title: Milrinone, a phosphodiesterase III inhibitor, prevents reduction of jugular bulb saturation during rewarming from hypothermic cardiopulmonary bypass.
abstract: BACKGROUND
  Inadequate cerebral oxygen balance during cardiopulmonary bypass may cause neuropsychological dysfunction. Milrinone, a phosphodiesterase III inhibitor, augments cerebral blood flow by direct vasodilatation. We conducted a prospective, randomized study in patients undergoing cardiac surgery with cardiopulmonary bypass to clarify the clinical efficacy of milrinone in the imbalance of cerebral oxygen supply and demand during the rewarming period of cardiopulmonary bypass.
  
  
  METHODS
  This is a prospective, randomized and placebo-controlled study. After anesthesia, a 5.5 F fiberoptic oximeter catheter was inserted into the right jugular bulb retrogradely for monitoring the jugular venous oxyhemoglobin saturation (SjO(2)). Patients were randomly assigned to two groups, one receiving a continuous infusion of milrinone, 0.5 µg/kg/min during hypothermic cardiopulmonary bypass, and the other receiving saline as control.
  
  
  RESULTS
  Milrinone significantly prevented the reduction of the jugular venous oxyhemoglobin saturation at 10 minutes from the start of rewarming compared with the control group, but did not do so from 10 to 20 minutes after rewarming.
  
  
  CONCLUSIONS
  Milrinone suppresses the reduction of SjO(2) and improves the balance of cerebral oxygen supply and demand during the early rewarming period of hypothermic cardiopulmonary bypass.
authors.affiliation: Department of Anesthesiology, Osaka University Medical School, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Iritakenishi
authors.forename: Y
authors.initials: Y
authors.lastname: Hayashi
authors.forename: H
authors.initials: H
authors.lastname: Yamanaka
authors.forename: T
authors.initials: T
authors.lastname: Kamibayashi
authors.forename: K
authors.initials: K
authors.lastname: Ueda
authors.forename: T
authors.initials: T
authors.lastname: Mashimo
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D003072:Cognition Disorders / Q000517:prevention & control; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007262:Infusions, Intravenous; D007601:Jugular Veins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D010100:Oxygen / Q000378:metabolism*; D010108:Oxyhemoglobins / Q000378:metabolism; D058987:Phosphodiesterase 3 Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D017694:Rewarming; D013997:Time Factors
chemical_list: D010108:Oxyhemoglobins; D058987:Phosphodiesterase 3 Inhibitors; D020105:Milrinone; D010100:Oxygen