Primacor question

Tenesma · Mar 11, 2004

i don't want to give the whole answer away (cause i think this is an important thing for you to know, and the best way to learn is to look it up in any up-to-date critical care textbook in the chapter regarding cardiac surgery).... but the bottom-line: the heart post-pump is cold, is undergoing some level of reperfusion-injury, and sometimes the cardioplegia wasn't perfect and you might have some damaged myocardium, the list goes on and on...

however, i would say it is not the norm to send patients to the ICU on milrinone - because most of them don't really need it... they usually start needing it after the honeymoon period usually 12 to 24 hours post-pump because of changes in ventricular compliance.

chaosRN, ASN, RN · Mar 11, 2004

Thanks for responding! I have tried to look this up in some cardiac books that I have with no success. I will look in the section you suggested. Only a very few pts come back from OR with Milrinone, but like you said, the ones that need it are started on it 12-24 hrs post-op. Again, thanks! :)

BlakeS · Mar 11, 2004

Although I don't work in CVICU, I would say the reason for the loading dose would be to help the heart come off pump. It would increase contractility and dilate vascular smooth muscle without increasing HR or myocardial oxygen consumption. Am I on the right track??

Tenesma · Mar 11, 2004

it isn't often that you need milrinone to come off pump --- usually it is a volume/tone thing way before it is a contractility thing...

Nitecap · Mar 16, 2004

hello

Tenesma · Mar 16, 2004

Nitecap...

I agree fully with you --- there is more and more literature to support the use of an inotrope in patients with EF 55years)... In fact, I think milrinone is a wonderful drug...

but even in those patients, you can come off the pump pretty easily with good tone and good volume management and pacing, without the use of an inotrope.... Lately I have been doing 3 CABGs/Valves/Asc. Aortas per day and i would say I start milrinone coming off-pump on every 6-8th patient (and these people are pretty sick) - and I am at a major teaching hospital.

but in totum, i agree with your prediction....