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BJA Advance Access published online on September 3, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh252
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted June 21, 2004

Clinical Investigation

Effects of milrinone on jugular bulb oxygen saturation and cerebrovascular carbon dioxide reactivity in patients undergoing coronary artery bypass graft surgery

Y. J. Oh 1, S. H. Kim 2, H. K. Shinn 3, C. S. Lee 3, Y. W. Hong 4, and Y. L. Kwak 4

1 Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University School of Medicine, Seoul, Korea
2 Department of Anesthesiology and Pain Medicine, Yonsei University School of Medicine, Suwon, Korea
3 Department of Anesthesiology and Pain Medicine, Inha University School of Medicine, Inchon, Korea
4 Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University School of Medicine, Seoul, Korea; Yonsei Cardiovascular Research Institute, Yonsei University School of Medicine, Seoul, Korea


  Abstract

Background. Jugular bulb oxygen saturation (SjvO2) is a surrogate marker for global cerebral oxygenation. The effect of milrinone on SjvO2 and the cerebrovascular carbon dioxide reactivity (CCO2R) was investigated.

Methods. Thirty patients scheduled for coronary artery bypass graft surgery (CABG) were studied prospectively. After sternotomy, normoventilation (at T1; PaCO2=4.7-5.0 kPa) and hyperventilation (at T2; PaCO2=3.3-3.7 kPa) were induced and the changes in SjvO2 ({Delta}SjvO2) and PaCO2 ({Delta}PaCO2), and {Delta}SjvO2/{Delta}PaCO2 (CCO2R) were measured. After normoventilation was re-established (at T3), milrinone 50 µg kg-1 was given (at T4), followed by hyperventilation (at T5), and {Delta}SjvO2, {Delta}PaCO2 and CCO2R were measured.

Results. After milrinone administration at normoventilation (T3 and T4), cardiac index and mixed venous oxygen saturation increased, while mean arterial pressure and systemic vascular resistance index decreased, without a significant change in SjvO2. Before milrinone administration (T1 and T2), hyperventilation decreased PaCO2 and SjvO2, and {Delta}SjvO2 showed positive linear correlation with {Delta}PaCO2. After milrinone administration (T4 and T5), hyperventilation decreased PaCO2 and SjvO2, and {Delta}SjvO2 showed positive linear correlation with {Delta}PaCO2. There was no significant difference in CCO2R before and after milrinone administration (13.3 (5.7)% kPa-1 and 12.3 (3.9)% kPa-1, respectively).

Conclusions. Although milrinone induced significant haemodynamic changes, SjvO2 and CCO2R were unchanged during its administration.

Keywords: anaesthesia, cardiac; carbon dioxide, hypocarbia; monitoring, jugular bulb oxygen saturation; pharmacology, milrinone.
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