MILRINONE VERSUS GLUCAGON - COMPARATIVE HEMODYNAMIC-EFFECTS IN CANINEPROPRANOLOL POISONING

Glucagon has been reported to be one of the most effective treatments for severe beta-blocker poisoning. Recently, amrinone was suggested as an alternative therapeutic choice for beta-blocker poisoning. Milrino ne, a derivative of amrinone, acts independently of beta-adrenoceptors and increases cyclic AMP. Therefore milrinone may also be effective i n the treatment of beta-blocker poisoning. In the present study, we co mpared the effect of glucagon and milrinone in treating severe beta-bl ocker poisoning. Following the administration of 10 mg/kg propranolol IV over 10 min, heart rate, cardiac output, mean arterial pressure, st roke volume, and end tidal CO2 were depressed, while central venous pr essure, and pulmonary capillary wedge pressure increased significantly (p < 0.05). Following the administration of saline (Group S, N = 3), glucagon 20 mu g/kg (Group G, N = 5), and milrinone 300 mu g/kg (Group M, N = 5), hemodynamic parameters were observed for 30 min. In group M, mean arterial pressure, cardiac output and stroke volume recovered to their baseline values, while central venous pressure and pulmonary capillary wedge pressure decreased. Although there were no significant differences between groups G and M, the heart rate, central venous pr essure and pulmonary capillary wedge pressure, mean arterial pressure and stroke volume did not return to baseline values in group G. Milrin one administration produced a significant hemodynamic improvement with out increasing the heart rate in the canine model of severe heart fail ure caused by propranolol. In the glucagon treatment group, central ve nous pressure and pulmonary capillary wedge pressure improved less tha n the milrinone group. Although more data are needed before a clinical recommendation, milrinone might be an effective drug to treat beta-bl ocker poisoning.