The rational selection of inotropic drugs in cardiac surgery

Despite improvements in surgical technique and intraoperative myocardial protection, certain patients have need for inotropic drug support after cardiac surgery. This review examines drugs that are currently in use for inotropic support of the heart, including calcium, epinephrine, dopamine, dobutamine, isoproterenol, and amrinone. Patient factors that may have an impact on the selection of appropriate drugs are also examined. Application of these data to specific patients must be guided by the particular hemodynamic derangements present. Careful analysis of the specific hemodynamic disorder and tailoring of inotropic therapy to these abnormalities are crucial. Such a rational approach to the selection of inotropic agents requires continuous hemodynamic assessment and recognition that the patient's condition and needs may change rapidly early after heart surgery dictating adjustment of subsequent therapy.