Canadian Journal of Anaesthesia

, Volume 45, Issue 1, pp 67–70 | Cite as

Treatment of milrinone — associated tachycardia with ß-blockers

Clinical Reports

Abstract

Purpose

To describe a case of milrinone-associated tachycardia that was successfully treated with two ß-blockers.

Clinical features

A 74-yr-old male patient underwent elective abdominal aortic aneurysm repair under combined epidural/general anaesthesia. He had a history of alcohol abuse, controlled hypertension and ischaemic heart disease. Postoperatively, the patient had persistent sinus tachycardia that was initially unsuccessfully treated with metoprolol. Subsequently, the patient’s blood pressure and cardiac index decreased with an associated increase in pulmonary artery pressure. Analysis of the ST-segment revealed no evidence of myocardial ischaemia or infarction. These haemodynamic changes were treated with milrinone which exacerbated the baseline tachycardia without adverse blood pressure response. The subsequent administration of ß-blockers (esmolol and metoprolol) was successful in controlling the heart rate response to milrinone without adversely affecting the patient’s haemodynamic profile.

Conclusion

This report demonstrates the efficacy of esmolol and metoprolol for the treatment of milrinoneassociated tachycardia, without compromising the haemodynamic effects of milrinone.

Objectif

Rapporter un cas de tachycardie causée par la milrinone contrôlée avec deux ß-bloquants.

Éléments cliniques

Un homme de 74 ans a subi une réparation non urgente d’un anévrisme abdominal sous anesthésie épidurale combinée à une anesthésie générale. Il avait des antécédents d’alcoolisme, d’hypertension sous contrôle et d’insuffisance coronaire. En postopératoire, il présentait une tachycardie sinusale persistante traitée initialement avec du métopolol. Par la suite, sa pression artérielle et son index cardiaque ont diminuné simultanément avec une augmentation de la pression artérielle pulmonaire. L’analyse du segment ST ne révélait pas d’ischémie myocardique ni d’infarctus. Ces désordres hémodynamiques ont été traités avec de la milrinone qui a exagéré la tachycardie initiale sans affecter la pression artérielle. L’administration subséquente de ß-bloquants (esmolol et métoprolol) a réussi à contrôler la réponse cardiaque à la milrinone sans détérioration du profil hémodynamique.

Conclusion

Cette observation démontre l’efficacité de l’esmolol et du métroprolol dans le traitement de la tachycardie associée à la milrinone, sans en atténuer les effets hémodynamiques.

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Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  1. 1.Department of Critical Care MedicineOttawa Civic Hospital, University of OttawaCanada

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