title: Effects of milrinone versus epinephrine on grafted internal mammary artery flow after cardiopulmonary bypass.
abstract: OBJECTIVE
  To compare changes on grafted internal mammary artery (IMA) flow after cardiopulmonary bypass in response to the administration of milrinone or epinephrine.
  
  
  METHODS
  Prospective and randomized.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Twenty consenting, adult patients undergoing CABG.
  
  
  METHODS
  Patients were randomized to receive either milrinone, 50 microg/kg, or epinephrine, 0.03 microg/kg/min, immediately after cardiopulmonary bypass. IMA flow was measured with a laser Doppler flow probe before and after the administration of either drug.
  
  
  RESULTS
  Baseline grafted IMA flow was similar for both groups (milrinone, 38+/-14 mL/min; epinephrine, 33+/-10 mL/min). In patients who received milrinone, flow increased by 24% to 50+/-17 mL/min, p<0.05; whereas with epinephrine, it remained essentially unchanged (33+/-10 v. 31+/-11 mL/min).
  
  
  CONCLUSIONS
  This study confirms that the vasodilatory effect of milrinone on the IMA is also present after its anastomosis, whereas low-dose epinephrine exhibits neither beneficial nor adverse effects. It is suggested that in the absence of excessive vasodilation, milrinone should be considered as a first-line inotrope after coronary artery bypass graft surgery, to achieve an increase in contractility and IMA artery flow.
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, Gainesville, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Lobato
authors.forename: F
authors.initials: F
authors.lastname: Urdaneta
authors.forename: T D
authors.initials: TD
authors.lastname: Martin
authors.forename: N
authors.initials: N
authors.lastname: Gravenstein
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000494:pharmacology*; D001026:Coronary Artery Bypass; D004837:Epinephrine / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008323:Mammary Arteries / Q000187:drug effects* / Q000637:transplantation; D020105:Milrinone / Q000494:pharmacology*; D009200:Myocardial Contraction / Q000187:drug effects; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology*; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000494:pharmacology*
chemical_list: D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D020105:Milrinone; D004837:Epinephrine