Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients

Yunseok Jeon, Jung Hee Ryu, Young Jin Lim, Chong Sung Kim, Jae Hyon Bahk, Seung-Zhoo Yoon, Ju Youn Choi

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Objective: Phosphodiesterase inhibitor is essential to the pharmacologic management of decompensated heart failure because it increases contractility and decreases afterload of right ventricle. It also improves hemodynamics and increases blood flow of the grafted internal mammary arteries and middle cerebral arteries during coronary artery bypass surgery. However, it induces vasodilation and necessitates the use of vasoconstrictors, such as norepinephrine. We hypothesized that vasopressin could recover hypotension induced by milrinone with less effect on pulmonary vascular resistance (PVR) compared to norepinephrine. Methods: Fifty patients, undergoing coronary artery bypass graft (CABG) surgery, were assigned randomly in a double-blind manner to receive either vasopressin or norepinephrine. After baseline hemodynamic measurements, a loading dose of milrinone 50 μg/kg was infused slowly for 20 min followed by continuous infusion of 0.5 μg/(kg min). Immediately after the loading dose of milrinone, hemodynamic variables were measured, and vasopressin (VP group) or norepinephrine (NE groups) was infused. After being titrated until the mean arterial pressure was increased by 20%, hemodynamic variables were measured again. Results: Milrinone infusion reduced both systemic vascular resistance (SVR, 1218 ± 299 dyne s/cm5 vs 838 ± 209 dyne s/cm5, 1345 ± 299 dyne s/cm5 vs 1011 ± 195 dyne s/cm5) and PVR (95 ± 34 dyne s/cm5 vs 72 ± 30 dyne s/cm5, 119 ± 85 dyne s/cm5 vs 87 ± 33 dyne s/cm5) in the VP and NE groups, respectively. Vasopressin and norepinephrine infusion increased both SVR (838 ± 209 dyne s/cm5 vs 1100 ± 244 dyne s/cm5, 1011 ± 195 dyne s/cm5 vs 1446 ± 681 dyne s/cm5, respectively) and PVR (72 ± 30 dyne s/cm5 vs 84 ± 18 dyne s/cm5, 87 ± 33 dyne s/cm5 vs 139 ± 97 dyne s/cm5, respectively). The PRV/SVR ratio was decreased after vasopressin infusion (0.10 ± 0.03 vs 0.08 ± 0.03), while no changes were found after norepinephrine infusion (0.09 ± 0.02 vs 0.09 ± 0.02). Conclusions: In the patients undergoing CABG surgery, both norepinephrine and low dose vasopressin were effective in restoring milrinone-induced decrease of SVR. However, only low-dose vasopressin decreased the PVR/SVR ratio that was increased by milrinone. Considering the importance of maintaining systemic perfusion pressure as well as reducing right heart afterload, milrinone-vasopressin may provide better hemodynamics than milrinone-norephinephrine during the management of right heart failure.

Original languageEnglish
Pages (from-to)952-956
Number of pages5
JournalEuropean Journal of Cardio-thoracic Surgery
Volume29
Issue number6
DOIs
Publication statusPublished - 2006 Jun 1
Externally publishedYes

Fingerprint

Controlled Hypotension
Milrinone
Off-Pump Coronary Artery Bypass
Vasopressins
Norepinephrine
Hemodynamics
Vascular Resistance
Coronary Artery Bypass
S 0139
Heart Failure
Transplants
Phosphodiesterase Inhibitors
Mammary Arteries
Middle Cerebral Artery
Vasoconstrictor Agents
Vasodilation
Heart Ventricles
Arterial Pressure
Perfusion
Pressure

Keywords

  • Milrinone
  • Norepinephrine
  • Off-pump coronary artery bypass surgery
  • Vasopressin

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. / Jeon, Yunseok; Ryu, Jung Hee; Lim, Young Jin; Kim, Chong Sung; Bahk, Jae Hyon; Yoon, Seung-Zhoo; Choi, Ju Youn.

In: European Journal of Cardio-thoracic Surgery, Vol. 29, No. 6, 01.06.2006, p. 952-956.

Research output: Contribution to journalArticle

Jeon, Yunseok ; Ryu, Jung Hee ; Lim, Young Jin ; Kim, Chong Sung ; Bahk, Jae Hyon ; Yoon, Seung-Zhoo ; Choi, Ju Youn. / Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients. In: European Journal of Cardio-thoracic Surgery. 2006 ; Vol. 29, No. 6. pp. 952-956.
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abstract = "Objective: Phosphodiesterase inhibitor is essential to the pharmacologic management of decompensated heart failure because it increases contractility and decreases afterload of right ventricle. It also improves hemodynamics and increases blood flow of the grafted internal mammary arteries and middle cerebral arteries during coronary artery bypass surgery. However, it induces vasodilation and necessitates the use of vasoconstrictors, such as norepinephrine. We hypothesized that vasopressin could recover hypotension induced by milrinone with less effect on pulmonary vascular resistance (PVR) compared to norepinephrine. Methods: Fifty patients, undergoing coronary artery bypass graft (CABG) surgery, were assigned randomly in a double-blind manner to receive either vasopressin or norepinephrine. After baseline hemodynamic measurements, a loading dose of milrinone 50 μg/kg was infused slowly for 20 min followed by continuous infusion of 0.5 μg/(kg min). Immediately after the loading dose of milrinone, hemodynamic variables were measured, and vasopressin (VP group) or norepinephrine (NE groups) was infused. After being titrated until the mean arterial pressure was increased by 20{\%}, hemodynamic variables were measured again. Results: Milrinone infusion reduced both systemic vascular resistance (SVR, 1218 ± 299 dyne s/cm5 vs 838 ± 209 dyne s/cm5, 1345 ± 299 dyne s/cm5 vs 1011 ± 195 dyne s/cm5) and PVR (95 ± 34 dyne s/cm5 vs 72 ± 30 dyne s/cm5, 119 ± 85 dyne s/cm5 vs 87 ± 33 dyne s/cm5) in the VP and NE groups, respectively. Vasopressin and norepinephrine infusion increased both SVR (838 ± 209 dyne s/cm5 vs 1100 ± 244 dyne s/cm5, 1011 ± 195 dyne s/cm5 vs 1446 ± 681 dyne s/cm5, respectively) and PVR (72 ± 30 dyne s/cm5 vs 84 ± 18 dyne s/cm5, 87 ± 33 dyne s/cm5 vs 139 ± 97 dyne s/cm5, respectively). The PRV/SVR ratio was decreased after vasopressin infusion (0.10 ± 0.03 vs 0.08 ± 0.03), while no changes were found after norepinephrine infusion (0.09 ± 0.02 vs 0.09 ± 0.02). Conclusions: In the patients undergoing CABG surgery, both norepinephrine and low dose vasopressin were effective in restoring milrinone-induced decrease of SVR. However, only low-dose vasopressin decreased the PVR/SVR ratio that was increased by milrinone. Considering the importance of maintaining systemic perfusion pressure as well as reducing right heart afterload, milrinone-vasopressin may provide better hemodynamics than milrinone-norephinephrine during the management of right heart failure.",
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author = "Yunseok Jeon and Ryu, {Jung Hee} and Lim, {Young Jin} and Kim, {Chong Sung} and Bahk, {Jae Hyon} and Seung-Zhoo Yoon and Choi, {Ju Youn}",
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TY - JOUR

T1 - Comparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients

AU - Jeon, Yunseok

AU - Ryu, Jung Hee

AU - Lim, Young Jin

AU - Kim, Chong Sung

AU - Bahk, Jae Hyon

AU - Yoon, Seung-Zhoo

AU - Choi, Ju Youn

PY - 2006/6/1

Y1 - 2006/6/1

N2 - Objective: Phosphodiesterase inhibitor is essential to the pharmacologic management of decompensated heart failure because it increases contractility and decreases afterload of right ventricle. It also improves hemodynamics and increases blood flow of the grafted internal mammary arteries and middle cerebral arteries during coronary artery bypass surgery. However, it induces vasodilation and necessitates the use of vasoconstrictors, such as norepinephrine. We hypothesized that vasopressin could recover hypotension induced by milrinone with less effect on pulmonary vascular resistance (PVR) compared to norepinephrine. Methods: Fifty patients, undergoing coronary artery bypass graft (CABG) surgery, were assigned randomly in a double-blind manner to receive either vasopressin or norepinephrine. After baseline hemodynamic measurements, a loading dose of milrinone 50 μg/kg was infused slowly for 20 min followed by continuous infusion of 0.5 μg/(kg min). Immediately after the loading dose of milrinone, hemodynamic variables were measured, and vasopressin (VP group) or norepinephrine (NE groups) was infused. After being titrated until the mean arterial pressure was increased by 20%, hemodynamic variables were measured again. Results: Milrinone infusion reduced both systemic vascular resistance (SVR, 1218 ± 299 dyne s/cm5 vs 838 ± 209 dyne s/cm5, 1345 ± 299 dyne s/cm5 vs 1011 ± 195 dyne s/cm5) and PVR (95 ± 34 dyne s/cm5 vs 72 ± 30 dyne s/cm5, 119 ± 85 dyne s/cm5 vs 87 ± 33 dyne s/cm5) in the VP and NE groups, respectively. Vasopressin and norepinephrine infusion increased both SVR (838 ± 209 dyne s/cm5 vs 1100 ± 244 dyne s/cm5, 1011 ± 195 dyne s/cm5 vs 1446 ± 681 dyne s/cm5, respectively) and PVR (72 ± 30 dyne s/cm5 vs 84 ± 18 dyne s/cm5, 87 ± 33 dyne s/cm5 vs 139 ± 97 dyne s/cm5, respectively). The PRV/SVR ratio was decreased after vasopressin infusion (0.10 ± 0.03 vs 0.08 ± 0.03), while no changes were found after norepinephrine infusion (0.09 ± 0.02 vs 0.09 ± 0.02). Conclusions: In the patients undergoing CABG surgery, both norepinephrine and low dose vasopressin were effective in restoring milrinone-induced decrease of SVR. However, only low-dose vasopressin decreased the PVR/SVR ratio that was increased by milrinone. Considering the importance of maintaining systemic perfusion pressure as well as reducing right heart afterload, milrinone-vasopressin may provide better hemodynamics than milrinone-norephinephrine during the management of right heart failure.

AB - Objective: Phosphodiesterase inhibitor is essential to the pharmacologic management of decompensated heart failure because it increases contractility and decreases afterload of right ventricle. It also improves hemodynamics and increases blood flow of the grafted internal mammary arteries and middle cerebral arteries during coronary artery bypass surgery. However, it induces vasodilation and necessitates the use of vasoconstrictors, such as norepinephrine. We hypothesized that vasopressin could recover hypotension induced by milrinone with less effect on pulmonary vascular resistance (PVR) compared to norepinephrine. Methods: Fifty patients, undergoing coronary artery bypass graft (CABG) surgery, were assigned randomly in a double-blind manner to receive either vasopressin or norepinephrine. After baseline hemodynamic measurements, a loading dose of milrinone 50 μg/kg was infused slowly for 20 min followed by continuous infusion of 0.5 μg/(kg min). Immediately after the loading dose of milrinone, hemodynamic variables were measured, and vasopressin (VP group) or norepinephrine (NE groups) was infused. After being titrated until the mean arterial pressure was increased by 20%, hemodynamic variables were measured again. Results: Milrinone infusion reduced both systemic vascular resistance (SVR, 1218 ± 299 dyne s/cm5 vs 838 ± 209 dyne s/cm5, 1345 ± 299 dyne s/cm5 vs 1011 ± 195 dyne s/cm5) and PVR (95 ± 34 dyne s/cm5 vs 72 ± 30 dyne s/cm5, 119 ± 85 dyne s/cm5 vs 87 ± 33 dyne s/cm5) in the VP and NE groups, respectively. Vasopressin and norepinephrine infusion increased both SVR (838 ± 209 dyne s/cm5 vs 1100 ± 244 dyne s/cm5, 1011 ± 195 dyne s/cm5 vs 1446 ± 681 dyne s/cm5, respectively) and PVR (72 ± 30 dyne s/cm5 vs 84 ± 18 dyne s/cm5, 87 ± 33 dyne s/cm5 vs 139 ± 97 dyne s/cm5, respectively). The PRV/SVR ratio was decreased after vasopressin infusion (0.10 ± 0.03 vs 0.08 ± 0.03), while no changes were found after norepinephrine infusion (0.09 ± 0.02 vs 0.09 ± 0.02). Conclusions: In the patients undergoing CABG surgery, both norepinephrine and low dose vasopressin were effective in restoring milrinone-induced decrease of SVR. However, only low-dose vasopressin decreased the PVR/SVR ratio that was increased by milrinone. Considering the importance of maintaining systemic perfusion pressure as well as reducing right heart afterload, milrinone-vasopressin may provide better hemodynamics than milrinone-norephinephrine during the management of right heart failure.

KW - Milrinone

KW - Norepinephrine

KW - Off-pump coronary artery bypass surgery

KW - Vasopressin

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