Amrinone versus dopamine and nitroglycerin in neonates after arterial switch operation for transposition of the great arteries

J Cardiothorac Vasc Anesth. 1999 Apr;13(2):186-90. doi: 10.1016/s1053-0770(99)90085-x.

Abstract

Objective: To compare the efficacy and safety of amrinone and a combination of dopamine and nitroglycerin in neonates after reconstructive surgery for transposition of the great arteries.

Design: A prospective, randomized, double-blind study.

Setting: Pediatric intensive care unit in a university hospital.

Participants: Thirty-five neonates with transposition of the great arteries.

Interventions: A loading dose of amrinone, 2 mg/kg, followed by a maintenance infusion of 7.5 microg/kg/min, were administered to 16 neonates before separation from cardiopulmonary bypass. The remaining 19 patients were administered a combination of dopamine, 5 microg/kg/min, and nitroglycerin, 1 microg/kg/min. An open-label epinephrine infusion was administered in both groups as required.

Measurements and main results: The circulatory state of the patients was evaluated from 4 to 18 hours after cardiopulmonary bypass. The systemic blood flow index, calculated using the Fick principle, was higher in the amrinone group (1.7+/-0.5 L/min/m2 [mean +/- SD]) compared with the dopamine-nitroglycerin group (1.4+/-0.4 L/min/m2; p < 0.04). The systemic vascular resistance in the amrinone group was lower (26+/-8 Wood units x m2) than in the dopamine-nitroglycerin group (35+/-12 Wood units x m2; p < 0.02). The oxygen extraction ratio was higher in the dopamine-nitroglycerin group (0.34+/-0.08) compared with the amrinone group (0.28+/-0.06; p < 0.02). Lower platelet counts were observed in the amrinone group, but no difference in hemorrhagic complications was seen between the groups.

Conclusion: With the dosage regimen used, supplemented with epinephrine, amrinone provides a higher cardiac output and more favorable oxygen dynamics than a combination of dopamine and nitroglycerin.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic Agonists / administration & dosage
  • Adrenergic Agonists / therapeutic use
  • Amrinone / administration & dosage
  • Amrinone / therapeutic use*
  • Blood Circulation / drug effects
  • Cardiac Output / drug effects
  • Cardiopulmonary Bypass
  • Cardiotonic Agents / administration & dosage
  • Cardiotonic Agents / therapeutic use*
  • Dopamine / administration & dosage
  • Dopamine / therapeutic use*
  • Double-Blind Method
  • Epinephrine / administration & dosage
  • Epinephrine / therapeutic use
  • Female
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Infusions, Intravenous
  • Injections, Intravenous
  • Male
  • Nitroglycerin / administration & dosage
  • Nitroglycerin / therapeutic use*
  • Oxygen / blood
  • Oxygen Consumption / drug effects
  • Platelet Count / drug effects
  • Postoperative Hemorrhage / etiology
  • Prospective Studies
  • Safety
  • Transposition of Great Vessels / surgery*
  • Vascular Resistance / drug effects
  • Vasodilator Agents / administration & dosage
  • Vasodilator Agents / therapeutic use*

Substances

  • Adrenergic Agonists
  • Cardiotonic Agents
  • Vasodilator Agents
  • Nitroglycerin
  • Amrinone
  • Oxygen
  • Dopamine
  • Epinephrine