title: Milrinone is superior to epinephrine as treatment of myocardial depression due to ropivacaine in pigs.
abstract: OBJECTIVE
  To determine whether milrinone is more effective than epinephrine in the resuscitation of ropivacaine induced cardiotoxicity in pigs.
  
  
  METHODS
  Arterial, pulmonary, and LVdP/dt catheters were placed in 12 anesthetized, intubated and mechanically ventilated pigs. They received ropivacaine iv to cardiovascular toxicity: 50% decrease in LVdP/dt, cardiac output and mean arterial pressure (MAP). Group I (n=6) was treated with 100 microg x kg(-1) milrinone iv, and Group II (n=6) received 0.5 mg epinephrine iv. Resuscitation was successful if cardiac output returned to baseline, and MAP reached 80% of baseline.
  
  
  RESULTS
  After ropivacaine, MAP decreased from 88 +/- 7 to 49 +/- 8 mmHg (P < 0.05), CO decreased from 2.8 +/- 0.4 to 1.2 +/- 0.2 L x min(-1) (P < .05), HR decreased from 103 +/- 8 to 74 +/- 7 beats x min (P < 0.05) and LVdp/dt decreased from 1,950 +/- 130 to 755 +/- 125 mmHg (P < 0.05). The LV EDP increased from 5 +/- 1 to 8 +/- 1 mmHg (P < 0.05) and SVR from 2,317 to 3,000 +/- 120 dynes x sec(-1) x cm(-5). Electrocardiogram changes included increases in the QTU interval and QRS duration. In all animals, milrinone restored MAP, CO, SV, HR, and dP/dt to baseline and no animal developed arrhythmias. In contrast, epinephrine produced severe hypertension and tachycardia. There was no improvement in CO or SV, and SVR increased. Epinephrine caused A-V dissociation and ventricular arrhythmias in three animals.
  
  
  CONCLUSIONS
  Milrinone, was more successful than epinephrine in resuscitating anesthetized pigs from ropivacaine-induced cardiovascular toxicity.
authors.affiliation: Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY 10029-6574, USA. steven-neustein@smtplink.mssm.edu
authors.forename: S
authors.initials: S
authors.lastname: Neustein
authors.forename: I
authors.initials: I
authors.lastname: Sampson
authors.forename: I
authors.initials: I
authors.lastname: Dimich
authors.forename: H
authors.initials: H
authors.lastname: Shiang
authors.forename: J
authors.initials: J
authors.lastname: Tatu
mesh_terms: D000577:Amides / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000494:pharmacology*; D000818:Animals; D003864:Depression, Chemical; D004562:Electrocardiography; D004837:Epinephrine / Q000494:pharmacology*; D006321:Heart / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D020105:Milrinone / Q000494:pharmacology*; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology*; D000077212:Ropivacaine; D013552:Swine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D010726:Phosphodiesterase Inhibitors; D000077212:Ropivacaine; D020105:Milrinone; D004837:Epinephrine