[Enoximone and pediatric heart surgery].
The double mode of action of enoximone, inotropic and vasodilator, makes it a valuable drug in adult cardiac surgery. There have been no reports of its use in paediatric cardiac surgery. We studied its effects in 15 children with a right heart malformation, 5 with cardiac transplants and 5 with various malformations of different complexity. Enoximone was administered as an IV bolus of 1 mg/kg over 10 minutes, relayed by a continuous infusion of 7.5 gamma/kg/mn. This drug was used alone in 15 patients and in association with dobutamine or dopamine in the others. Enoximone was associated with an improved haemodynamic status after repair of right heart malformations related to better left ventricular contractility, a moderate but statistically significant elevation of mean blood pressure without tachycardia, and stable right heart filling pressures. Improved systemic perfusion was also observed in children awaiting cardiac transplantation. This treatment provided a bridge to cardiac transplantation which was attained in good condition, given the difficulties of using mechanical circulatory assistance in children and the scarcity of donors. When associated with other pulmonary vasodilators, enoximone was effective in the treatment of right heart failure with pulmonary hypertension. When used alone or in association with catecholamines, enoximone is a treatment of choice in per and postoperative paediatric intensive care, especially as the synergist effect obtained enables a reduction in the quantity of classical inotropic agents used, thereby contributing to an attenuation of the phenomenon of exhaustion observed with catecholergic drugs.
Jayais
P
P
Service d'anesthésie-réanimation, hôpital Paul-Brousse, Villejuif.
Mauriat
P
P
Pouard
P
P
Journois
D
D
D000293:Adolescent; D000367:Age Factors; D002316:Cardiotonic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017335:Enoximone; D005112:Extracorporeal Circulation; D006330:Heart Defects, Congenital / Q000601:surgery*; D006331:Heart Diseases / Q000601:surgery; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn
D002316:Cardiotonic Agents; D007093:Imidazoles; D017335:Enoximone
Enoximone et chirurgie cardiaque pédiatrique.