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Canadian Journal of Anaesthesia

, Volume 47, Issue 11, pp 1114–1118 | Cite as

Milrinone is superior to epinephrine as treatment of myocardial depression due to ropivacaine in pigs

  • Steven Neustein
  • Ian Sampson
  • Ivan Dimich
  • Howard Shiang
  • Juvonen Tatu
Laboratory Investigations

Abstract

Purpose: To determine whether milrinone is more effective than epinephrine in the resuscitation of ropivacaine induced cardiotoxicity in pigs.

Methods: Arterial, pulmonary, and LVdP/dt catheters were placed in 12 anesthetized, intubated and mechanically ventilated pigs. They received ropivacaineiv to cardiovascular toxicity: 50% decrease in LVdP/dt, cardiac output and mean arterial pressure (MAP). Group 1 (n=6) was treated with 100 µg·kg−1 milrinoneiv, and Group II (n=6) received 0.5 mg epinephrineiv. Resuscitation was successful if cardiac output returned to baseline, and MAP reached 80% of baseline.

Results: After ropivacaine, MAP decreased from 88±7 to 49±8 mmHg (P<0.05), CO decreased from 2.8±0.4 to 1.2±0.2 L·min−1 (P<.05), HR decreased from 103±8 to 74±7 beats·min (P<0.05) and LVdp/dt decreased from 1950±130 to 755±125 mmHg (P<0.05). The LV EDP increased from 5±1 to 8±1 mmHg (P<0.05) and SVR from 2317 to 3000±120 dynes·sec−1·cm−5. Electrocardiogram changes included increases in the QTU interval and QRS duration. In all animals, milrinone restored MAP, CO, SV, HR, and dP/dt to baseline and no animal developed arrhythmias. In contrast, epinephrine produced severe hypertension and tachycardia. There was no improvement in CO or SV, and SVR increased. Epinephrine caused A-V dissociation and ventricular arrhythmias in three animals.

Conclusion: Milrinone, was more successful than epinephrine in resuscitating anesthetized pigs from ropivacaine-induced cardiovascular toxicity.

Keywords

Bupivacaine Mean Arterial Pressure Ropivacaine Milrinone Cardiovascular Toxicity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Déterminer si la milrinone est plus efficace que l’épinéphrine au moment de réanimer des porcs victimes d’une cardiotoxicité induite par la ropivacaïne.

Méthode: Des cathéters artériels, pulmonaires et ventriculaires gauches (dP/dtVG) ont été mis en place chez 12 porcs anesthésiés, intubés et sous ventilation mécanique. Ils ont reçu de la ropivacaïneiv qui a provoqué la cardiotoxicité manifestée par: une baisse de 50 % dP/dtVG, du débit cardiaque (DC) et de la pression artérielle moyenne (PAM). Le groupe I (n=6) a été traité avec 100µg·kg−1 de milrinoneiv et le groupe II (n=6) avec 0,5 mg d’épinéphrineiv. La réanimation était réussie lorsque le DC revenait aux valeurs de base et que la PAM atteignait 80 % des valeurs de base.

Résultats: Après l’administration de la ropivacaïne, la PAM a chuté de 88±7 à 49±8 mmHg (P<0,05), le DC de 2,8±0,4 à 1,2±0,2 L·min−1 (P<0,05), la FC de 103±8 to 74±7 battements·min (P<0,05) et dP/dtVG de 1950±130 à 755±125 mmHg (P<0,05). La pression télédiastolique du VG a augmenté, passant de 5±1 à 8±1 mmHg (P<0,05) et la résistance vasculaire périphérique (RVP) de 2317 à 3000±120 dynes·s−1·cm−5. Les changements à l’électrocardiogramme comprenaient des augmentations de l’intervalle QTU et de la durée de QRS. Chez tous les animaux, la milrinone a ramené la PAM, le DC, le débit systolique (DS), la FC et dP/dt aux valeurs de base et aucun animal n’a présenté d’arythmie. Par ailleurs, l’épinéphrine a produit une sévère hypertension et de la tachycardie. Il n’y a pas eu d’amélioration du DC ou du DS et la RVP a augmenté. L’épinéphrine a aussi causé une dissociation AV et des arythmies ventriculaires chez trois animaux.

Conclusion: La milrinone a été plus efficace que l’épinéphrine pour la réanimation de porcs anesthésiés qui ont subi une cardiotoxicité provoquée par de la ropivacaïne.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Steven Neustein
    • 1
  • Ian Sampson
    • 1
  • Ivan Dimich
    • 1
  • Howard Shiang
    • 1
  • Juvonen Tatu
    • 1
  1. 1.From the Departments of Anesthesiology and Cardiothoracic SurgeryThe Mount Sinai Medical CenterNew YorkUSA

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