Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000300003
Brazilian Journal of Anesthesiology
Scientific Article

Comparação dos efeitos da dobutamina e da milrinona sobre a hemodinâmica e o transporte de oxigênio em pacientes submetidos à cirurgia cardíaca com baixo débito cardíaco após indução anestésica

Comparison of the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in patients undergoing cardiac surgery with low cardiac output after anesthetic induction

Maria José Carvalho Carmona; Laura Mariana Martins; Matheus Fachini Vane; Breno Altero Longo; Lemuel Silva Paredes; Luiz Marcelo Sá Malbouisson

http://dx.doi.org/10.1590/S0034-70942010000300003 Braz J Anesthesiol, vol.60, n3, p.237-246, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: Diversas classes de fármacos inotrópicos, com efeitos hemodinâmicos diferentes, são utilizadas no tratamento do baixo débito cardíaco em pacientes com disfunção sistólica submetidos a procedimento cirúrgico cardíaco. O objetivo deste estudo foi comparar o efeito da dobutamina e da milrinona sobre a hemodinâmica e o transporte de oxigênio nessa população de pacientes. MÉTODO: Após aprovação do Comitê de Ética institucional e obtenção do consentimento escrito pós-informado, 20 pacientes submetidos à cirurgia cardíaca e com índice cardíaco < 2 L.min-1.m-2 pós-indução anestésica e instalação de cateter de artéria pulmonar foram distribuídos aleatoriamente para receber dobutamina 5 µg.kg-1.min-1 (n = 10) ou milrinona 0,5 µg.kg-1.min-1 (n = 10). Medidas hemodinâmicas foram obtidas pós-indução, 30 e 60 minutos após, e gasometrias arterial e venosa nos momentos basal e 60 minutos. Os dados foram comparados usando teste t de Student não pareado ou ANOVA de duas vias para medidas repetidas. RESULTADOS: A dobutamina e a milrinona promoveram aumentos significativos no índice cardíaco (56% e 47%) e no transporte de oxigênio (53% e 45%), redução nos índices de resistência vascular sistêmica (33% e 36%) e pulmonar (34% e 19%), respectivamente. Contudo, não foram observadas diferenças entre os fármacos. CONCLUSÕES: Ambos os fármacos inotrópicos foram igualmente efetivos em restaurar o fluxo tecidual sanguíneo e a oferta tecidual de oxigênio para valores adequados em pacientes com baixo débito cardíaco submetidos à cirurgia cardíaca.

Palavras-chave

ANESTESIA, CIRURGIA, CIRURGIA, COMPLICAÇÕES, DROGAS, DROGAS, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Several classes of inotropic drugs with different hemodynamic effects are used in the treatment of low cardiac output in patients with diastolic dysfunction undergoing cardiac surgery. The objective of the present study was to compare the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in this population of patients. METHODS: After approval by the Ethics Committee of the institution and signing of the informed consent, 20 patients undergoing cardiac surgery with cardiac index < 2 L.min-1.m2 after anesthetic induction and place ment of a pulmonary artery catheter were randomly divided to receive dobutamine 5 µg.kg-1. min-1 (n = 10), or milrinone 0.5 µg.kg-1.min-1 (n = 10). Hemodynamic parameters were measured after anesthetic induction and after 30 and 60 minutes, and arterial and venous blood gases were measured at baseline and 60 minutes. Non-paired Student t test or two-way ANOVA for repeated measurements was used to compare the data. RESULTS: Dobutamine and milrinone promoted significant increases in cardiac index (56% and 47%) and oxygen supply (53% and 45%), and reduction in systemic (33% and 36%) and pulmonary (34% and 19%) vascular resistance, respectively. However, statistically significant differences were not observed between both drugs. CONCLUSIONS: Both inotropic drugs were similarly effective in restoring tissue blood flow and oxygen supply to adequate levels in patients with low cardiac output undergoing cardiac surgery.

Keywords

ANESTHESIA, COMPLICATIONS, DRUGS, DRUGS, DRUGS, SURGERY, SURGERY

References

Mager G, Klocke RK, Kux A. Phosphodiesterase III inhibition or adrenoreceptor stimulation: milrinone as an alternative to dobutamine in the treatment of severe heart failure. Am Heart J. 1991;121:1974-1983.

Feneck RO, Sherry KM, Withington PS. Comparison of the hemodynamic effects of milrinone with dobutamine in patients after cardiac surgery. J Cardiothorac Vasc Anesth. 2001;15:306-315.

Karlsberg RP, DeWood MA, DeMaria AN. Comparative efficacy of short-term intravenous infusions of milrinone and dobutamine in acute congestive heart failure following acute myocardial infarction: Milrinone-Dobutamine Study Group. Clin Cardiol. 1996;19:21-30.

Aranda Jr JM, Schofield RS, Pauly DF. Comparison of dobutamine versus milrinone therapy in hospitalized patients awaiting cardiac transplantation: a prospective, randomized trial. Am Heart J. 2003;145:324-329.

Yamani MH, Haji SA, Starling RC. Comparisonof dobutamine: based and milrinone-based therapy for advanced decompensated congestive heart failure: hemodynamic efficacy, clinical outcome, and economic impact. Am Heart J. 2001;142:998-1002.

Higgins TL, Estafanous FG, Loop FD. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients: A clinical severity score. JAMA. 1992;267:2344-2348.

Liang CS, Thomas A, Imai N. Effects of milrinone on systemic hemodynamics and regional circulations in dogs with congestive heart failure: comparison with dobutamine. J Cardiovasc Pharmacol. 1987;10:509-516.

Eichhorn EJ, Konstam MA, Weiland DS. Differential effects of milrinone and dobutamine on right ventricular preload, afterload and systolic performance in congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1987;60:1329-1333.

Lowes BD, Tsvetkova T, Eichhorn EJ. Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol. Int J Cardiol. 2001;81:141-149.

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