title: Dopamine stabilizes milrinone-induced changes in heart rate and arterial pressure during anaesthesia with isoflurane.
abstract: OBJECTIVE
  Phosphodiesterase-III inhibitors and dobutamine effectively improve cardiac function in patients with cardiac failure, but they are limited by possible hypotensive effects. We tested the hypothesis that dopamine contributes to stabilizing milrinone-induced haemodynamic changes.
  
  
  METHODS
  Nine patients undergoing major surgery were anaesthetized using nitrous oxide and oxygen supplemented with isoflurane 1-2%. After baseline haemodynamics were recorded, milrinone (25 or 50 microg kg(-1)) was administered over 10min, followed by a continuous infusion (0.5 microg kg(-1) min(-1). The second set of haemodynamic values was measured 50 min after beginning the continuous infusion of milrinone. Dopamine (4 microg kg(-1) min(-1)) was then administered with milrinone.
  
  
  RESULTS
  Milrinone significantly increased the heart rate from 81 +/- 8 to 102 +/- 16beats min(-1), but it decreased the mean arterial pressure from 83 +/- 10 to 66 +/- 10 mmHg and systemic vascular resistance (P < 0.05 for each). The pulmonary capillary wedge pressure, cardiac index and pulmonary vascular resistance did not change significantly. The addition of dopamine to the milrinone infusion significantly decreased the heart rate (94 +/- 12 beats min(-1)) and increased the mean arterial pressure (82 +/- 11 mmHg). Dopamine and milrinone, but not milrinone alone, significantly increased the cardiac index and the rate-pressure product.
  
  
  CONCLUSIONS
  The combination regimen of milrinone and dopamine improved cardiac function, and changes in heart rate and mean arterial pressure induced by milrinone were attenuated by dopamine. The results suggest that a combination regimen of milrinone and dopamine rather than milrinone alone should be used to maintain arterial pressure.
authors.affiliation: National Defense Medical College, Department of Anaesthesiology, Saitama, Tokorozawa, Japan. karasawa@me.ndmc.ac.jp
authors.forename: F
authors.initials: F
authors.lastname: Karasawa
authors.forename: T
authors.initials: T
authors.lastname: Okuda
authors.forename: M
authors.initials: M
authors.lastname: Tsutsui
authors.forename: N
authors.initials: N
authors.lastname: Matsuoka
authors.forename: S
authors.initials: S
authors.lastname: Yamada
authors.forename: Y
authors.initials: Y
authors.lastname: Kawatani
authors.forename: T
authors.initials: T
authors.lastname: Satoh
mesh_terms: D000704:Analysis of Variance; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002316:Cardiotonic Agents / Q000494:pharmacology*; D004067:Digestive System Neoplasms / Q000601:surgery*; D004298:Dopamine / Q000494:pharmacology*; D004359:Drug Therapy, Combination; D006339:Heart Rate / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007530:Isoflurane / Q000627:therapeutic use*; D008297:Male; D020105:Milrinone / Q000494:pharmacology*
chemical_list: D018685:Anesthetics, Inhalation; D002316:Cardiotonic Agents; D007530:Isoflurane; D020105:Milrinone; D004298:Dopamine