A comparison of the efficacy of dopexamine and dobutamine for increasing oxygen delivery in high-risk surgical patients.
Peri-operative increase of oxygen delivery has been shown to reduce mortality in high-risk surgical patients. This study compares the effectiveness of dopexamine and dobutamine when used to increase cardiac output as part of a regimen to increase oxygen delivery. Sixteen surgical patients were randomly allocated to receive either dopexamine or dobutamine, which was increased to a stable dose defined as either oxygen delivery index > 600 ml/min/m2, or tachycardia > 20% above baseline, other dysrhythmias or angina. At this "stable" dose there were significant increases in cardiac index (2.4 +/- 0.2 vs 3.7 +/- 0.3 l/min/m2) and oxygen delivery (380 +/- 73 vs 579 +/- 40 ml/min/m2) in the dopexamine group (P < 0.05); but not the dobutamine group. Five out of eight patients receiving dopexamine and three out of eight receiving dobutamine reached target oxygen delivery. Three dobutamine patients, but no dopexamine patients, had angina or dysrhythmias. In preoperative high-risk surgical patients, dopexamine can allow greater increases in oxygen delivery than dobutamine, due to cardiac effects that limit the dobutamine infusion rate.
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000139:chemically induced; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D016280:Atrial Function, Right / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004298:Dopamine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000187:drug effects*; D011651:Pulmonary Artery; D012307:Risk Factors; D013514:Surgical Procedures, Operative; D015996:Survival Rate; D013610:Tachycardia / Q000139:chemically induced; D014655:Vascular Resistance / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D006454:Hemoglobins; D014665:Vasodilator Agents; C046318:dopexamine; D004280:Dobutamine; D010100:Oxygen; D004298:Dopamine