Enoximone versus Dopamine in Patients Being Weaned from Cardiopulmonary Bypass

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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“…The enoximone group exhibited a significantly lesser increase in HR and a greater increase in stroke index than did either the dopamine or dobutamine group, and also exhibited significantly a greater increase in CI and decrease in SVR in comparison with dopamine. Birnbaum and coworkers [70] conducted an earlier, prospective, randomized, blinded comparison of enoximone (two boluses of 0.5 mg/kg followed by an infusion of 5 μg/kg per min) with dopamine (3.0–4.0 μg/kg per min) in 20 patients and obtained similar results.…”

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

“…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].…”