A comparison of amrinone with sodium nitroprusside for control of hemodynamics during infrarenal abdominal aortic surgery.
OBJECTIVE
The control of hemodynamic changes during surgical resection of abdominal aortic aneurysms (AAA) remains a challenge to anesthesiologists. In the past, hypertensive episodes have been treated with sodium nitroprusside (SNP). However, amrinone may provide some benefits when compared with SNP because of its positive inotropic and vasodilatory properties. Therefore, the purpose of this study was to compare amrinone with SNP for hemodynamic control during AAA surgery.


METHODS
This study was a prospective, randomized investigation.


METHODS
This study was performed at a single university hospital.


METHODS
This study included 20 patients undergoing AAA resection.


METHODS
After institutional review board approval, participants were randomized to receive either SNP (group N = 10) or amrinone (group A = 10). Both agents were started 10 minutes before aortic cross-clamping and discontinued 10 minutes before unclamping. Anesthesia was induced with thiopental or etomidate and maintained with oxygen, nitrous oxide, isoflurane, fentanyl, and vecuronium. Hemodynamic measurements included heart rate, systolic and diastolic blood pressure, cardiac output, systolic and diastolic pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, mixed venous oxygen saturation, electrocardiogram, and ST-T wave trend analysis.


RESULTS
Demographic and clinical characteristics for the two groups were similar. Mixed venous oxygen saturation was significantly lower (p < 0.05) in group N immediately after unclamping. There were no differences between groups for the other measurements studied. There were no episodes of myocardial ischemia in either group.


CONCLUSIONS
This study demonstrates that amrinone provides equivalent hemodynamic control to SNP during abdominal aortic aneurysm surgery because it allows moderate reductions in blood pressure without affecting other hemodynamic measurements. Further studies are needed to assess whether patients with poor preoperative left ventricular function would benefit from amrinone management during AAA resection.
Dentz
M E
ME
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
Lubarsky
D A
DA
Smith
L R
LR
McCann
R L
RL
Moskop
R J
RJ
Inge
W
W
Grichnik
K P
KP
D000368:Aged; D000676:Amrinone / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007431:Intraoperative Complications / Q000188:drug therapy*; D008297:Male; D016343:Monitoring, Intraoperative; D009599:Nitroprusside / Q000627:therapeutic use*; D011446:Prospective Studies
D000959:Antihypertensive Agents; D009599:Nitroprusside; D000676:Amrinone