Wednesday December 14, 2005
7 pearls re. Milrinone
1. Milrinone need to be protected from light and if drip is discoloured or precipitation is visible (light effect) - it may be an ineffective bag.
2. Dose need to be adjusted according to renal funtion. (unfortunately often get ignored in ICUs)
3. Milrinone induced hypotension is more responsive to low dose vasopressin (.01 - .04 units/min).
4. Initial bolus should be given atleast over 10 minutes.
5. Milrinone is drug of choice over Dobutamine in cardiogenic pulmonary edema.
6. Limited known is the direct beneficial role of milrinone in severe cardiac depression from calcium channel blocker overdose. (Caution about hypotension!)
7. Pre-emptive perioperative infusion of milrinone in off-pump coronary artery bypass surgery showed to improve cardiac performance when compared to normal saline.
References: Click to get abstract/article
1. Comparative efficacy of short-term intravenous infusions of milrinone and dobutamine in acute congestive heart failure following acute myocardial infarction. Milrinone-Dobutamine Study Group - via pubmed Clin Cardiol. 1996 Jan;19(1):21-30
2. Vasopressin as an alternative to norepinephrine in the treatment of milrinone-induced hypotension - Critical Care Medicine: Volume 28(1) January 2000 pp 249-252
3. Efficacy of pre-emptive milrinone in off-pump coronary artery bypass surgery: comparison between patients with a low and normal pre-graft cardiac index - Eur J Cardiothorac Surg 2004;26:687-693