2. Ein shams university, Egypt.
3. Prince Sultan cardiac center, Riyadh, Saudi Arabia.
Objective: This study was done to compare the effects of early and late use of milrinone in pediatric patients undergoing complex cardiac surgery.
Design: The study was a prospective randomized study. Setting: Prince Sultan cardiac center, Saudi Arabia.
Methods: A prospective study involved 40 pediatric patients undergoing congenital corrective cardiac surgery, classified randomly into two groups (N=20). Group A: Milrinone infusion was started without loading dose, at 0.5mcg/kg/min at the beginning of CPB and continued postoperatively (0.5-0.75 mcg/kg/min) in the PCICU. Group B: Milrinone was started as a loading dose 50mcg/kg over 10 min after aortic declamping and continued as infusion (0.5-0.75 mcg/kg/min) postoperatively in the PCICU. Data were collected at baseline, 1st, 6th, 12th, and 24th postoperative hours in the ICU.
Results:The inotropic supports and mechanical supports were needed more in group B than group A. The comparison of heart rate, CVP, temperature, hemoglobin, SpO2 and PaCO2, were insignificant between the two groups (P>0.05). The mean arterial blood pressure through the first 6 hours postoperatively was higher in group A than group B (P<0.05), but became insignificant through other timepoints. The urine output and central venous oxygen saturation were higher in group A than group B (P<0.05).The serum lactate levels were significantly higher in group B more than group A (P<0.05).
Conclusion: early use of milrinone, lead to easy weaning from CPB , decreased requirement of pharmacological and mechanical support and decreased the incidence of low cardiac output syndrome after pediatric cardiac surgery and there was no complications related to milrinone in our study patients.
Keywords: pediatric patients, inotropes, milrinone, low cardiac output syndrome