Use of Enoximone in Weaning from Cardiopulmonary Bypass following Mitral Valve Surgery

Tarr, T.J.; Jeffrey, Robert R.; Kent, A.P.; Cowen, Michael E.

doi:10.1159/000174672

Cited by 6 publications

(2 citation statements)

References 7 publications

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“…Milrinone is most frequently used and has been shown to reduce pulmonary pressures and augment RV function in many studies in patients with pulmonary vascular dysfunction [160-164]. Enoximone improves RV function in pulmonary vascular dysfunction after cardiac surgery [165,166] and in patients with decompensated chronic obstructive pulmonary disease (COPD) [167]. Enoximone leads to fewer postoperative myocardial infarctions than does dobutamine [168,169], which may relate to the resulting improved gas exchange when compared with dobutamine and GTN [170].…”

Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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IntroductionPulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care.MethodsA systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method.ResultsClinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy.ConclusionsThis systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.

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Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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“…Previous studies have investigated enoximone given before [2], during [3][4][5][6][7] and after [8][9][10] cardiopulmonary bypass. At present there is limited experience of piroximone in cardiac surgical patients [11][12][13].…”

Section: Resultsmentioning

confidence: 99%

Comparison of the Haemodynamic Effects of Enoximone and Piroximone in Patients After Cardiac Surgery

Patel¹,

Caldicott²,

Skoyles³

et al. 1993

British Journal of Anaesthesia

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We have compared the haemodynamic effects of the imidazole derivative phosphodiesterase inhibitors enoximone and piroximone in patients with low cardiac output after cardiac surgery. Ten patients (group E) received enoximone and 10 patients (group P) received piroximone, both at a loading dose of 0.5 mg kg-1 followed by an infusion of 5 micrograms kg-1 min-1. In both groups the main changes with time were increases in cardiac index (maximum 24.5% in group E, 25.8% in group P) and decreases in systemic vascular resistance (maximum 26.8% in group E and 24.8% in group P). There were moderate increases in heart rate (maximum 11.3% in group E and 13% in group P) but a greater percentage decrease in mean arterial pressure in group E (maximum 11.9% vs 7.9%) with time. One patient in group E developed hypertension during the loading dose. Two patients in group E and two in group P developed hypotension during the loading dose. One patient in group E developed ventricular extrasystoles which may have been related to the drug being studied.

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Enoximone

Davis¹

2007

xPharm: The Comprehensive Pharmacology Reference

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Use of Enoximone in Weaning from Cardiopulmonary Bypass following Mitral Valve Surgery

Cited by 6 publications

References 7 publications

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Comparison of the Haemodynamic Effects of Enoximone and Piroximone in Patients After Cardiac Surgery

Enoximone

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