The hemodynamic drifts of enoximone and nicardipine were compared during the early postcardiac surgery period in 40 patients with systemic hypertension and moderate cardiac dysfunction.

The hemodynamic drifts of enoximone and nicardipine were compared during the early postcardiac surgery period in 40 patients with systemic hypertension and moderate cardiac dysfunction. Patients were prospectively randomized into pair groups. Mean right atrial compressing was maintained above 7 mm Hg The unsalable article infusion rate was adjusted to maintain mean systemic artery constraining force (SAP) within the 65 to 80 mm Hg range. unbroken hemodynamic evaluations were performed before any put drugs into infusion and during the following 24 h with special attention to [O.sub.2]-related variables. Oxygen consumption, cardiac index, and calamity index improved significantly and similarly in the brace groups. The SAP and systemic vascular resistance decreased more rapidly in the enoximone dispose but whole body lactate horizontal increased after the second hour of infusion. Furthermore, this was paralleled from an arteriovenous [O.sub.2] contents difference deficit. In our inquiry nicardipine was found superior athwart enoximone in terms of retrieval from intraoperative tissue hypoxia. Furthermore, enoximone's inotropic powers were not found to be clinically relevant.

(Chest 1994; 106:52-58)

cAMP=cyclic adenosine monophosphate;

[C.sub.a-v][O.sub.2]= arteriovenous oxygen easy in mind difference;

CI=cardiac index; [Do.sub.2]= oxygen delivery;

IV=intravenous;

mPAP=mean pulmonary artery pressure;

PWP=pulmonary wedge pressure;

RAP=right atrial pressure;

SI=stroke index;

sSAP=systolic systemic artery pressure;

SVR=systemic vascular resistance;

[Vosub2]=oxygen consumption

tonic words: calcium channel blockers, hemodynamics, phosphodiesterase inhibitors

Although line systemic circulation is maintained during cardiac surgery using an extracorporeal cross-examine anaerobic tissue metabolism is resort to frequently due to an imperfect circulatory function replacement.(1)(2)(3) Thus, in the early postoperative period, associated with the rewarming, single in kind major hemodynamic objective is the regaining from that tissue hypoxia. onward the other hand, the critical goal of a ready circulatory adaptation to an increased oxygen demand must be achieved despite every-day cardiac alterations due to the pair the disease itself and the postcardioplegic myocardial dysfunction. Moreover, in this setting, an increased children pressure is often observed, which impedes cardiac output and may contribute to inappropriate tissue and myocardial oxygen delivery ([Do.sub.2]).(1)(2)(3) Therefore, in the early postoperative course of patients who have undergone cardiac surgery vasodilative agents and if necessary, inotropic agents are widely used.(2)(3)(4)(5)(6)

Enoximone, a lately available inotropic drug with vasodilator effects(7) that acts mainly from inhibiting phosphodiesterase III, has been reported to be of interest in heart failure.(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) However, in various situations like as low output and vasoconstriction, enoximone's vasodilative power may substantially outweight its inotropic consequence promoting profound and prolonged hypotension and moreover, there has been a certain quantity of concern about a possible detrimental consequence of oral enoximone.(19)(20) As enoximone has the couple inotropic and vasodilative effects, the clinical concatenations of the inotropic properties should be derived from the comparison of enoximone's beneficial validitys against a pure vasodilator as direct group. Very few studies, however, have dealt with this issue in an intention-to-treat evaluation,(9)(10)(11) and no reflection to our knowledge has reported a well stocked [i]or[/i] provided 24-h complete hemodynamic evaluation, including life-blood lactate and [O.sub.2]-related variables.

Therefore, in postoperative cardiac surgery patients, after optimizing heart filling, the choice of an arterial vasodilator as a first-line therapy remains questionable. We designed a prospective cogitation to compare the hemodynamic tenors of a therapeutic strategy based onward nicardipine vs enoximone, with special attention to [O.sub.2]-related variables and furthermore to evaluate whether enoximone's inotropic properties add to the benefits provided by the agency of its vasodilative effects.

(*)From the CERIC Intensive Care Unit, Clinique Ambroise Pare, Neuilly, France.

Manuscript received June 29 1993; revision accepted November 30

Reprint requests; Dr Squara, CERIC, 27 Bd Victor Hago, 92200 Neuilly, France

METHODS

Patients

The research population consisted of 40 patients prefered among the patients who had heart surgery in our institution. All patients gave their informed assent and the protocol was approved from our institution's human ethics committee. The anesthetic practice was standardized and used 80 to 100 [micro]g [multiplied by] [kgsup-1] fentanyl, if wanted with isoflurane inhalation to have charge of intraoperative blood pressure. Extracorporeal circulatory assistance was performed using membrane oxygenation and a nonpulsating proceed of 2.4 L [multiplied by] [mnsup-1] [multiplied by] [Msup-2] subordinate to moderate hypothermia. Operative myocardial protection was obtained using repeated Breitschneider solution cardioplegic administration. The inclusion criterion was a mean systemic artery squeezing (SAP) > 115 mm Hg within 2 h of weaning from the extracorporeal circuit. Patients who had received salicylates during the week preceding the operation were exclud All patients were mechanically ventilated during the first 8 h of the protocol.

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