ABSTRACT
Background: Vasoactive drugs used in the reanimation of septic patients, can modify splanchnic perfusion. Aim: To compare the effects of dobutamine and amrinone on gastric intramucosal pH (pHi), lactate levels and hemodynamics in surgical patients with compensated septic shock. Patients and methods: Fourteen postoperative patients with abdominal sepsis and compensated septic shock (pHi <7.32 or lactate >2.5 mmol/l) were studied in a prospective, randomized, unblinded study. Patients were randomized to receive (Group 1, n=7) dobutamine at 5 µg/Kg/min or (Group 2, n=7) amrinone at 5 µg/Kg/min. Hemodynamic data, arterial lactate and pHi were measured before and 30, 60 and 120 minutes after starting drug infusion. Results: Both drugs were associated with a decrease in lactate levels. Dobutamine infusion, but not amrinone, increased gastric pHi, as well as cardiac index and oxygen delivery. Conclusions: An improvement in gastric pHi associated with an increase in oxygen delivery, was observed with dobutamine. Amrinone showed no effect at the fixed, low dose used in the study
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Amrinone/pharmacology , Dobutamine/pharmacology , Shock, Septic/drug therapy , Postoperative Complications/drug therapy , Abdomen, Acute/surgery , Lactates/metabolism , Lactates/blood , Splanchnic Circulation , Hydrogen-Ion Concentration , Shock, Septic/etiologyABSTRACT
The effect of pretreatment with graded concentration of diltiazem on the inotropic responses to amrinone were studied on isolated atria of rabbit. The responses to amrinone were modified by diltiazem in a biphasic manner; initial potentiation followed by inhibition. The potentiation is proposed to be due to synergistic rise in cytosolic calcium ion concentration by diltiazem and amrinone. The inhibition by diltiazem in higher concentration may be due to blockade of calcium ion influx and depletion of intracellular calcium ion from storage sites.
Subject(s)
Amrinone/pharmacology , Animals , Atrial Function , Calcium Channel Blockers/pharmacology , Cardiotonic Agents/pharmacology , Diltiazem/pharmacology , Drug Synergism , Heart Atria/drug effects , Myocardial Contraction/drug effects , Phosphodiesterase Inhibitors/pharmacology , RabbitsABSTRACT
La amrinona y milrinona forman parte de un grupo de drogas que poseen propiedades inótropas y vasodilatadoras. Su mecanismo de acción es diferente a la dopamina. El resultado de su acción es un aumento de la contractilidad miocárdica asociado a una disminución de la resistencia vascular periférica. El objetivo de este trabajo es entregar una revisión de la literatura reciente en cuanto al uso de estos agentes en pediatría
Subject(s)
Humans , Amrinone/pharmacology , Cardiotonic Agents/pharmacology , Amrinone , Amrinone , Myocardial Contraction , Dobutamine/pharmacology , Drug Therapy, Combination , Vascular Resistance/drug effectsSubject(s)
Humans , Male , Middle Aged , Perfusion , Coronary Disease , Myocardial Contraction , Ventricular Function, Left , Myocardial Revascularization/methods , Amrinone/pharmacology , Tomography, Emission-Computed, Single-Photon , Dipyridamole/pharmacology , Stimulation, Chemical , RadioisotopesABSTRACT
In the present study, the interaction of calcium and amrinone was examined on isolated rabbit aorta by using different calcium concentrations in the bathing solution. Norepinephrine-induced contractions were then recorded both in the absence and in the presence of amrinone. The present data show that the responses of rabbit aortic strips to each of NE and amrinone depended not only on ambient Ca2+ concentration, but also on the sequence of exposure of the vessel to the different drugs. This may have implications in clinical practice in cardiac patients with hypocalcemia who require both calcium and amrinone infusions; the resultant hemodynamic effect would depend on which of the infusions was started first
Subject(s)
Amrinone/pharmacology , Calcium Channel Blockers , Aorta/drug effectsABSTRACT
En el presente estudio hemos comparado los efectos de Milrinona (M), un nuevo fármaco inótropo, positivo con un inhibidor de enzima convertidora, Captopril (C), en la condición clínica y respuesta adrenérgica al esfuerzo físico leve en pacientes con insuficiencia cardíaca congestiva (ICC) en CF III. El estudio randomizado, cruzado y doble ciego evaluó los efectos de M, 10 mg c/6 hr. o C 50 mg c/8 hr. durante 9 semanas, comparados con placebo, en 16 pacientes con ICC (6 de causa isquéemica, 10 por miocardiopatíia dilatada), que recibían digital y diuréticos. Se determinó un score clínico (SC), que incluía síntomas, examen físico y Rx. tórax, (rango 0-14), la fracción de eyección radio isotópica (FE) y la actividad de renina plasmática (ARP). La noradrenalina plasmática (NAD) se midió en reposo (r) y a iguales niveles de esfuerzo físico leve (e) (6 min. Naughton, VO2 8-9 ml/kg/min.). El score clínico mejoró en forma significativa y similar por efectos de ambas drogas (5.2+-0.4 a 4.4+-0.5, 4.1+-0.4 respectivamente, p<0.01). Lo mismo ocurrió con la fracción de eyección de VI que aumentó de 23.6+-2.6% por efecto de milrinona y a 28.6+-3.2% por efecto de captopril, (p<0.01). La respuesta neurohumoral fue diferente ya que no hubo modificaciones de la ARP o NAD en reposo y esfuerzo por efecto de Milrinona. La ARP aumentó (1.6+-0.5 a 5.3+-1.5 ng/ml/hr y la NAD en esfuerzo disminuyó (1228+-158 a 820+-100 pg/ml) por efecto de Captopril (p<0.01). La elevación de ARP y la menor respuesta adrenégica al esfuerzo físico observada con C confirma un diferente efecto humoral con respecto de M e indican que favorece una mejor adaptación al esfuerzo físico en pts. con ICC