[The influence of the new phosphodiesterase inhibitor enoximone in patients with an acute catecholamine-refractory heart insufficiency during open-heart surgery]. / Der Einfluss des neueren Phosphodiesterase-Inhibitors Enoximon bei Patienten mit einer akuten katecholamin-refraktären Herzinsuffizienz während Operationen am offenen Herzen.

19 patients in whom cardiopulmonary bypass (cpb) was performed during different types of cardiac operations, developed myocardial failure which remained refractory to inotropic support with increasing doses of adrenaline, dopamine and dobutamine, so that it was impossible to discontinue cpb. After changing the therapeutic approach to a new regime consisting of adrenaline, dopamine and enoximone, low-output syndrome (LCOS) could be successfully reversed in 12 of the 19 patients. In the 7 remaining patients blood pressure dropped in a clinically relevant way under treatment with enoximone. 5 of these patients needed intraaortic balloon pumping (IABP) inspite of the application of enoximone, before cpb could be successfully discontinued. In three patients receiving enoximone, persisting ventricular tachyarrhythmia appeared under treatment, and disappeared after discontinuation of the drug. One patient needed IABP and left heart bypass by means of the centrifugal pump before cpb could be duly discontinued. One patient died intraoperatively due to untreatable right ventricular failure and inability to discontinue cpb. It is concluded that enoximone represents a useful drug in a significant number of patients developing heart failure refractory to inotropic support, on emerging from cpb during cardiac surgery.

[Effect of isoflurane on intracranial pressure]. / Die Wirkung von Isofluran auf den intrakraniellen Druck.

The influence exercised by isoflurane on intracranial pressure is studied in a total of 22 patients subjected to neurosurgery. Of these, 12 patients had brain tumours, 4 hydrocephalus occlusus (preoperative measurement of the intracranial pressure) and 6 severe craniocerebral trauma (continuous monitoring of intracranial pressure). In the patients suffering from cerebral tumours the intracranial pressure remained generally unchanged under isoflurane or dropped only slightly in accordance with the drop in median arterial pressure. This drop in median arterial pressure was considerable (-20% to -30%). In patients with hydrocephalus occlusus a biphasic course of the intracranial pressure was frequently observed. After a transient rise the pressure dropped again to the starting level. Isoflurane, on the other hand, led to marked increases in intracranial pressure in 5 patients with craniocerebral trauma (+4 to 22 mmHg). If the median arterial pressure also dropped at the same time, critical ranges were occasionally calculated for the cerebral perfusion pressure. The influence of nitrous oxide in respect of the performance of isoflurane in connection with intracranial pressure is discussed. It appears possible that in contrast to halothane isoflurane does not further increase the intracranial pressure if used in low doses and in the presence of nitrous oxide. However, the results presented here point to the need to exercise caution when using isoflurane in patients with markedly limited intracranial compliance.