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Dopamine stabilizes milrinone-induced changes in heart rate and arterial pressure during anaesthesia with isoflurane

Published online by Cambridge University Press:  02 June 2005

F. Karasawa ,
T. Okuda ,
M. Tsutsui ,
N. Matsuoka ,
S. Yamada ,
Y. Kawatani  and
T. Satoh
F. Karasawa
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Japan
T. Okuda
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Japan
M. Tsutsui
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Japan
N. Matsuoka
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Japan
S. Yamada
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Japan
Y. Kawatani
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Japan
T. Satoh
Affiliation:
National Defense Medical College, Department of Anaesthesiology, Tokorozawa, Japan
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Abstract

Summary

Background and objective: Phosphodiesterase-III inhibitors and dobutamine effectively improve cardiac function in patients with cardiac failure, but they are limited by possible hypotensive effects. We tested the hypothesis that dopamine contributes to stabilizing milrinone-induced haemodynamic changes.

Methods: Nine patients undergoing major surgery were anaesthetized using nitrous oxide and oxygen supplemented with isoflurane 1–2%. After baseline haemodynamics were recorded, milrinone (25 or 50 μg kg−1) was administered over 10 min, followed by a continuous infusion (0.5 μg kg−1 min−1). The second set of haemodynamic values was measured 50 min after beginning the continuous infusion of milrinone. Dopamine (4 μg kg−1 min−1) was then administered with milrinone.

Results: Milrinone significantly increased the heart rate from 81 ± 8 to 102 ± 16 beats min−1, but it decreased the mean arterial pressure from 83 ± 10 to 66 ± 10 mmHg and systemic vascular resistance (P < 0.05 for each). The pulmonary capillary wedge pressure, cardiac index and pulmonary vascular resistance did not change significantly. The addition of dopamine to the milrinone infusion significantly decreased the heart rate (94 ± 12 beats min−1) and increased the mean arterial pressure (82 ± 11 mmHg). Dopamine and milrinone, but not milrinone alone, significantly increased the cardiac index and the rate–pressure product.

Conclusions: The combination regimen of milrinone and dopamine improved cardiac function, and changes in heart rate and mean arterial pressure induced by milrinone were attenuated by dopamine. The results suggest that a combination regimen of milrinone and dopamine rather than milrinone alone should be used to maintain arterial pressure.

Keywords

ANAESTHETICS, INHALATION, isofluraneCARDIOTONIC AGENTS, dopamineHAEMODYNAMICS, heart rateblood pressurecardiac outputPHOSPHODIESTERASE INHIBITORS, milrinone
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 2 , February 2003 , pp. 120 - 123
Copyright
2003 European Society of Anaesthesiology

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