RESUMO
AIM: The aim of this study was to examine the effects of milrinone on tissue metabolism perioperatively in cardiac surgery patients using extracorporeal circulation, in comparison to adrenaline and placebo. These effects were measured indirectly by measuring serum lactate, base excess and glucose levels at standard intervals. METHODS: Seventy-seven consecutive patients, who underwent elective cardiac surgery, were allocated in 3 groups. Inotropic support was initiated coming off CPB (cardiopulmonary bypass) if there was evidence of hypotension (mean arterial pressure [MAP] <60 mmHg), after adequate preload (pulmonary capillary wedge pressure [PCWP] >10 mmHg). Milrinone was used in patients with pulmonary hypertension (MPAP >20 mmHg). Group 1 (N.=26) received no inotropes, placebo. Group 2 (N.=32) received adrenaline. Group 3 (N.=19) received adrenaline + milrinone at 0.5 microg/kg/min infusion. Adrenaline was infused at a variable dose (0.01-0.02 microg/kg/min) to achieve a MAP >60 mmHg. The serum lactate, base excess and glucose levels were measured at standard intervals in all 3 groups. Diabetic, hepatic or renal failure patients (serum creatinine >2 mg/dL), were excluded from the study. Patient demographic and clinical characteristics were similar in all 3 groups. RESULTS: Repeated measure analysis of variance between groups showed significantly lower serum lactate levels and higher base excess in the milrinone group (P<0.05), after 2 to 4 hours of treatment. Serum glucose levels were higher in the adrenaline group (P=0.01). There were no immediate complications, morbidity or mortality in the study groups. CONCLUSION: These findings suggest that milrinone has a beneficiary effect on aerobic tissue metabolism after extracorporeal circulation, reflected on serum lactate, base excess and glucose levels, possibly due to a combination of positive inotropic and peripheral vasodilatory effect of the drug.
Assuntos
Acidose/prevenção & controle , Glicemia/efeitos dos fármacos , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Cardiotônicos/uso terapêutico , Epinefrina/uso terapêutico , Ácido Láctico/sangue , Milrinona/uso terapêutico , Vasodilatadores/uso terapêutico , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/sangue , Adulto , Idoso , Cardiotônicos/administração & dosagem , Epinefrina/administração & dosagem , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Milrinona/administração & dosagem , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/administração & dosagemRESUMO
Intramuscular haemangiomas of thoracic skeletal muscle are uncommon tumours. They are locally invasive and tend to recur if not completely and widely excised. This report illustrates the diagnosis and management of a 25-year-old man with an intramuscular haemangioma of the chest wall. A literature report on the aetiology and management of these tumours is also given.