Recent advances in cardiac pharmacology

The general surgical population has become increasingly complex. In caring for these patients with advanced cardiac failure and ischemia, myocardial disease, new inotropic, anti-ischemic, and antidysrhythmic drugs are becoming available. The potency and rapidity of action of the new cardiac drugs described in this article make them attractive for use in the perioperative period. Milrinone, a new phosphodiesterase inhibitor, is an inodilator with potentially fewer side effects than its congener amrinone. Dopexamine's unique advantages of inotropism and renal protection need further elucidation but may potentially be useful in major vascular surgery. Enalaprilat has enjoyed success as an IV arterial vasodilator in hypertension and congestive heart failure states. Lastly, adenosine is currently widely used to treat SVT and has the benefit of an extremely short half-life and relatively few adverse effects.