title: Hemodynamic effects of amrinone in children after cardiac surgery.
abstract: The hemodynamic effects of amrinone were assessed in seven children following cardiac surgery. Amrinone was administered as a bolus of 1 mg kg-1 body wt., followed by continuous infusion at 10 micrograms kg-1 min-1 for 1 h and two stepwise increases to 20 and 40 micrograms kg-1 min-1 for 30 min each. Hemodynamic data were obtained and plasma concentrations of amrinone measured 1 h after the bolus dose and immediately before each increment of the infusion rate. Amrinone levels ranged from 0.7 to 2.3 mg l-1. Administration of amrinone lowered systemic vascular resistance from 20.0 +/- 4.3 to 16.5 +/- 4.6 mmHg l-1 min-1 m-2 (p less than 0.05) and reduced mean arterial pressure from 71.7 +/- 9.5 to 62.6 +/- 13.5 mmHg (p less than 0.05) at the highest infusion rate, confirming the known vasodilative effect of the drug. However, these effects did not result in a statistically significant increase in stroke volume (35.0 +/- 7.5 to 35.5 +/- 7.0 ml m-2, NS) or cardiac index (3.10 +/- 0.50 to 3.20 +/- 0.40 l min-1 m-2). One additional patient, in whom a higher loading dose was tried in order to achieve a higher plasma concentration, developed systemic hypotension. A correlation was established between the plasma concentrations of amrinone and the percentage decrease in systemic resistance (r = 0.70, p less than 0.05). These results suggest that in children after open heart surgery, amrinone acts primarily as a systemic vasodilator, with questionable inotropic effect. Accordingly, its use should be restricted to children with severe cardiac failure and documented highly elevated afterload.
authors.affiliation: Clinique Universitaire de Pediatrie, Geneva, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Berner
authors.forename: C
authors.initials: C
authors.lastname: Jaccard
authors.forename: I
authors.initials: I
authors.lastname: Oberhansli
authors.forename: J C
authors.initials: JC
authors.lastname: Rouge
authors.forename: B
authors.initials: B
authors.lastname: Friedli
mesh_terms: D000293:Adolescent; D000676:Amrinone / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D011184:Postoperative Period; D014655:Vascular Resistance
chemical_list: D000676:Amrinone