[The use of dobutamine during the intraoperative period to prevent organ hypoperfusion in non-heart surgery. Administration modality and monitoring].
Dobutamine is strongly recommended in the treatment of critical intensive care patients in order to improve cardiac performance and peripheral perfusion. In non-cardiac surgery there are frequent cases of organ hypoperfusion that could be treated with dobutamine; the drug, however, is not advocated since it is difficult to control without invasive hemodynamic monitoring. This study analyzed the possibilities of using and controlling dobutamine in non-cardiac surgery. The study covered 186 patients ranging from 40 to 80 years of age who were divided into two groups according to ASA class and the type of surgery they were to undergo (Group I ASA 1-2 major surgery, group 2 ASA 3-4 standard and major surgery). Of these, 93 patients were treated with dobutamine infusion, 3 mu/kg/min, started before anesthesia and modulated for the duration of the operation on the basis of the patient's monitoring values. The remaining 93 patients were the controls who underwent the same anesthesiological procedure without receiving the drug. During anesthesia we monitored: mean blood pressure, pulsioxiometry, fraction of exhaled CO2 and heart rate. Analyses were done using a personal computer network connected to the patient monitoring system. For each parameter we calculated the number of times per hour of anesthesia that different readings were taken (higher or lower) with respect to the value recorded immediately after premedication. The following variations were considered significant. 5 mmHg for blood pressure, 10 b/min for heart rate, 4% higher or lower for exhaled CO2; plus or minus 95% for pulsioximetry. The data were evaluated using the chi 2 test. The treated patients showed significantly higher blood pressure, exhaled CO2 and heart rate values, demonstrating that dobutamine infusion can be piloted on the basis of these monitoring parameters. The treated patients had 4% higher exhaled CO2 levels showing the close correlation between exhaled CO2 and the use of the inotrope. The overall results show that dobutamine is easy to use and readily piloted during anesthesia for non-cardiac surgery.
Lanza
V
V
Ospedale Buccheri La Ferla Fatebenefratelli, Palermo.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000758:Anesthesia; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects*; D002985:Clinical Protocols; D004280:Dobutamine / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000517:prevention & control; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012039:Regional Blood Flow / Q000187:drug effects*
D004280:Dobutamine