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      Enoximone versus Dopamine in Patients Being Weaned from Cardiopulmonary Bypass

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          Abstract

          The efficacy of acute haemodynamic support with intravenous enoximone (2 × bolus 0.5 mg/kg; infusion 5.0 µg/kg/min) versus dopamine (3.0–4.0 µg/kg/min), over an 18-hour period, was investigated in patients to be weaned from cardiopulmonary bypass (placebo-controlled trial). Under steady-state conditions, enoximone produced a substantial increase in cardiac index (20.6 ± 1.7%), but no change in heart rate. The improvement in cardiac index with time until constant values were reached (6 h) was not directly paralleled by the plasma concentration of enoximone. Pharmacodynamically relevant concentrations were already present after 1 h of infusion (480 ± 68 ng/ml) and comparable with the value determined after 6 h (442 ± 37 ng/ml). After 18 h of infusion, plasma concentration had reached 742 ± 47 ng/ml without a further improvement in cardiac function. The augmentation of stroke volume index (23.3 ± 2.5%) occurred concomitantly with a decrease in systemic vascular resistance (-23.1 ± 0.6%), obviously due to a decrease in diastolic arterial pressure (-12.0 ± 3.8%). The pulmonary capillary wedge pressure remained unaffected. There was only a slight decrease in pulmonary vascular resistance (-9.3 ± 3.2%). During both enoximone infusion and dopamine infusion, right atrial pressure increased (10.0 ± 3.1 and 9.0 ± 1.8%, respectively), in contrast to the untreated control group. This is contradictory to the drugs’ described effect in patients suffering from congestive heart failure. At a concentration which would not normally cause cardiac acceleration, dopamine provided minor haemodynamic support in the period after cardiopulmonary bypass. A small increase in cardiac index (5.9 ± 2.2%) was accompanied by a slight decrease in systemic (-4.2 ± 3.2%) and pulmonary ( 11.4 ± 2.4%) vascular resistances. The results indicate that enoximone produced beneficial haemodynamic effects in the period following cardiopulmonary bypass. Both inotropic and vasodilatory effects appeared to be manageable.

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          Author and article information

          Journal
          CRD
          Cardiology
          10.1159/issn.0008-6312
          Cardiology
          S. Karger AG
          978-3-8055-5255-4
          978-3-318-00032-0
          0008-6312
          1421-9751
          1990
          1990
          12 November 2008
          : 77
          : Suppl 3
          : 34-41
          Affiliations
          Department of Cardiovascular Surgery, Rehabilitation Center, Bad Krozingen, FRG
          Article
          174669 Cardiology 1990;77:34–41
          10.1159/000174669
          2148278
          © 1990 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 8
          Categories
          Session II

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