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Enoximone in low output states following cardiac surgery

par Naeije, Robert ;Carlier, Eric ;De Smet, Jean-Marie ;Leclerc, Jean Louis ;Kahn, Robert
Référence Journal of critical care, 4, 2, page (112-117)
Publication Publié, 1989

Article révisé par les pairs

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Résumé :

Enoximone, a phosphodiesterase F-III inhibitor with inotropic and vasodilating properties, was administered to six patients with a low output state (cardiac index below 2.0 L/min /m2) early after cardiac surgery for valvular replacement (n = 4) or coronary artery bypass grafts (n = 2). Incremental slow (20-minute) intravenous (IV) boluses of enoximone of 0.5 mg/kg in the first three patients and 0.25 mg/kg in the remaining three patients, up to a total dose ranging from 0.25 to 2.5 mg/kg, produced an increase in cardiac index from 1.6 ± 0.1 (mean ± SE) to 2.2 ± 0.1 L/min /m2 (P < .01), an increase in heart rate from 83 ± 7 to 102 ± 13 beats/min (P < .02), a decrease in pulmonary capillary wedge pressure from 20 ± 2 to 15 ± 1 mm Hg (P < .05), and a decrease in mean arterial pressure from 77 ± 4 to 64 ± 6 mm Hg (P < .05). Left ventricular stroke work did not change, 16 ± 1 to 17 ± 3 g/m (P is not significant). Mean arterial pressure decreased to below 60 mm Hg in five patients at various times up to 30 minutes after the last IV enoximone bolus, and this hypotension had to be treated with dopamine alone (n = 3), in combination with 600 mL IV colloids (n = 1), or with norepinephrine alone (n = 1). Arrhythmias occurred in three patients and consisted in sustained ventricular tachycardia (n = 1), ventricular premature beats and a short episode of ventricular tachycardia (n = 1), and supraventricular tachycardia (n = 2). Temporal relationship strongly suggests that both hypotension and arrhythmia were caused by the administration of enoximone in these patients. Thus, enoximone increases cardiac output but appears to be poorly tolerated in low output states following cardiac surgery. © 1989.