[Continuous beta-block with esmolol in combination with enoximone: influence on cardiac function in high risk patients undergoing vascular surgery].
BACKGROUND
The aim of this study was to assess cardiac function in vascular surgery patients with known coronary artery disease (CAD) who received continuous perioperative beta blocker therapy with esmolol alone versus esmolol in combination with the phosphodiesterase (PDE) III inhibitor enoximone.


METHODS
Over a period of 24 h, 28 patients were assigned to receive heart rate (HR) control by continuous infusion of esmolol in combination with the PDE III inhibitor enoximone (Esmolol+Enoximone group) or esmolol alone (Esmolol group; n=14). Cardiac function was assessed by the use of a pulmonary artery catheter and serial measurements of plasma troponin T (TnT) und B-type natriuretic peptide (BNP).


RESULTS
The heart rate significantly decreased to the target rate of 50-60 min(-1) in both groups over the observation period. Cardiac index increased significantly only in Esmolol+Enoximone-treated patients (from 2.4+/-0.2 lxmin(-1)xm(-2) to 3.1+/-0.1 lxmin(-1)xm(-2)) and was significantly higher than in the esmolol alone group (from 2.5+/-0.2 lxmin(-1)xm(-2) to 2.4+/-0.1 lxmin(-1)xm(-2)). No patient had detectable levels of cTnT perioperatively. Peak plasma BNP concentrations were significantly increased in both groups but the highest values were measured in the esmolol alone group.


CONCLUSIONS
Inotropic therapy with the PDE III inhibitor enoximone improves cardiac function in high risk patients with known CAD undergoing vascular surgery and also when receiving systematic heart rate control by continuous infusion of esmolol.
Suttner
S
S
Klinik für Anästhesie und Operative Intensivmedizin, Klinikum der Stadt Ludwigshafen, Bremser Str. 79, 67063, Ludwigshafen. suttner@gmx.de
Boldt
J
J
Lang
K
K
Mayer
J
J
Röhm
K
K
Piper
S N
SN
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000758:Anesthesia; D009320:Atrial Natriuretic Factor / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D017335:Enoximone / Q000627:therapeutic use*; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000502:physiology*; D006334:Heart Function Tests; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D011412:Propanolamines / Q000627:therapeutic use*; D012306:Risk; D020107:Troponin T / Q000097:blood; D014656:Vascular Surgical Procedures
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D011412:Propanolamines; D020107:Troponin T; D009320:Atrial Natriuretic Factor; D017335:Enoximone; C036604:esmolol