Effects of dopexamine on creatinine clearance, systemic inflammation, and splanchnic oxygenation in patients undergoing coronary artery bypass grafting.
Impairment of splanchnic and peripheral tissue perfusion during cardiopulmonary bypass (CPB) may be responsible for endotoxin-mediated systemic inflammation and acute phase responses. We examined the effects of dopexamine on hemodynamic parameters, creatinine clearance, systemic and splanchnic oxygenation, gastric mucosal pH (pHi), and mixed and hepatic venous plasma levels of endotoxin, interleukin-6 (IL-6), serum amyloid A (SAA), and C-reactive protein (CRP) in 44 patients scheduled for coronary artery bypass grafting. Patients were randomized to receive continuous infusions of 0.5, 1.0, or 2 micrograms.kg-1.min-1 dopexamine (n = 10 per group) or placebo (n = 14) prior to surgery, intraoperatively, and postoperatively. Dopexamine infusion increased systemic oxygen delivery (P < or = 0.01). Hepatic venous oxygen saturation did not change, and pHi decreased during and after CPB in all patients (P < or = 0.01). Postoperative increases in IL-6 were smallest in patients who received 2.0 micrograms.kg-1.min-1 dopexamine (P < or = 0.02). SAA and CRP increases during the postoperative period were less pronounced with dopexamine throughout the study. Creatinine clearance was elevated in all dopexamine groups (P < or = 0.025). This elevation was higher with lower dopexamine doses (P < or = 0.025). We conclude that dopexamine improves creatinine clearance and reduces systemic inflammation without affecting splanchnic oxygenation.
Berendes
E
E
Department of Anesthesiology and Intensive Care Medicine, University of Münster, Germany.
Möllhoff
T
T
Van Aken
H
H
Schmidt
C
C
Erren
M
M
Deng
M C
MC
Weyand
M
M
Loick
H M
HM
D000210:Acute-Phase Reaction / Q000378:metabolism*; D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D002097:C-Reactive Protein / Q000032:analysis; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000378:metabolism*; D004298:Dopamine / Q000031:analogs & derivatives* / Q000494:pharmacology; D004731:Endotoxins / Q000097:blood; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006503:Hepatic Veins; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015850:Interleukin-6 / Q000097:blood; D007668:Kidney / Q000503:physiopathology; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D000685:Serum Amyloid A Protein / Q000032:analysis; D013152:Splanchnic Circulation
D000318:Adrenergic beta-Agonists; D004731:Endotoxins; D015850:Interleukin-6; D000685:Serum Amyloid A Protein; D019344:Lactic Acid; C046318:dopexamine; D002097:C-Reactive Protein; D003404:Creatinine; D010100:Oxygen; D004298:Dopamine