Amrinone versus dopamine and nitroglycerin in neonates after arterial switch operation for transposition of the great arteries.
OBJECTIVE
To compare the efficacy and safety of amrinone and a combination of dopamine and nitroglycerin in neonates after reconstructive surgery for transposition of the great arteries.


METHODS
A prospective, randomized, double-blind study.


METHODS
Pediatric intensive care unit in a university hospital.


METHODS
Thirty-five neonates with transposition of the great arteries.


METHODS
A loading dose of amrinone, 2 mg/kg, followed by a maintenance infusion of 7.5 microg/kg/min, were administered to 16 neonates before separation from cardiopulmonary bypass. The remaining 19 patients were administered a combination of dopamine, 5 microg/kg/min, and nitroglycerin, 1 microg/kg/min. An open-label epinephrine infusion was administered in both groups as required.


RESULTS
The circulatory state of the patients was evaluated from 4 to 18 hours after cardiopulmonary bypass. The systemic blood flow index, calculated using the Fick principle, was higher in the amrinone group (1.7+/-0.5 L/min/m2 [mean +/- SD]) compared with the dopamine-nitroglycerin group (1.4+/-0.4 L/min/m2; p < 0.04). The systemic vascular resistance in the amrinone group was lower (26+/-8 Wood units x m2) than in the dopamine-nitroglycerin group (35+/-12 Wood units x m2; p < 0.02). The oxygen extraction ratio was higher in the dopamine-nitroglycerin group (0.34+/-0.08) compared with the amrinone group (0.28+/-0.06; p < 0.02). Lower platelet counts were observed in the amrinone group, but no difference in hemorrhagic complications was seen between the groups.


CONCLUSIONS
With the dosage regimen used, supplemented with epinephrine, amrinone provides a higher cardiac output and more favorable oxygen dynamics than a combination of dopamine and nitroglycerin.
Laitinen
P
P
Department of Anesthesiology, Hospital for Children and Adolescents, University of Helsinki, Finland.
Happonen
J M
JM
Sairanen
H
H
Peltola
K
K
Rautiainen
P
P
D000322:Adrenergic Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000676:Amrinone / Q000008:administration & dosage / Q000627:therapeutic use*; D001775:Blood Circulation / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects; D010976:Platelet Count / Q000187:drug effects; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D012449:Safety; D014188:Transposition of Great Vessels / Q000601:surgery*; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D000322:Adrenergic Agonists; D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D005996:Nitroglycerin; D000676:Amrinone; D010100:Oxygen; D004298:Dopamine; D004837:Epinephrine