The use of amrinone in noncardiac surgery

Abstract

T HE MANAGEMENT of patients with ventricular dysfunction remains a distinct challenge to the anesthesiologist. Cardiovascular disease represents a major health care problem, and perioperative cardiac morbidity is the leading cause of death following surgery and anesthesia.’ Anesthesiologists often anesthetize patients with severe coronary artery disease (CAD), valvular heart disease, and congestive heart failure (CHF). Implementation of inotropic support often becomes necessary to improve myocardial performance and prevent severe ventricular dysfunction. There is a lack of literature on the use of phosphodiesterase-III (PDE-III) inhibitors such as am&one in patients with cardiac disease and low cardiac output (CO) syndrome (LCOS) undergoing noncardiac surgery. Amrinone exhibits both inotropic and vasodilating properties (inodilator) and offers a new option in the management of ventricular dysfunction in such patients. Amrinone can be used alone or in combination with catecholamines to support the failing heart.*” This discussion will highlight potential uses of amrinone in noncardiac surgery and review clinical situations in which PDE-III inhibitors have shown promising activity.