Journal: Acta Anaesthesiol Scand 52(7):991-996, 2008.
Reprint: Intensive Care Unit, Osaka University Hospital, 2-15, Yamadaoka, Suita, Osaka 565-0871, Japan (A Uchiyama, MD)
Faculty Disclosure: Abstracted by L. Easley, who has nothing to disclose.
Milrinone is effective in the treatment of patients with congestive heart failure. The accumulation of milrinone leads to a high plasma concentration, which produces various serious side effects such as ventricular arrhythmia or decreased blood pressure. There are little data examining the relationship between plasma concentration of milrinone (pCmil) and renal function in intravenous infusion.
The purpose of this study was to examine the pCmil at intravenous infusion to critically ill patients. Ten patients who were admitted to the ICU needing the administration of milrinone due to cardiac failure after cardiovascular surgery were enrolled in the study. The continuous venous infusion rate of milrinone was set at 0.2 mcg/kg body weight (BW)/ min, which was recommended in patients with a corrected creatinine clearance (CLcr) of 5 mL/min/1.73 m2 body surface area (BSA) by the prescribing information from the manufacturer. Urine was stored during the first 24 hr to measure the creatine and milrinone concentrations of the collected urine. The main elimination route of milrinone was renal. Measurement of the milrinone concentration of the samples was performed using the high-performance liquid chromatography method. The total administration dose of milrinone during the first 24 hr was 17.7 ± 2.8 mg. The total urine extraction amount of milrinone during the first 24 hr was 11.4 ± 2.4 mg, which was 64.5 ± 9.5% of the administration drug. During the first 24 hr, CLcr and renal clearance of milrinone (rCLmil) were 62.2 ± 30.6 mL/min and 1.67 ± 0.77 mL/kg/min, respectively. The pCmil was highly correlated with BW/CLcr.
The main findings of the present study are as follows: the pCmil exhibited stability 6 hr or later after the continuous infusion of milrinone; the pCmil can be estimated by the value of CLcr. In the present study, the mean pCmil in all the patients was 96.1 ng/mL at 24 hr after the beginning of the infusion. The pCmils in this study were a little lower than those previously reported. Although the value of pCmil in the present study was relatively low, it was enough to achieve a favorable clinical response. In the present study, while the mean corrected CLcr of the study patients was 64.7 mL/min/1.73m2 BSA, 24 hr urinary excretion was 64.5% of the administered drug. During the first 24 hr, CLcr and rCLmil were 62.2 mL/min and 1.67 mL/kg/min, respectively.
In this study a significant linear relationship was found between rCLmil and CLcr. In conclusion, the pCmil exhibited stability 6 hr or later after the continuous infusion of milrinone 0.2 mcg/kg/min. The pCmil can be estimated by the value of CLcr and BW. |
