Ephedrine, dopamine, or dobutamine to treat hypotension with propofol during epidural anesthesia.
OBJECTIVE
To compare the efficacy of ephedrine, dopamine and dobutamine for circulatory support during thoracic epidural anesthesia after anesthetic induction with propofol.


METHODS
Forty patients undergoing lobectomy or mastectomy were divided into four groups of 10: a control group received no vasopressor; an ephedrine group received 5 mg ephedrine when the mean arterial pressure (MAP), measured every 2.5 min, decreased by 10% from baseline; dopamine and dobutamine groups received 5 microg x kg(-1) x min(-1) dopamine or 3 microg x kg(-1) x min(-1) dobutamine from five minutes after epidural injection of local anesthetic to the end of tracheal intubation. Anesthesia was induced with 2 mg x kg(-1) propofol. The MAP and heart rate (HR) were measured at baseline, 20 min after epidural injection, three minutes after propofol, and one minute after tracheal intubation.


RESULTS
In the control group, MAP and HR decreased from 86+/-9 mmHg, 74+/-8 bpm to 62+/-9 mm Hg; P<0.0001, 60+/-8 bpm; P = 0.0003 after propofol. After tracheal intubation, MAP was restored to (81+/-13 mmHg, 70+/-13 bpm). In the ephedrine, dopamine, and dobutamine groups, MAP and HR remained unchanged during epidural anesthesia and propofol induction. However, after tracheal intubation, MAP and HR increased in the ephedrine (104+/-11 mm Hg; P = 0.004, 87+/-11 bpm; P<0.0001) and dobutamine (117+/-13 mm Hg; P = 0.0005, 100+/-11 bpm; P<0.0001) groups, but not in the dopamine group compared with baseline.


CONCLUSIONS
Dopamine is preferable to ephedrine and dobutamine in providing hemodynamic stability during propofol induction and tracheal intubation following epidural anesthesia.
Kasaba
T
T
Department of Anesthesiology, Miyazaki Medical College, Japan. binjik@post1.miyazaki-med.ac.jp
Yamaga
M
M
Iwasaki
T
T
Yoshimura
Y
Y
Takasaki
M
M
D018663:Adrenergic Agents / Q000627:therapeutic use*; D000704:Analysis of Variance; D000767:Anesthesia, Epidural; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004280:Dobutamine / Q000627:therapeutic use*; D004298:Dopamine / Q000627:therapeutic use*; D004809:Ephedrine / Q000627:therapeutic use*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007442:Intubation, Intratracheal; D008297:Male; D008408:Mastectomy; D008875:Middle Aged; D011013:Pneumonectomy; D015742:Propofol / Q000008:administration & dosage*; D013566:Sympathomimetics / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D018663:Adrenergic Agents; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002316:Cardiotonic Agents; D013566:Sympathomimetics; D014662:Vasoconstrictor Agents; D004280:Dobutamine; D004809:Ephedrine; D004298:Dopamine; D015742:Propofol