Selecting an inotrope for the cardiac surgery patient

Although a wide variety of positive inotropic agents have been administered to cardiac surgery patients, few of them have been carefully studied in controlled clinical trials, in surgical patient populations. The limited data available suggest that one of the more widely used agents, calcium, may lack efficacy and possibly inhibit the actions of catecholamines. Dopamine, dobutamine, and dopexamine are highly effective agents, but more prone to produce tachycardia than epinephrine. Amrinone is an effective agent by itself, but is especially useful in combination with a beta-adrenergic agonist for patients with severe left-ventricular dysfunction.