Dopamine counteracts hypertension during general anesthesia and hypotension during combined thoracic epidural anesthesia for abdominal aortic surgery.
The influence of the degree of sympathetic nervous system activation on the cardiovascular effects of dopamine was studied during abdominal aortic surgery in 13 patients. The arterial plasma norepinephrine concentration (NE) was used as an index of sympathetic nervous system activity. During anesthesia with nitrous oxide and fentanyl, 7 patients (group 1) had a NE above 700 pg/mL and an increased mean arterial pressure (MAP) compared with the preanesthetic level (150 +/- 6 v 117 +/- 10 mm Hg; p less than 0.01, mean +/- SEM). The other 6 patients (group 2) had no significant change in MAP compared with the preanesthetic MAP (119 +/- 7 v 105 +/- 4 mm Hg). Dopamine, 4 micrograms/kg/min, decreased MAP in group 1 by 19% (150 +/- 6 to 121 +/- 8 mm Hg; P less than 0.05) because of a 32% +/- 9% decrease (P less than 0.05) in systemic vascular resistance. MAP was not altered by dopamine in group 2 (119 +/- 7 v 123 +/- 6 mm Hg; not significant). Following termination of dopamine, the anesthetic was supplemented with thoracic epidural anesthesia (TEA). This reduced MAP to 65 +/- 7 mm Hg (P less than 0.01) and 56 +/- 3 mm Hg (P less than 0.01), and NE to 441 +/- 76 (P less than 0.05) and 235 +/- 45 pg/mL (P less than 0.05) in groups 1 and 2, respectively. During TEA, dopamine increased MAP similarly in both groups, to 85 +/- 7 mm Hg (P less than 0.01) and 82 +/- 9 mm Hg (P less than 0.05), respectively. In conclusion, dopamine, at the same dosages, counteracted hypertension during general anesthesia and counteracted hypotension during general anesthesia combined with TEA.
Lundberg
J
J
Department of Anesthesiology, University Hospital, Lund, Sweden.
Lundberg
D
D
Norgren
L
L
Werner
O
O
D000704:Analysis of Variance; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects*; D001012:Aorta, Abdominal / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D004298:Dopamine / Q000494:pharmacology / Q000627:therapeutic use*; D004837:Epinephrine / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000517:prevention & control*; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011651:Pulmonary Artery; D014655:Vascular Resistance / Q000187:drug effects
D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine