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[Application of a PDE III inhibitor, olprinone, for fast track pediatric cardiac surgery]
Miyuki Itou1, Hirotsugu Okamoto, Junko Suwa
1Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 228-8555.
Insights
Olprinone (OLP), a PDE III inhibitor, significantly reduced extubation time in pediatric cardiac surgery patients compared to chlorpromazine (CPZ). OLP also improved hemodynamics, enabling faster recovery.
Area of Science:
- Pediatric Cardiac Surgery
- Pharmacology
- Anesthesiology
Background:
- Fast track cardiac surgery aims for rapid recovery.
- PDE III inhibitors like olprinone (OLP) may improve outcomes.
- Evaluating OLP as an alternative to chlorpromazine (CPZ) for vasodilation.
Purpose of the Study:
- To assess the efficacy of OLP in reducing extubation time.
- To evaluate the hemodynamic effects of OLP in pediatric cardiac surgery.
- To compare OLP with CPZ in fast track cardiac surgery.
Main Methods:
- 19 pediatric patients undergoing fast track cardiac surgery.
- Comparison between chlorpromazine (CPZ) group (n=5) and olprinone (OLP) group (n=14).
- OLP (50 mcg/kg) administered before weaning from cardiopulmonary bypass (CPB).
Main Results:
- Mean extubation time was significantly shorter in the OLP group (28.2 min) vs. CPZ group (250.4 min).
- Mean arterial pressure was higher in the OLP group post-surgery.
- OLP plasma concentration was within the therapeutic range (22.4 ng/mL).
Conclusions:
- Olprinone (OLP) facilitates early extubation in pediatric cardiac surgery.
- OLP provides stable hemodynamics, supporting its use in fast track protocols.
- OLP is a potentially valuable alternative to CPZ for these patients.
Background:
We examined the effects of olprinone (OLP), a PDE III inhibitor, on the time to extubation and on the hemodynamics in infants and children undergoing fast track cardiac surgery.
Methods:
Nineteen consecutive children undergoing fast track cardiac surgery were recruited in this study. In the first five children, chlorpromazine (CPZ) was administered conventionally for the purpose of vasodilation during the cardiac surgery (CPZ group). In the latter fourteen children, OLP (50 micrograms.kg-1) was administered 30 minutes prior to the weaning from cardiopulmonary bypass (CPB) as a substitute of CPZ (OLP group). Hemodynamic parameters were stored as data at the period of pre-CPB, post-CPB, and at the end of the surgery. Plasma concentration of OLP was measured 30 minutes after CPB.
Results:
In the OLP group, mean time to extubation was 28.2 min, which is shorter than that in CPZ group (250.4 min). Mean arterial pressure at the end of the surgery was higher in OLP group than in CPZ group. Other hemodynamic variables were not different between the two groups. Plasma concentration of OLP was 22.4 ng.ml-1, which is within the therapeutic window.
Conclusions:
The administration of OLP enables us to perform an immediate early extubation and provides stable hemodynamics. OLP would be useful in children undergoing fast track cardiac surgery.
