A comparison of fenoldopam with dopamine and sodium nitroprusside in patients undergoing cross-clamping of the abdominal aorta.
Fenoldopam, a selective dopamine-1-receptor agonist, decreases arterial blood pressure rapidly, with a brief duration of action similar to sodium nitroprusside (SNP), but in contrast to SNP, it increases renal blood flow. We compared the hemodynamic and renal effects of fenoldopam in patients undergoing abdominal aortic surgery requiring cross-clamping of the aorta with another therapeutic option, dopamine and SNP. Fenoldopam or 2 mcg x kg(-1) x min(-1) of dopamine and SNP was infused before incision in 60 randomly selected patients in a double-blind fashion. Hemodynamic variables were recorded before incision, immediately before clamping the aorta, 5 min after cross-clamp release and upon completion of surgery. Urine output, serum creatinine, and creatinine clearance were measured intraoperatively and postoperatively. Characteristics were compared between groups using two-sample rank sum test for continuous variables and Fisher's exact test for discrete variables. The occurrence of severe hypotension, maximum systolic blood pressure, and need for additional antihypertensive drugs were not different between the groups. Most intraoperative hemodynamic variables and all indices of renal function did not differ according to treatment. Therefore, fenoldopam has no therapeutic advantage compared with similar therapies in patients undergoing major vascular surgery involving cross-clamping of the aorta.
Oliver
William C
WC
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. oliver.william@mayo.edu
Nuttall
Gregory A
GA
Cherry
Kenneth J
KJ
Decker
Paul A
PA
Bower
Thomas
T
Ereth
Mark H
MH
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001012:Aorta, Abdominal / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects; D004298:Dopamine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D018818:Fenoldopam / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000627:therapeutic use*; D014656:Vascular Surgical Procedures / Q000379:methods*
D000959:Antihypertensive Agents; D009599:Nitroprusside; D018818:Fenoldopam; D004298:Dopamine