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Intravenous milrinone in cardiac surgery
Jerrold H Levy1, James M Bailey, G Michael Deeb
1Division of Cardiothoracic Anesthesiology and Critical Care, Emory University School of Medicine and Emory Healthcare, Atlanta, Georgia, USA. jerrold_levy@emory.org
The Annals of Thoracic Surgery
|February 9, 2002
Summary
Milrinone, a phosphodiesterase inhibitor, enhances cardiac function and blood flow post-cardiac surgery. It also shows promise in preventing artery spasms and improving organ perfusion.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Phosphodiesterase inhibitors, such as milrinone, increase cyclic adenosine monophosphate (cAMP) levels in the myocardium.
- Elevated cAMP leads to positive inotropic effects, enhancing heart muscle contraction.
Purpose of the Study:
- To evaluate the effects of milrinone on hemodynamic parameters after cardiopulmonary bypass.
- To explore milrinone's potential in managing internal mammary artery spasm and pulmonary vasoconstriction.
- To investigate the anti-inflammatory and splanchnic perfusion effects of low-dose milrinone.
Main Methods:
- Administered a loading dose of 50 microg/kg followed by an infusion of 0.5 microg x kg(-1) x min(-1) milrinone.
- Monitored stroke volume index and left ventricular velocity of circumferential fiber shortening.
- Assessed milrinone's vasodilative properties, particularly in pulmonary circulation.
Main Results:
- Milrinone increased stroke volume index and left ventricular velocity of circumferential fiber shortening post-cardiac surgery.
- Demonstrated potent pulmonary vasodilation, beneficial for right ventricular dysfunction.
- Exhibited vasodilative effects similar to papaverine, suggesting utility in preventing internal mammary artery spasm.
- Low-dose milrinone may possess anti-inflammatory properties and improve splanchnic perfusion.
Conclusions:
- Milrinone is effective in improving cardiac performance after cardiopulmonary bypass.
- Milrinone offers therapeutic potential for pulmonary hypertension and internal mammary artery spasm.
- Further research into low-dose milrinone's anti-inflammatory and perfusion-enhancing effects is warranted.