AMRINONE VERSUS DOPAMINE-NITROGLYCERIN AFTER RECONSTRUCTIVE SURGERY FOR COMPLETE ATRIOVENTRICULAR SEPTAL-DEFECT

Objectives: To compare the effectiveness and safety of amrinone and a combination of dopamine and nitroglycerin in infants after reconstruct ive surgery for congenital heart disease. Design: A prospective, rando mized, double-blind study. Setting: Pediatric intensive care unit in a university hospital. Participants: Thirty-two infants with complete a trioventricular septal defect.Interventions: Amrinone loading dose, 2 mg/kg, followed by a maintenance infusion, 7.5 mu g/kg/min, was given to 17 infants before separation from cardiopulmonary bypass. The remai ning 15 patients received a combination of dopamine, 5 mu g/kg/min, an d nitroglycerin, 1 mu g/kg/min. Measurements and Main Results: The cir culatory state of the patients was evaluated from cardiopulmonary bypa ss. The systemic blood flow index, calculated using the Fick principle , was higher in the amrinone group (2.5 +/- 0.7 L/min/m(2)) compared w ith the dopamine-nitroglycerin group (2.0 +/- 0.6 L/min/m(2), mean +/- SD). The pulmonary blood flow index in the amrinone group was higher (2.9 +/- 0.6 L/min/m(2)) than in the dopamine-nitroglycerin group (2.2 +/- 0.6 L/min/m(2)); no significant difference was noted in the mean pulmonary artery pressure. The oxygen extraction ratio was higher in t he dopamine-nitroglycerin group (0.41 +/- 0.07) compared with the amri none group (0.34 +/- 0.08). Despite lower platelet counts in the amrin one group, no hemorrhagic complications were seen in any patient. Conc lusions: With this dosage regimen, amrinone provides a higher cardiac output, more favorable oxygen dynamics, and lower pulmonary vascular r esistance than dopamine and nitroglycerin. Copyright (C) 1997 by W.B. Saunders Company.