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DOI: 10.1055/s-2006-925633
The effects of adrenaline and milrinone on plasma lactate levels in patients with myocardial dysfunction after CABG
Objective: The use of adrenaline has been associated with hyperlactatemia after cardiac surgery (1). It is not known, if this effect may also be observed during PDE-III-inhibitor treatment.
Methods: 18 patients with a cardiac index (CI) below 2.5 l/min/m2 were randomly treated with adrenaline (n=7) or milrinone (n=11) to achieve an CI >3.0 l/min/m2. 20 patients without inotropes served as controls (C). Lactate, glucose, hemodynamics and insulin requirements were determined at 0, 2, 6, 10, and 14 hours after ICU-admission.
Results: Patients demographics (including the number of diabetics) and aortic cross-clamp-time were not different between the groups. After 2 hours, CI >3.0 was achieved in either adrenaline or milrinone treated patients and maintained during the observation period. Lactate levels in adrenaline treated patients were significantly higher than in milrinone- or control-group patients (Figure 1) despite comparable hemodynamics. Glucose levels were not different between groups, but the adrenaline-group needed more insulin than control or milrinone-treated patients (p<0.05).
Conclusions: In contrast to adrenaline, the use of milrinone for the treatment of postoperative myocardial dysfunction is not associated with hyperlactatemia despite comparable hemodynamics. The use of adrenaline may thus confound with lactate determinations for detection of tissue hypoperfusion in this situation and induces higher insulin requirements than milrinone.
References: 1. Raper R et al. Crit Care Med 25;1997.
Fig. 1