Hemodynamic effects of amrinone and colloid administration in children following cardiac surgery.
Amrinone was used as the sole vasoactive medication in 9 of 14 children (aged 5 months to 8.25 years) given the drug following open repair of congenital cardiac lesions. Four children received a concomitant dopamine infusion and one infant had the infusion stopped after 5 hours for low mean arterial pressure (49 mmHg). In the 10 children receiving only amrinone, cardiac index increased 21% (range, 0 to 94%) after a total loading dose of 4.5 mg/kg given over 1 hour. Four of 14 patients (29%) required dopamine infusions to maintain mean arterial pressure over 55 mmHg and in these children cardiac index increased from baseline and was maintained during the amrinone infusion. Preload was held constant by administration of whole blood or plasmanate during amrinone loading; a decrease in systemic vascular resistance index was seen resulting in a stable arterial blood pressure. Minimal chronotropic effect was seen and no arrhythmias occurred. The sole child with postoperative pulmonary hypertension had a beneficial decrease in pulmonary artery pressure, increase in cardiac index, and stable systemic blood pressure during amrinone use. Cardiac index changes during amrinone loading in these children were variable and less clearly related to serum levels than reported in adults. Pharmacokinetic analysis in 12 children showed a clearance of 3.4 mL/min/kg, a volume of distribution of 1.65 L/kg, and an elimination half-life of 5.75 hours. Decreases in platelet counts were seen in 6 children and platelet transfusion was needed in 1; thus, serial platelet counts should be monitored.(ABSTRACT TRUNCATED AT 250 WORDS)
Lynn
A M
AM
Department of Anesthesiology, School of Medicine, University of Washington, Seattle.
Sorensen
G K
GK
Williams
G D
GD
Anderson
G D
GD
Opheim
K E
KE
D000676:Amrinone / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid; D003102:Colloids / Q000009:adverse effects / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D008111:Liver Function Tests; D010976:Platelet Count; D011183:Postoperative Complications / Q000188:drug therapy*; D014655:Vascular Resistance / Q000187:drug effects
D003102:Colloids; D000676:Amrinone