Influence of dopexamine on hemodynamics, intramucosal pH, and regulators of the macrocirculation and microcirculation in patients undergoing abdominal aortic surgery.
OBJECTIVE
To investigate whether dopexamine hydrochloride beneficially influences splanchnic perfusion and regulators of the macrocirculation and microcirculation in patients undergoing surgery of the abdominal aorta.


METHODS
Prospective, blinded, and randomized study.


METHODS
University-affiliated hospital.


METHODS
Twenty patients undergoing elective abdominal aortic surgery.


METHODS
The patients were randomized to one of two groups. In the dopexamine group (DOP, n = 10), dopexamine, 1 microg/kg/min, was started before surgery and continued for 24 hours. In the control group (COG, n = 10), patients received saline solution as placebo. Extensive hemodynamic monitoring was carried out using a pulmonary artery catheter, and intramucosal pH was measured using a gastric tonometer. From arterial blood samples, important regulators of the circulation were measured before dopexamine was administered (T0), before aortic clamping (T1), 20 minutes after aortic clamping (T2), after declamping the first leg (T3), at the end of surgery (T4), 1 hour postoperatively (T5), and 24 hours postoperatively (T6).


RESULTS
Heart rate increased significantly in DOP (63+/-16 to 84+/-18 beats/min). At T5, mean pulmonary artery pressure was significantly lower in DOP (15+/-6 mmHg) than in COG (22+/-6 mmHg). During aortic clamping, pulmonary capillary wedge pressure increased significantly in both groups. Cardiac index increased significantly from baseline only in the dopexamine patients. No significant differences between the groups were seen with regard to oxygenation parameters and intramucosal pH. Renin plasma levels increased significantly only in COG (46+/-32 to 99+/-55 microU/mL). Endothelin and atrial natriuretic peptide plasma levels showed no significant differences between the two groups. Atrial natriuretic peptide increased significantly only in DOP (366+/-171 pg/mL; COG, 159+/-71 pg/mL). Antidiuretic hormone, norepinephrine, and epinephrine plasma levels increased significantly from baseline in both groups, without showing significant differences between the groups.


CONCLUSIONS
In patients undergoing abdominal aortic surgery, prophylactic perioperative administration of dopexamine hydrochloride produced effects on hemodynamics but without improving oxygenation and intramucosal pH. From the measured regulators of the circulation, only renin was beneficially affected.
Piper
S N
SN
Department of Anesthesiology and Intensive Care Medicine and Surgery, Klinikum der Stadt Ludwigshafen, Akademisches Lehrkrankenhaus der Universität Mainz, Germany.
Boldt
J
J
Schmidt
C C
CC
Brosch
C
C
Maleck
W H
WH
Berchtold
C
C
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D004298:Dopamine / Q000031:analogs & derivatives* / Q000494:pharmacology; D018491:Dopamine Agonists / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D011446:Prospective Studies
D018491:Dopamine Agonists; C046318:dopexamine; D004298:Dopamine