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Dobutamine versus milrinone after subarachnoid hemorrhage
Andrew Naidech1, Yunling Du, Kurt T Kreiter
1Department of Neurology, Columbia University, New York, New York, USA. a-naidech@northwestern.edu
Neurosurgery
|December 25, 2004
Summary
Milrinone and dobutamine show different effects in treating neurogenic stunned myocardium after subarachnoid hemorrhage. Milrinone is more effective at increasing cardiac output and stroke volume, while dobutamine may be better for low blood pressure.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Neurogenic stunned myocardium is a known complication of subarachnoid hemorrhage.
- Dobutamine and milrinone are commonly used treatments, but comparative data are limited.
Purpose of the Study:
- To compare the physiological dose-response of dobutamine and milrinone in patients with subarachnoid hemorrhage.
- To determine the differential effects of these inotropes on hemodynamic parameters.
Main Methods:
- A retrospective analysis of 11 patients with subarachnoid hemorrhage who received dobutamine or milrinone.
- Pulmonary artery catheter data were analyzed using a mixed-effects model to account for drug, dose, and patient variation.
Main Results:
- Milrinone significantly increased cardiac output and stroke volume compared to dobutamine.
- Milrinone also significantly decreased vascular resistance and systolic blood pressure compared to dobutamine.
- These effects were observed after adjusting for vasopressin levels.
Conclusions:
- Milrinone and dobutamine have distinct clinical applications in neurogenic stunned myocardium.
- Milrinone may be preferred for patients with severely depressed systolic function and normal vascular resistance, prioritizing cardiac output.
- Dobutamine might be more suitable for patients with low vascular resistance or blood pressure.