[Use of cardiovascular drugs for cardiac surgery--based on recent studies].
Protective effects of each cardiovascular drug on major organ functions are reviewed. Based on these effects, proper use of the drugs is presented. It is probable that norepinephrine and dobutamine have the most protective effect against major organ dysfunctions. It has been shown that perioperative beta-blocker administration reduces cardiovascular complications. Nicorandil is likely to have ischemic preconditioning properties. In case of hypotension, low doses of noradrenaline should be administered first, and then dobutamine should be added. In case of systolic dysfunction, low doses of dobutamine should be chosen first, and then noradrenaline, and finally olprinone could be added. In case of hypotension and systolic dysfunction, combination of norepinephrine and dobutamine is the first choice. Then adrenaline could be added. When ischemic heart disease exists, nicorandil should be given. When decreasing or stabilizing heart rate is required, an ultra-short acting beta-blocker, such as landiolol, is recommended. To maintain hypotension in a certain situation, prostaglandin E1 is better to use than nicardipine, diltiazem, and nitroglycerin. It is important to administer the drugs focusing on postoperative complications and outcome.
Kim
Chol
C
Department of Anesthesiology, Nippon Medical School, Tokyo 113-8602.
Sakamoto
Atsuhiro
A
D000758:Anesthesia; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D013504:Cardiovascular Surgical Procedures; D002395:Catecholamines / Q000008:administration & dosage; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D019990:Perioperative Care; D058987:Phosphodiesterase 3 Inhibitors; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D014665:Vasodilator Agents / Q000008:administration & dosage
D002317:Cardiovascular Agents; D002395:Catecholamines; D058987:Phosphodiesterase 3 Inhibitors; D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents