Treatment with phosphodiesterase inhibitors type III and V: milrinone and sildenafil is an effective combination during thromboxane-induced acute pulmonary.

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Treatment with phosphodiesterase inhibitors type III and V: milrinone and sildenafil is an effective combination during thromboxane-induced acute pulmonary hypertension E.B. Lobato, T Beaver, J Muehlschlegel, D.S. Kirby, C Klodell, A Sidi British Journal of Anaesthesia Volume 96, Issue 3, Pages 317-322 (March 2006) DOI: 10.1093/bja/ael009 Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 1 Changes in PVR in all four groups. All values represent mean (sem). During the infusion of U44619, PVR increased more than 4-fold. Sildenafil (Group 1) decreased PVR from 1317(279) to 840(147) dynes cm−1 s−5 and milrinone (Group 2) from 1022 (222) to 600 (132) dynes cm−1 s−5. The combination of both drugs (Group 3) had an additive effect, decreasing PVR from 1104 (276) to 428 (57) dynes cm−1 s−5. Pulmonary vasodilatation was short-lived, however, as by 60 min PVR had significantly increased. There were no significant changes after placebo (Group 4). PHTN, pulmonary hypertension. *P<0.05 compared with other sampling points; †P<0.05 compared with PHTN; ‡P<0.05 compared with 60 min. British Journal of Anaesthesia 2006 96, 317-322DOI: (10.1093/bja/ael009) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 2 Changes in SVR in all groups. All values represent mean (sem). The systemic vasodilatory effect of milrinone with or without sildenafil was evident. Milrinone alone (Group 2) lowered SVR from 2800 (280) to 1766 (360) dynes cm−1 s−5. The decrease in SVR with milrinone and sildenafil combined (Group 3) was similar to that with milrinone alone [from 2400(342) to 1542(257) dynes cm−1 s−5]. SVR remained unchanged after sildenafil (Group 1) or placebo (Group 4). PHTN, pulmonary hypertension. *P<0.05 compared with other sampling points; †P<0.05 compared with PHTN. British Journal of Anaesthesia 2006 96, 317-322DOI: (10.1093/bja/ael009) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions

Fig 3 Changes in RV contractility (RV dP/dT) over time. All values represent mean (sem). Acute PHTN was associated with a significant decrease in dP/dT in all groups. Milrinone, alone (Group 2) and in combination with sildenafil (Group 3), had a significant, yet self-limited, inotropic effect on the right ventricle, increasing RV dP/dT by 31% [from 320 (244) to 460 (175) mm Hg s−1] and 34% [from 332 (276) to 502(243) mm Hg s−1,] respectively. With sildenafil (Group 1) or placebo (Group 4), RV dP/dT remained significantly depressed. PHTN, pulmonary hypertension. *P<0.05 compared with baseline; †P<0.05 compared with PHTN. British Journal of Anaesthesia 2006 96, 317-322DOI: (10.1093/bja/ael009) Copyright © 2006 British Journal of Anaesthesia Terms and Conditions