Table 4 Role of each intervention in hemodynamic management of neonatal intracranial AVSs with heart failure

Sedation and mechanical ventilation

Fentanyl 0.5-2.0 μg/kg/h iv Remifentanil 0.1-1.0 μg/kg/min iv

To optimize cardiopulmonary interactions

Inotropic or vasopressor agents

Epinephrine 0.1-1 μg/kg/min iv

Dobutamine 5–10 μg/kg/min iv Dopamine 5–10 μg/kg/min iv

Vasopressin 0.0001–0.001 μg/kg/min iv

To improve cardiac contractility and increase systolic pressure

Diuretics

Ethacrynic acid 0.1–0.2 mg/kg/h iv

To reduce volume overload

Milrinone

Milrinone 0.3–0.75 μg/kg/min iv

To improve myocardial LV and RV performance and reduce pulmonary hypertension

Pulmonary vasodilators

Inhaled nitric oxide (iNO) 5–20 ppm

Sildenafil 1.6 mg/kg/day iv

To reduce pulmonary vascular resistance and RV afterload

Prostaglandins infusion

PGE1 0.01 μg/kg/min iv

To maintain patent ductus arteriosus directing the increased blood flow through the pulmonary arteries to the systemic circulation and reduce pulmonary arterial pressure

Levosimendan

72 h continuous iv infusion of 0.1 μg/kg/min

To improve myocardial LV performance without increasing oxygen demand