title: Milrinone, not epinephrine, improves left ventricular compliance after cardiopulmonary bypass.
abstract: OBJECTIVE
  To compare the effects of milrinone versus epinephrine administered after cardiopulmonary bypass (CPB) on left ventricular compliance.
  
  
  METHODS
  Prospective and randomized.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Twenty consenting adult patients.
  
  
  METHODS
  Patients undergoing aortocoronary bypass surgery were randomized to receive 50 microg/kg of milrinone (group M; n = 10) or 0.03 microg/kg/min of epinephrine (group E; n = 10) shortly after separation from CPB. Left ventricular compliance was assessed by observing changes in left ventricular end-diastolic area (LVEDA) in the short-axis view with transesophageal echocardiography, while maintaining a constant left atrial pressure. Measurements were performed (1) before CPB, (2) after separation from CPB, and (3) after either milrinone or epinephrine.
  
  
  RESULTS
  Baseline LVEDA decreased by 20% after CPB in the milrinone group (from 16.6 +/- 3.1 cm2 to 14.3 +/- 2.4 cm2; p < 0.05) and by 22% in the epinephrine group (from 19.4 +/- 4.1 cm2 to 17.2 +/- 3.8 cm2; p < 0.05). LVEDA increased by 15% after milrinone (from 14.3 +/- 2.4 cm2 to 15.6 +/- 2.8 cm2; p < 0.05) but remained unchanged after epinephrine (from 17.2 +/- 3.8 cm2 to 17.1 +/- 4.2 cm2; p = ns).
  
  
  CONCLUSIONS
  Left ventricular compliance was decreased after CPB. The administration of milrinone, but not epinephrine, was associated with a partial return to prebypass values. The exact mechanism of action remains to be determined.
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, Gainesville 32610-0254, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Lobato
authors.forename: N
authors.initials: N
authors.lastname: Gravenstein
authors.forename: T D
authors.initials: TD
authors.lastname: Martin
mesh_terms: D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000368:Aged; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003187:Compliance; D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D020105:Milrinone / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D020105:Milrinone; D004837:Epinephrine