What is the place of the phosphodiesterase inhibitors?

Pharmacological support is often required during and after weaning from cardiopulmonary bypass. Most standard therapy acts on alpha-, beta- or dopaminergic-receptors, but down-regulation of beta-receptors has led to the development of agents which act independently from the beta-receptor. The phosphodiesterase (PDE) III inhibitor enoximone, was evaluated in cardiac surgery. Application of enoximone prior to weaning from CPB improved overall cardiac function, reduced the need for catecholaminergic inotropic support, and provided increased organ perfusion even 2 h after the operation. 'Pre-treatment' with enoximone may be beneficial, due to its ability to combine inotropic support with systemic and pulmonary vasodilatation, and may be considered as a first-line approach instead of catecholamines.