[Value of phosphodiesterase inhibitors in anesthesia and intensive care]

During anesthesia and in intensive care, pharmacological support is often required in patients with preexisting myocardial dysfunction as well as in patients with normal preoperative ventricular function. Abnormalities in both systolic and diastolic function may occur in this situation. Standard therapy used in this situation act on alpha-, beta- or dopaminergic-receptors. However, the observation of beta-receptor down-regulation phenomenon has led to the development of substances which act independently of the beta-receptor. The imidazole derivative enoximone belongs to a new class of non-catecholaminergic positive inotropics, which acts by selectively inhibiting phosphodiesterase type-III thus using a mechanism distal of the beta-receptor. Enoximone has been proven to successfully improve hemodynamics by either its positive inotropic and lusitropic or its vasodilating properties. The expected increase in MVO2 secondary to the increase in myocardial contractility appears to be compensated by the decrease in ventricular pre- and afterload. The most obvious positive hemodynamic effects are reported for patients undergoing cardiac surgery. In both adults and pediatric patients hemodynamics were improved significantly in this situation. There is a particular indication for enoximone for patients with severely impaired hemodynamics awaiting heart transplantation ("pharmacological" bridging). The first promising results were documented when PDE-III-inhibitors were given in myocardial infarction and septic shock patients. The most important risk associated with the use of enoximone is the reduction in blood pressure due to its arterial and venous vasodilatory effects. Limitation to a bolus of 0.5 mg/kg or a perfusor controlled therapy help to avoid critical decrease in perfusion pressure.(ABSTRACT TRUNCATED AT 250 WORDS)