New Cardiac Drugs

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Currently, numerous intravenous pharmacological agents to treat cardiovascular dysfunction are available for perioperative use, and some new drugs are still undergoing clinical investigations. Patients with congenital or acquired cardiac diseases undergoing noncardiovascular surgery may develop acute cardiovascular dysfunction during anesthesia or in the intensive care unit. Furthermore, patients undergoing cardiovascular surgery may have preexisting congestive heart failure due to ischemic or valvular heart disease with down-regulated β1-adrenergic receptors [1], or may develop new acute ventricular dysfunction after surgery due to multiple causes such as aortic clamping, reperfusion injury, or inflammatory responses to cardiopulmonary bypass [2]. When these abnormalities occur, the mainstay of therapeutic agents used to improve ventricular function in cardiac surgical patients or patients undergoing noncardiac surgery has been inotropic agents and vasodilators. Understanding the cardiovascular effects of pharmacological interventions is important for anesthesiologists and intensivists when deciding about therapeutic interventions. New cardiac drugs are reviewed in this chapter to understand their mechanisms of action, pharmacology, and appropriate usage. Catecholamines also are discussed for comparison and because the use of drugs like epinephrine and norepinephrine may not be familiar. Although certain drugs like the intravenous dihydropyridine calcium-channel blockers have been widely available in most parts of the world, intravenous nicardipine is the first drug of its class to be available in the United States, and is reviewed.

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