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Right arrow Cardiothoracic Anesthesia, Respiration and Airway

Canadian Journal of Anesthesia, Vol 47, 1114-1118, Copyright © 2000 by Canadian Anesthesiologists' Society

ARTICLES

Milrinone is superior to epinephrine as treatment of myocardial depression due to ropivacaine in pigs

S Neustein, I Sampson, I Dimich, H Shiang and J Tatu
Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY 10029-6574, USA. steven-neustein@smtplink.mssm.edu

PURPOSE: 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. CONCLUSION: Milrinone, was more successful than epinephrine in resuscitating anesthetized pigs from ropivacaine-induced cardiovascular toxicity.


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