The effects of adrenaline and milrinone on plasma lactate levels in patients with myocardial dysfunction after CABG

Objective: The use of adrenaline has been associated with hyperlactatemia after cardiac surgery (1). It is not known, if this effect may also be observed during PDE-III-inhibitor treatment. Methods: 18 patients with a cardiac index (CI) below 2.5 l/min/m 2 were randomly treated with adrenaline (n=7) or milrinone (n=11) to achieve an CI >3.0 l/min/m 2 . 20 patients without inotropes served as controls (C). Lactate, glucose, hemodynamics and insulin requirements were determined at 0, 2, 6, 10, and 14 hours after ICU-admission. Results: Patients demographics (including the number of diabetics) and aortic cross-clamp-time were not different between the groups. After 2 hours, CI >3.0 was achieved in either adrenaline or milrinone treated patients and maintained during the observation period. Lactate levels in adrenaline treated patients were significantly higher than in milrinone- or control-group patients (Figure 1) despite comparable hemodynamics. Glucose levels were not different between groups, but the adrenaline-group needed more insulin than control or milrinone-treated patients (p