Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Oct 1992
Randomized Controlled Trial Comparative Study Clinical TrialAmrinone and dobutamine as primary treatment of low cardiac output syndrome following coronary artery surgery: a comparison of their effects on hemodynamics and outcome.
This study was undertaken in order to compare the effectiveness of amrinone and dobutamine as primary treatment of a low cardiac output (CO) after coronary artery bypass graft (CABG) surgery. Thirty patients with preoperative left ventricular dysfunction participated in this open-label randomized study. Patients were included if they failed to separate from cardiopulmonary bypass (CPB) without inotropic support or if they had a cardiac index (CI) less than 2.4 L/min/m2 after CPB regardless of the blood pressure, in the presence of adequate filling pressures. ⋯ Six dobutamine patients (40%) had postoperative myocardial infarction (MI) as opposed to none among the amrinone patients (P = 0.017). These results indicate that amrinone compares favorably with dobutamine as a primary treatment of low CO after CABG. Further study in a larger number of patients will be required in order to determine if the lower incidence of MI in the amrinone group was due to the treatment drug.
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J. Cardiothorac. Vasc. Anesth. · Oct 1992
Multicenter Study Clinical TrialIntravenous milrinone following cardiac surgery: I. Effects of bolus infusion followed by variable dose maintenance infusion. The European Milrinone Multicentre Trial Group.
The hemodynamic and adverse effects of intravenous milrinone were studied in 99 adult patients (66 men) following elective myocardial revascularization, mitral and/or aortic valve surgery. All patients had a low cardiac output (cardiac index [CI] mean 1.93, range, 1.11 to 2.5 L/min/m2) despite adequate cardiac filling pressure (mean pulmonary capillary wedge pressure [PCWP] 11.5 mmHg, range, 8 to 20 mmHg). Following a period of baseline stability (mean 17.8 minutes, range, 10 to 50 minutes), patients received a bolus infusion of 50 micrograms/kg over 10 minutes. ⋯ These effects were maintained to a significant degree by each of the three maintenance infusion regimens, although the pulmonary vasodilator effects appeared less predictable and more dose dependent. Eighteen patients (19%) had arrhythmias; 16 of these were judged not to be serious events. Two were deemed serious; these were both episodes of fast atrial fibrillation (AF).(ABSTRACT TRUNCATED AT 250 WORDS)
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J. Cardiothorac. Vasc. Anesth. · Oct 1992
Multicenter Study Clinical TrialIntravenous milrinone following cardiac surgery: II. Influence of baseline hemodynamics and patient factors on therapeutic response. The European Milrinone Multicentre Trial Group.
Further analysis of the data from 99 adult patients who received an intravenous infusion of milrinone following elective cardiac surgery was done. All patients received a bolus infusion of 50 micrograms/kg over 10 minutes, followed by a maintenance infusion of either 0.375, 0.5 or 0.75 microgram/kg/min for a period of 12 hours. Hemodynamic measurements were made after the bolus infusion (15 minutes), and then after 30, 45, and 60 minutes at 3, 6, and 12 hours, and 4 hours after treatment was stopped. ⋯ Patients with a low CI (1.59 L/min/m2) had a 54% increase after the bolus infusion compared to a 27% increase in patients with a higher pretreatment value (2.2 L/min/m2) (P < 0.05); (2) patients with a high resting level of pulmonary vascular resistance (PVR > 200 dynes.sec.cm-5) had a greater response to treatment (26% fall in PVR) than the remainder (9% fall in PVR) after 60 minutes; (3) patients with a low pretreatment mean arterial pressure (MAP) (n = 17, MAP 64 mmMg, range, 52 to 70) showed no fall in MAP following treatment, but showed a significant increase in CI (+55%). A good therapeutic response was found that was similar in patients undergoing valve replacement surgery or coronary artery bypass graft surgery, and in patients in sinus rhythm or atrial fibrillation before treatment. It is concluded that the therapeutic response to intravenous milrinone following cardiac surgery is partially determined by pretreatment hemodynamics.
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J. Cardiothorac. Vasc. Anesth. · Oct 1992
Dobutamine increases heart rate more than epinephrine in patients recovering from aortocoronary bypass surgery.
To determine whether epinephrine might prove to be a cost-effective substitute for dobutamine, two 8-minute infusions of either epinephrine (10 and 30 ng/kg/min, n = 28) or dobutamine (2.5 and 5 micrograms/kg/min, n = 24) were administered to 52 patients recovering in the intensive care unit (ICU) after aortocoronary bypass (CABG) surgery. At the higher dose, both drugs significantly (P < .05) increased cardiac index (CI), epinephrine from 2.8 +/- 0.1 at baseline to 3.3 +/- 0.1 L/min/m2, and dobutamine from 3.2 +/- 0.1 at baseline to 4.1 +/- 0.2 L/min/m2. Epinephrine increased CI significantly less than dobutamine. ⋯ On the other hand, while the higher dose of both drugs significantly increased heart rate (HR), epinephrine from 88 +/- 2 at baseline to 90 +/- 2 beats/min and dobutamine from 89 +/- 2 at baseline to 105 +/- 3 beats/min, the increase following the higher dose of dobutamine was significantly greater than that seen after epinephrine. Effects of the two drugs on mean arterial pressure, central venous pressure, pulmonary artery occlusion pressure, systemic vascular resistance, pulmonary vascular resistance, and left-ventricular stroke work did not significantly differ. Similar results were obtained in the subset of patients with baseline CI less than 3 L/min/m2 who more closely resembled patients who might acutely require inotropic drug administration.(ABSTRACT TRUNCATED AT 250 WORDS)