Dopexamine has no additional benefit in high-risk patients receiving goal-directed fluid therapy undergoing major abdominal surgery.
BACKGROUND
Dopexamine has been shown to reduce both mortality and morbidity in major surgery when it is used as part of a protocol to increase oxygen delivery in the perioperative period. A European multicenter study has examined the use of dopexamine in patients undergoing major abdominal surgery, showing a trend toward improved survival and reduced complications in high-risk patients when receiving low-dose dopexamine (0.5 μg · kg(-1) · min(-1)). A reduced oxygen uptake at the anaerobic threshold (AT) has been shown to confer a significant risk of mortality in patients undergoing major abdominal surgery and allows objective identification of a high-risk operative group. In this study, we assessed the effects of low-dose dopexamine on morbidity after major abdominal surgery in patients who were at increased risk by virtue of a reduced AT.


METHODS
Patients undergoing elective major colorectal or urological surgery who had an AT of <11 mL · kg(-1) · min(-1) or an AT of 11 to 14 mL · kg(-1) · min(-1) with a history of ischemic heart disease were recruited. Before surgery, a radial arterial cannula was placed and attached to an Edwards Lifesciences FloTrac/Vigileo system for measuring cardiac output. Patients were given a 250-mL bolus of Voluven (6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride) until the stroke volume no longer increased by 10%, then received either dopexamine (0.5 μg · kg(-1) · min(-1)) or saline 0.9% for 24 hours. During surgery, fluid boluses of Voluven were given if the stroke volume variation was >10%. No crystalloid was given during surgery. A standardized postoperative fluid regime with Hartmann solution was prescribed at 1.5 mL · kg(-1) · h(-1) for 24 hours. The primary outcome measure was postoperative morbidity measured by the Postoperative Morbidity Survey.


RESULTS
One hundred twenty-four patients were recruited over a 23-month period. The incidence of morbidity as measured by the Postoperative Morbidity Survey on day 5 was 55% in the control group versus 47% in the dopexamine group (P = 0.14). There was no significant reduction in morbidity on any measured postoperative day. Complication rates, mortality, and hospital length of stay were similar between the 2 groups; however, administration of dopexamine was associated with earlier return of tolerating an enteral diet.


CONCLUSIONS
With the effective use of goal-directed fluid therapy in elective surgical patients, the routine use of dopexamine does not confer an additional clinical benefit.
Department of Anaesthesia, York Teaching Hospitals NHS Foundation Trust, North Yorkshire, United Kingdom. simon.davies@york.nhs.uk
Simon J
SJ
Davies
David
D
Yates
R Jonathan T
RJ
Wilson
D000005:Abdomen / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D004298:Dopamine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D019990:Perioperative Care / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors
C046318:dopexamine; D004298:Dopamine