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Stephen L. Wallenhaupt – One of the best experts on this subject based on the ideXlab platform.

  • Amrinone in cardiac surgical patients with left ventricular dysfunction a prospective randomized placebo controlled trial
    Chest, 1993
    Co-Authors: Roger L. Royster, John F. Butterworth, Richard C. Prielipp, Stephen Lawless, Stephen L. Wallenhaupt

    Abstract:

    Study objective To evaluate the efficacy of Amrinone for facilitating weaning from cardiopulmonary bypass (CPB). Design Prospective, randomized, double-blind, placebo-controlled trial with epinephrine as “rescue” therapy. Setting Operating room of a large, metropolitan tertiarycare center. Patients Thirty-nine patients with preoperative left ventricular dysfunction undergoing cardiac surgery. Thirty-three patients underwent aortocoronary bypass grafting; six patients underwent valve replacement for severe mitral or aortic regurgitation. Interventions Patients received either Amrinone (1.5 mg/kg loading dose plus 10 µg/kg/min maintenance infusion; n = 20) or placebo (n = 19) in a randomized double-blind fashion shortly (median, 10.5 min; range, 2 to 24 min) before separation from CPB. Inotropic drugs (other than the study drug) were withheld prior to separation from CPB unless safety considerations demanded that the protocol be broken. Patients who could not be weaned from CPB, as well as those with a cardiac index of 2.2 L/min/m 2 or less after weaning from CPB, received epinephrine (60 to 120 ng/kg/min) by infusion. Measurements and results Fourteen of 19 patients receiving placebo but only 1 of the 20 patients receiving Amrinone (p = 0.00001) required epinephrine infusion to separate from bypass. The cardiac index of 4 patients receiving placebo (but no patients with Amrinone) failed to exceed 2.2 L/min/m 2 despite epinephrine infusion, requiring the protocol to be broken (p Conclusions Amrinone by itself is an effective agent to facilitate weaning from CPB, and therapy with Amrinone reduced the need for individualized titration of epinephrine. Amrinone is as effective as individualized titration of epinephrine (after CPB) to improve cardiac function. Patients in the group receiving Amrinone had no greater need for vasoconstricting agents than did patients in the group receiving placebo; however, proactive administration of Amrinone before separation from CPB appears to offer no greater benefit to high-risk patients than selective administration of drugs (epinephrine) only to those patients who demonstrate the need for drug support at the time of weaning.

  • Combined inotropic effects of Amrinone and epinephrine after cardiopulmonary bypass in humans.
    Anesthesia and analgesia, 1993
    Co-Authors: Roger L. Royster, John F. Butterworth, Richard C. Prielipp, Gary P. Zaloga, Stephen Lawless, Beverly J. Spray, Neal D. Kon, Stephen L. Wallenhaupt, A. R. Cordell

    Abstract:

    Amrinone, a phosphodiesterase inhibitor, and epinephrine, an alpha- and beta-adrenergic receptor agonist, are inotropic drugs used during cardiac surgery to reverse myocardial depression after cardiopulmonary bypass. However, these drugs have not been compared separately, or in combination, in this patient population. We hypothesized that the combination might have complementary actions in improving myocardial function. We, therefore, compared Amrinone, epinephrine, and the combination of Amrinone and epinephrine in a randomized, blinded, placebo-controlled study in patients undergoing coronary artery bypass grafting. Forty patients with ejection fractions > 0.45 were studied. Right ventricular ejection fraction pulmonary artery catheters and radial arterial catheters were inserted before fentanyl-midazolam anesthesia. After separation from bypass, patients received either a placebo (n = 20) or Amrinone bolus (1.5 mg/kg, n = 20) at time 0 and a placebo (n = 20) or epinephrine (30 ng.kg-1.min-1, n = 20) infusion at time 5 min. This resulted in four study groups, n = 10 in each group. Data were collected every 2.5 min for 10 min. Epinephrine, Amrinone, and the combination of both drugs significantly increased cardiac output, stroke volume, O2 delivery, and left ventricular stroke work. The increase in stroke volume (P < 0.05) was 12 +/- 6, 16 +/- 4, and 30 +/- 4 mL/beat with epinephrine, Amrinone, and the combination of Amrinone and epinephrine, respectively. The Amrinone-epinephrine combination increased stroke volume as much as the sum of Amrinone and epinephrine given separately. Systemic vascular resistance and pulmonary vascular resistance decreased with Amrinone and Amrinone-epinephrine, but not with epinephrine. Epinephrine increased mean arterial and mean pulmonary arterial pressures. Right ventricular ejection fraction did not significantly increase (P = 0.09) with epinephrine, but increased significantly with Amrinone (0.45 to 0.53, P = 0.01), and with the combination (0.43 to 0.55, P = 0.006). These data indicate that Amrinone and epinephrine effectively increase myocardial performance during cardiac surgery. Right ventricular function especially was improved with Amrinone and the combination of Amrinone and epinephrine. The combined effects of Amrinone and epinephrine may be useful in patients recovering from the ischemia and reperfusion injury resulting from coronary artery bypass grafting.

Stephen Lawless – One of the best experts on this subject based on the ideXlab platform.

  • Amrinone in cardiac surgical patients with left ventricular dysfunction a prospective randomized placebo controlled trial
    Chest, 1993
    Co-Authors: Roger L. Royster, John F. Butterworth, Richard C. Prielipp, Stephen Lawless, Stephen L. Wallenhaupt

    Abstract:

    Study objective To evaluate the efficacy of Amrinone for facilitating weaning from cardiopulmonary bypass (CPB). Design Prospective, randomized, double-blind, placebo-controlled trial with epinephrine as “rescue” therapy. Setting Operating room of a large, metropolitan tertiarycare center. Patients Thirty-nine patients with preoperative left ventricular dysfunction undergoing cardiac surgery. Thirty-three patients underwent aortocoronary bypass grafting; six patients underwent valve replacement for severe mitral or aortic regurgitation. Interventions Patients received either Amrinone (1.5 mg/kg loading dose plus 10 µg/kg/min maintenance infusion; n = 20) or placebo (n = 19) in a randomized double-blind fashion shortly (median, 10.5 min; range, 2 to 24 min) before separation from CPB. Inotropic drugs (other than the study drug) were withheld prior to separation from CPB unless safety considerations demanded that the protocol be broken. Patients who could not be weaned from CPB, as well as those with a cardiac index of 2.2 L/min/m 2 or less after weaning from CPB, received epinephrine (60 to 120 ng/kg/min) by infusion. Measurements and results Fourteen of 19 patients receiving placebo but only 1 of the 20 patients receiving Amrinone (p = 0.00001) required epinephrine infusion to separate from bypass. The cardiac index of 4 patients receiving placebo (but no patients with Amrinone) failed to exceed 2.2 L/min/m 2 despite epinephrine infusion, requiring the protocol to be broken (p Conclusions Amrinone by itself is an effective agent to facilitate weaning from CPB, and therapy with Amrinone reduced the need for individualized titration of epinephrine. Amrinone is as effective as individualized titration of epinephrine (after CPB) to improve cardiac function. Patients in the group receiving Amrinone had no greater need for vasoconstricting agents than did patients in the group receiving placebo; however, proactive administration of Amrinone before separation from CPB appears to offer no greater benefit to high-risk patients than selective administration of drugs (epinephrine) only to those patients who demonstrate the need for drug support at the time of weaning.

  • Combined inotropic effects of Amrinone and epinephrine after cardiopulmonary bypass in humans.
    Anesthesia and analgesia, 1993
    Co-Authors: Roger L. Royster, John F. Butterworth, Richard C. Prielipp, Gary P. Zaloga, Stephen Lawless, Beverly J. Spray, Neal D. Kon, Stephen L. Wallenhaupt, A. R. Cordell

    Abstract:

    Amrinone, a phosphodiesterase inhibitor, and epinephrine, an alpha- and beta-adrenergic receptor agonist, are inotropic drugs used during cardiac surgery to reverse myocardial depression after cardiopulmonary bypass. However, these drugs have not been compared separately, or in combination, in this patient population. We hypothesized that the combination might have complementary actions in improving myocardial function. We, therefore, compared Amrinone, epinephrine, and the combination of Amrinone and epinephrine in a randomized, blinded, placebo-controlled study in patients undergoing coronary artery bypass grafting. Forty patients with ejection fractions > 0.45 were studied. Right ventricular ejection fraction pulmonary artery catheters and radial arterial catheters were inserted before fentanyl-midazolam anesthesia. After separation from bypass, patients received either a placebo (n = 20) or Amrinone bolus (1.5 mg/kg, n = 20) at time 0 and a placebo (n = 20) or epinephrine (30 ng.kg-1.min-1, n = 20) infusion at time 5 min. This resulted in four study groups, n = 10 in each group. Data were collected every 2.5 min for 10 min. Epinephrine, Amrinone, and the combination of both drugs significantly increased cardiac output, stroke volume, O2 delivery, and left ventricular stroke work. The increase in stroke volume (P < 0.05) was 12 +/- 6, 16 +/- 4, and 30 +/- 4 mL/beat with epinephrine, Amrinone, and the combination of Amrinone and epinephrine, respectively. The Amrinone-epinephrine combination increased stroke volume as much as the sum of Amrinone and epinephrine given separately. Systemic vascular resistance and pulmonary vascular resistance decreased with Amrinone and Amrinone-epinephrine, but not with epinephrine. Epinephrine increased mean arterial and mean pulmonary arterial pressures. Right ventricular ejection fraction did not significantly increase (P = 0.09) with epinephrine, but increased significantly with Amrinone (0.45 to 0.53, P = 0.01), and with the combination (0.43 to 0.55, P = 0.006). These data indicate that Amrinone and epinephrine effectively increase myocardial performance during cardiac surgery. Right ventricular function especially was improved with Amrinone and the combination of Amrinone and epinephrine. The combined effects of Amrinone and epinephrine may be useful in patients recovering from the ischemia and reperfusion injury resulting from coronary artery bypass grafting.

  • Effect of Continuous Arteriovenous Haemofiltration on Pharmacokinetics of Amrinone
    Clinical pharmacokinetics, 1993
    Co-Authors: Stephen Lawless, Irene Restaino, Sakina Azin, David Corddry

    Abstract:

    This case report details the pharmacokinetic adjustments of an Amrinone infusion in a paediatric patient who developed multiorgan system failure with anuric renal failure and was prescribed continuous arteriovenous haemofiltration. A significant proportion of clearance of Amrinone is nonrenal. Near normal Amrinone clearance can occur in patients with hepatic and renal dysfunction if continuous arteriovenous haemofiltration is used. Hepatic dysfunction with renal failure may require a reduction in the continuous Amrinone infusion rate as previously reported for neonates.

John F. Butterworth – One of the best experts on this subject based on the ideXlab platform.

  • Amrinone in cardiac surgical patients with left ventricular dysfunction a prospective randomized placebo controlled trial
    Chest, 1993
    Co-Authors: Roger L. Royster, John F. Butterworth, Richard C. Prielipp, Stephen Lawless, Stephen L. Wallenhaupt

    Abstract:

    Study objective To evaluate the efficacy of Amrinone for facilitating weaning from cardiopulmonary bypass (CPB). Design Prospective, randomized, double-blind, placebo-controlled trial with epinephrine as “rescue” therapy. Setting Operating room of a large, metropolitan tertiarycare center. Patients Thirty-nine patients with preoperative left ventricular dysfunction undergoing cardiac surgery. Thirty-three patients underwent aortocoronary bypass grafting; six patients underwent valve replacement for severe mitral or aortic regurgitation. Interventions Patients received either Amrinone (1.5 mg/kg loading dose plus 10 µg/kg/min maintenance infusion; n = 20) or placebo (n = 19) in a randomized double-blind fashion shortly (median, 10.5 min; range, 2 to 24 min) before separation from CPB. Inotropic drugs (other than the study drug) were withheld prior to separation from CPB unless safety considerations demanded that the protocol be broken. Patients who could not be weaned from CPB, as well as those with a cardiac index of 2.2 L/min/m 2 or less after weaning from CPB, received epinephrine (60 to 120 ng/kg/min) by infusion. Measurements and results Fourteen of 19 patients receiving placebo but only 1 of the 20 patients receiving Amrinone (p = 0.00001) required epinephrine infusion to separate from bypass. The cardiac index of 4 patients receiving placebo (but no patients with Amrinone) failed to exceed 2.2 L/min/m 2 despite epinephrine infusion, requiring the protocol to be broken (p Conclusions Amrinone by itself is an effective agent to facilitate weaning from CPB, and therapy with Amrinone reduced the need for individualized titration of epinephrine. Amrinone is as effective as individualized titration of epinephrine (after CPB) to improve cardiac function. Patients in the group receiving Amrinone had no greater need for vasoconstricting agents than did patients in the group receiving placebo; however, proactive administration of Amrinone before separation from CPB appears to offer no greater benefit to high-risk patients than selective administration of drugs (epinephrine) only to those patients who demonstrate the need for drug support at the time of weaning.

  • Combined inotropic effects of Amrinone and epinephrine after cardiopulmonary bypass in humans.
    Anesthesia and analgesia, 1993
    Co-Authors: Roger L. Royster, John F. Butterworth, Richard C. Prielipp, Gary P. Zaloga, Stephen Lawless, Beverly J. Spray, Neal D. Kon, Stephen L. Wallenhaupt, A. R. Cordell

    Abstract:

    Amrinone, a phosphodiesterase inhibitor, and epinephrine, an alpha- and beta-adrenergic receptor agonist, are inotropic drugs used during cardiac surgery to reverse myocardial depression after cardiopulmonary bypass. However, these drugs have not been compared separately, or in combination, in this patient population. We hypothesized that the combination might have complementary actions in improving myocardial function. We, therefore, compared Amrinone, epinephrine, and the combination of Amrinone and epinephrine in a randomized, blinded, placebo-controlled study in patients undergoing coronary artery bypass grafting. Forty patients with ejection fractions > 0.45 were studied. Right ventricular ejection fraction pulmonary artery catheters and radial arterial catheters were inserted before fentanyl-midazolam anesthesia. After separation from bypass, patients received either a placebo (n = 20) or Amrinone bolus (1.5 mg/kg, n = 20) at time 0 and a placebo (n = 20) or epinephrine (30 ng.kg-1.min-1, n = 20) infusion at time 5 min. This resulted in four study groups, n = 10 in each group. Data were collected every 2.5 min for 10 min. Epinephrine, Amrinone, and the combination of both drugs significantly increased cardiac output, stroke volume, O2 delivery, and left ventricular stroke work. The increase in stroke volume (P < 0.05) was 12 +/- 6, 16 +/- 4, and 30 +/- 4 mL/beat with epinephrine, Amrinone, and the combination of Amrinone and epinephrine, respectively. The Amrinone-epinephrine combination increased stroke volume as much as the sum of Amrinone and epinephrine given separately. Systemic vascular resistance and pulmonary vascular resistance decreased with Amrinone and Amrinone-epinephrine, but not with epinephrine. Epinephrine increased mean arterial and mean pulmonary arterial pressures. Right ventricular ejection fraction did not significantly increase (P = 0.09) with epinephrine, but increased significantly with Amrinone (0.45 to 0.53, P = 0.01), and with the combination (0.43 to 0.55, P = 0.006). These data indicate that Amrinone and epinephrine effectively increase myocardial performance during cardiac surgery. Right ventricular function especially was improved with Amrinone and the combination of Amrinone and epinephrine. The combined effects of Amrinone and epinephrine may be useful in patients recovering from the ischemia and reperfusion injury resulting from coronary artery bypass grafting.