Effect of olprinone, a phosphodiesterase III inhibitor, on balance of cerebral oxygen supply and demand during cardiopulmonary bypass.

Neuropsychological dysfunction with cardiopulmonary bypass (CPB) may be facilitated by inadequate cerebral oxygen balance during CPB. Olprinone, a phosphodiesterase III inhibitor, augments cerebral blood flow by a direct vasodilator effect on cerebral arteries. We conducted the present randomized study in patients undergoing cardiac surgery with CPB to investigate whether olprinone improved the balance of cerebral oxygen supply and demand during the rewarming period of CPB. After anesthesia, a 5.5 F fiberoptic oximeter catheter was inserted into the right jugular bulb retrogradely for monitoring the jugular venous oxyhemoglobin saturation (SjO2), and a probe of transcranial near-infrared spectroscopy was placed over the forehead for monitoring the bilateral regional cerebral oxygen saturation (rSO2). Patients were randomly assigned to 3 groups, and olprinone was administered at 0, 0.2, or 0.4 μg·kg(-1)·min(-1) after establishment of hypothermic CPB. Olprinone significantly prevented the reduction of the SjO2 at 5 and 10 minutes after the start of rewarming, although it did not alter rSO2. Furthermore, there was a minor reduction of the bilateral rSO2 at low doses of olprinone (0.2 μg·kg(-1)·min(-1)). We conclude that olprinone prevents the decrease of the SjO2 at the rewarming period and improves the balance of cerebral oxygen supply and demand during the rewarming period of CPB. In addition, a future extended study may be required to elucidate the effect of low dose of olprinone.