[Indications for inotropic agents in cardiac surgery].
Inotropic drugs are widely used before, during and after cardiac surgery. Besides the old well known inotropic drugs, new sympathomimetic drugs and phosphodiesterase inhibitors are available. They can be used alone or in combination. The choice of drug is difficult to make and depends, for one part, on the side-effects of each drug. Before surgery, they are required for patients who present with cardiogenic shock while waiting for emergency repair of their lesion. During surgery, inotropic drugs are used before, during and after using cardiopulmonary bypass. After surgery, they are used to treat low cardiac output states. A decision algorithm is suggested, but it is modified by personal clinical experience, aetiological patterns and pharmacological data. Therapeutic doses must be adjusted according to haemodynamic data. Physiological controls are required, such as venous return and heart rate. Mechanical assistance devices must not be forgotten, especially after myocardial reperfusion and weaning from extracorporeal circulation.
Estanove
S
S
Département d'Anesthésie-Réanimation, Hôpital Cardiovasculaire et Pneumologique Louis-Pradel, Lyon.
Lehot
J J
JJ
Bastien
O
O
Girard
C
C
D000465:Algorithms; D002303:Cardiac Output, Low / Q000188:drug therapy; D006348:Cardiac Surgical Procedures; D009202:Cardiomyopathies / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005112:Extracorporeal Circulation; D006349:Heart Valve Diseases / Q000188:drug therapy*; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care; D009203:Myocardial Infarction / Q000188:drug therapy*; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011184:Postoperative Period; D011300:Preoperative Care
D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors
Indications des agents inotropes en chirurgie cardiaque.