Document Detail


High-dose amrinone is required to accelerate rewarming from deliberate mild intraoperative hypothermia for neurosurgical procedures.
MedLine Citation:
PMID:  12131112     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Since the time available to provide the cooling and rewarming is limited during deliberate mild hypothermia, the technique to accelerate the cooling and rewarming rate of core temperature has been studied. Amrinone has been reported to accelerate the cooling rate but not the rewarming rate of core temperature during deliberate mild hypothermia. The failure of amrinone effect on the rewarming rate might be due to an insufficient dose of amrinone during hypothermic conditions. The authors therefore tested whether higher doses of amrinone can accelerate the rewarming rate of core temperature during deliberate mild hypothermia for neurosurgery. METHODS: After institutional approval and informed consent, 30 patients were randomly assigned to one of three groups. Patients in the control group (n = 10) did not receive amrinone; patients in the AMR 15 group (n = 10) received 15 microg x kg(-1) x min(-1) amrinone with a 1.0-mg/kg loading dose of amrinone at the beginning of cooling; and patients in the ReAMR group (n = 10) received 5 microg x kg(-1) x min(-1) amrinone with 1.0-mg/kg loading and reloading doses of amrinone at the beginning of cooling and rewarming, respectively. Administration of amrinone was started just after the induction of cooling and continued until the end of anesthesia. Anesthesia was maintained with nitrous oxide in oxygen, propofol, and fentanyl. After induction of anesthesia, patients were cooled, and tympanic membrane temperature was maintained at 34.5 degrees C. After completion of the main surgical procedures, patients were actively rewarmed and extubated in the operating room. RESULTS: The cooling and rewarming rates of core temperature were both significantly faster in both amrinone groups than in the control group. During the cooling and rewarming periods, forearm minus fingertip temperature gradient was significantly smaller in both amrinone groups than in the control group. During the rewarming period, heart rate and mean arterial pressure in the AMR 15 group were significantly faster and lower, respectively, than in the control group. Systemic vascular resistance in the AMR 15 group was smaller than in the control group throughout the study; on the other hand, only the value after the start of rewarming in the ReAMR group was smaller than in the control group. CONCLUSIONS: Amrinone at an infusion rate of 15 or 5 microg x kg(-1) x min(-1) with a reloading at the beginning of rewarming accelerated the rewarming rate of core temperature during deliberate mild hypothermia. This suggests that high-dose amrinone is required to accelerate rewarming from deliberate mild intraoperative hypothermia for neurosurgical procedures.
Authors:
Satoki Inoue; Masahiko Kawaguchi; Takanori Sakamoto; Katsuyasu Kitaguchi; Hitoshi Furuya; Toshisuke Sakaki
Publication Detail:
Type:  Clinical Trial; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  97     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-19     Completed Date:  2002-08-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  116-23     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Nara Medical University, Kashihara, Nara, Japan. seninoue@nmu-gw.naramed-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Amrinone / blood,  pharmacology*
Cardiotonic Agents / pharmacology*
Female
Humans
Hypothermia, Induced*
Male
Middle Aged
Neurosurgical Procedures*
Rewarming*
Vascular Resistance / drug effects
Vasodilation / drug effects
Vasodilator Agents / pharmacology*
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Vasodilator Agents; 60719-84-8/Amrinone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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