Abstract
One hundred patients were randomly allocated to receive saline or amrinone, 0.75 mg · kg−1, ten minutes before separation from cardiopulmonary bypass (CPB) after elective coronary artery bypass grafting, in order to determine the effects of this agent on haemodynamic variables and O2 utilization. Anaesthesia and CPB were managed in a standard fashion. Before induction of anaesthesia, at pericardiotomy, then at 1, 10, 20 and 30 min after CPB, haemodynamic profiles, haematocrit, and O2 saturation of arterial and mixed venous blood were measured. Incremental doses of ephedrine or phenylephrine, or an infusion of norepinephrine with phentolamine were administered when required. The groups were demographically similar and surgical variables were also similar. Haemodynamic measurements were similar between groups at all times; however, a higher dose of phenylephrine was given immediately before weaning from CPB in the amrinone group, and more patients in this group received phenylephrine in the first 30 min after CPB. Mixed venous saturation (S− vO2) was higher in the amrinone patients at all times after CPB, leading to lower calculated oxygen consumption (VO2) (P < 0.05). Insufficient dosage may explain the lack of haemodynamic effect, while possible reasons for the higher S− vO2 and lower VO2 are either reduced whole body VO2 or peripheral shunting.
Résumé
Afin de déterminer les effets de l’amrinone sur les paramètres hémodynamiques et sur l’utilisation de l’oxygène, 100 patients ont été désignés au hasard à recevoir soit du soluté physiologique, soit de l’amrinone 0,75 mg · kg− 1 dix minutes avant l’arrêt de la circulation extracorporelle (CEC) pour une chirurgie de revascularisation coronarienne nonurgente. L’anesthésie et la CEC ont été réalisées de la manière habituelle. Les paramètres hémodynamiques, l’hématocrite, et la saturation en O2 du sang artériel et veineux mêlé ont été mesurés avant l’induction de l’anesthésie, lors de la péricardectomie et à 1, 10, 20 et 30 minutes après la CEC. Des doses progressives d’éphédrine ou de phényléphrine, ou une perfusion de norépinéphrinephentolamine étaient administrees au besoin. Les groupes étaient identiques sur la plan de la démographie ainsi que des variables chirurgicales. Les mesures hémodynamiques ont été comparables en tout temps entre les deux groupes. Cependant, dans le groupe amrinone, une dose plus élevée de phényléphrine a dû être administrée immédiatement avant le sevrage de la CEC et un plus grand nombre de patient ont dû recevoir ce médicament pendant les 30 minutes qui ont suivi la CEC. Après celleci, la saturation oxyhémoglobinée du sang veineux mêlé (S−vO2) a toujours été plus élevée chez les patients du groupe amrinone, ce qui a fait baisser la valeur calculée de la consommation d’oxy gène (VO2) (P < 0,05). Une dose insufflsante d’amrinone peut expliquer l’absence d’action hémodynamique, alors que la diminution de VO2 systémique ou un effet shunt périphérique pourrait expliquer l’augmentation de la S−vO2 et la diminution de la VO2.
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This work was funded in part by a grant from Winthrop Pharmaceuticals, and presented in part at the Canadian Anaesthetists’ Society Meeting, June, 1988, Halifax, Nova Scotia.
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Ramsay, J.G., DeJesus, J.M., Wynands, J.E. et al. Amrinone before termination of cardiopulmonary bypass: haemodynamic variables and oxygen utilization in the postbypass period. Can J Anaesth 39, 342–348 (1992). https://doi.org/10.1007/BF03009044
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DOI: https://doi.org/10.1007/BF03009044