[Enoximone, a new phosphodiesterase inhibitor: the spectrum of applications during heart surgery--a comparison with dobutamine].
During cardiac surgery treatment of deterioration of myocardial function is usually based on catecholamines. Development of selective phosphodiesterase-(PDE-)III-inhibitors seems to be a new aspect in treating myocardial dysfunction. Therefore the hemodynamic effects of the new PDE-inhibitor enoximone were investigated in 20 coronary surgery patients unable to be weaned from extracorporeal circulation (ECC) without pharmacological intervention (MAP less than 60 mmHg, CI less than 2.00 l/min.m2, PCP greater than 15 mmHg). After controlled reperfusion with 2.4 1/min.m2 two groups were separated in a random sequence receiving either 0.5 mg/kg enoximone as a bolus (n = 10), or dobutamine (n = 10, 5 micrograms/kg.min) as perfusion. In the dobutamine-group MAP and CI (-14%) were decreased, while HR was increased significantly (+30%). Application of enoximone was followed by a slight increase in CI (+5%), a significant decrease in TSR while HR remained almost unchanged. PCP, too, differed significantly between the groups (enoximone: -38%; dobutamine: -10%). Ten minutes after weaning from ECC additional pharmacologic therapy (calcium, vasodilators, epinephrine) was necessary in eight dobutamine treated patients in contrast to four patients in the enoximone group (calcium, epinephrine). In patients with impaired myocardial performance during weaning from ECC enoximone seems to be an alternative therapy and is judged to be of some advantage compared to dobutamine application in this situation. The mechanism for improvement appears to be enhanced contractility owing to its positive inotropic effects, as well as a decrease in left ventricular outflow resistance resulting from peripheral vasodilation.
Boldt
J
J
Abteilung Anästhesiologie und Operative Intensivmedizin, Justus-Liebig-Universität Giessen.
Kling
D
D
Schuhmann
E
E
Scheld
H H
HH
Hempelmann
G
G
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D001026:Coronary Artery Bypass; D004280:Dobutamine / Q000494:pharmacology*; D004341:Drug Evaluation; D017335:Enoximone; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007093:Imidazoles / Q000494:pharmacology*; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology*; D011897:Random Allocation; D013318:Stroke Volume / Q000187:drug effects
D007093:Imidazoles; D010726:Phosphodiesterase Inhibitors; D004280:Dobutamine; D017335:Enoximone
Der neue Phosphodiesterasehemmer Enoximone: Einsatzmöglichkeiten im Rahmen herzchirurgischer Eingriffe. Eine vergleichende Untersuchung zu Dobutamin.