and human reports. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Compared with its alternatives [i.e., inhaled nitric oxide (iNO) and inhaled prostacyclin (iPGI 2 )], iMil possesses inotropic properties, is less expensive, does not require a complex administration system, and does not have toxic metabolites. Furthermore, contrasted with iPGI 2 , iMil is readily available in most cardiac operating rooms and needs no special preparation.…”

Enterovirus 71 infection and neurological complications

“…Milrinone is a drug for congestive heart failure, and has both inotropic and vasodilator properties53). Milrinone also has anti-inflammatory effects54). A recent prospective, open-label, randomized controlled study demonstrated that patients who were treated with intravenous milrinone (0.5 µg/kg/min) and intravenous immunoglobulin had a lower 1-week mortality rate compared with patients who were treated with dopamine or dobutamine and intravenous immunoglobulin (18.2% vs. 57.9%)55).…”

Milrinone Therapy for Enterovirus 71-Induced Pulmonary Edema and/or Neurogenic Shock in Children

“…Murinone when administered with catecholamines has been shown to improve cardiovascular function in volume-resuscitated pédiatrie patients with septic shock (31). It suppresses the production of pro-inflammatory cytokines, such as interleukin (IL)-Iß, IL-6, tumor necrosis factor-a, and matrix metallopeptidase-9, by elevating cyclic adenosine monophosphate levels (14,15,32). It suppresses the production of pro-inflammatory cytokines, such as interleukin (IL)-Iß, IL-6, tumor necrosis factor-a, and matrix metallopeptidase-9, by elevating cyclic adenosine monophosphate levels (14,15,32).…”