Comparison of Milrinone and Epinephrine on TAPSE
- Conditions
- Cardiac AnaesthesiaCardiopulmonary Bypass
- Interventions
- Registration Number
- NCT07144267
- Lead Sponsor
- Mansoura University
- Brief Summary
Cardiopulmonary bypass (CPB) is a critical technology in cardiac surgery, allowing for the temporary replacement of the heart and lung functions during intricate surgical procedures. it has significant post-surgical complications, the most important complications of CPB is right ventricle (RV) dysfunction. Diagnosis and management of RV dysfunction is crucial for maintenance of hemodynamic stability and organ function in early post-operation period and prognostic for later phase.
- Detailed Description
Epinephrine is the most potent adrenergic agonist which has positive inotropic and chronotropic effects and enhanced conduction in the heart (β1), smooth muscle relaxation in the vasculature and bronchial tree (β2), and vasoconstriction (α1). Low doses of this agent (\<0.1-0.2 μg/kg/min) mainly activate the β adrenoceptors with inotropic effects. Higher doses result in vasoconstrictor effect which takes the lead. Other effects include bronchial dilation, mydriasis, glycogenolysis, tachyarrhythmia, myocardial ischemia, pulmonary hypertension, hyperglycemia, and lactic acidosis. Epinephrine also reduces splanchnic and hepatic perfusion and increases metabolic workload of the liver. So this hypermetabolism that impairs oxygen exchange, glycolysis, and suppression of insulin cause lactic acidosis.
Milrinone is a phosphodiesterase-III inhibitor. This effect decreases the degradation of cyclic adenosine monophosphate (cAMP), increases the cAMP levels in cells, and then increases activation of protein kinase A. Therefore, its cardiac effects are positive inotropy and improved diastolic relaxation. Milrinone also causes potent vasodilation, with reduction in preload, afterload and pulmonary vascular resistance. Considering its characteristics, milrinone might be a useful agent for cardiac surgery patients.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 100
- American Society of Anesthesiologists (ASA) physical status II & III
- Age between 18 and 70 years
- Both Gender
- Body mass index less than 40 kg/m2
- Ejection fraction of >40%
- Tricuspid annular plane systolic excursion (TAPSE) < 1.7cm
- Patient refusal.
- Preoperative RV impairment
- Pulmonary hypertension (estimated pulmonary artery systolic pressure > 50 mmHg)
- Patients with any contraindications to Transesophageal echocardiography (TEE)
- Redo or Re-exploration surgery
- Patients with chronic kidney disease (serum creatinine > 1.5 mg/ dl)
- Patients with chronic liver disease (child pugh B and C)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Epinephrine group (group E) Epinephrine The patients receive 0.05-0.1 mcg/kg/min.of epinephrine 5-10 minutes before aortic unclamping Milrinone group (group M) Milrinone Injection patients will recieve an initial bolus dose of of 50 µg/kg, followed by 0.40 -0.80 µg/kg/min 5-10 minutes before aortic unclamping
- Primary Outcome Measures
Name Time Method Tricuspid annular plane systolic excursion (TAPSE) within 5 mins post-CPB within 5 mins post-cardiopulmonary bypass measured by Transesophageal echocardiography (TEE)
- Secondary Outcome Measures
Name Time Method Tricuspid annular plane systolic excursion (TAPSE) within 30-60 mins post-cardiopulmonary bypass measured by Transesophageal echocardiography (TEE)
Incidence of Right Ventricular Dysfunction after Cardiac Surgery 24 hours postoperative detected by ECHO when Tricuspid annular plane systolic excursion (TAPSE) ≤1.7 cm