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Ann Thorac Surg 2002;73:325-330
© 2002 The Society of Thoracic Surgeons

Review

Intravenous milrinone in cardiac surgery

Jerrold H. Levy, MD*a, James M. Bailey, MD, PhDa, G. Michael Deeb, MDb

a Division of Cardiothoracic Anesthesiology and Critical Care, The Emory Clinic, Emory University School of Medicine and Emory Healthcare, Atlanta, Georgia, USA
b Division of Cardiothoracic Surgery, The University of Michigan, Ann Arbor, Michigan, USA

* Address reprint requests to Dr Levy, Emory University Hospital, 1364 Clifton Rd, NE, Atlanta, GA 30322, USA
e-mail: jerrold_levy{at}emory.org

Phosphodiesterase inhibitors including milrinone produce positive inotropic effects by slowing the hydrolysis of cyclic adenosine monophosphate in the myocardium. With a loading dose of 50 µg/kg followed by an infusion of 0.5 µg · kg-1 · min-1, milrinone increases stroke volume index and left ventricular velocity of circumferential fiber shortening after weaning from cardiopulmonary bypass. Milrinone has potential for the treatment and prevention of internal mammary artery spasm because of its vasodilative effect, which is similar to that of papaverine, and is a potent pulmonary vasodilator for patients with right ventricular dysfunction and pulmonary vasoconstriction. Low-dose milrinone may have anti-inflammatory properties and potentially can improve splanchnic perfusion.




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