title: Effect of intraoperative dobutamine on splanchnic tissue perfusion and outcome after Whipple surgery.
abstract: OBJECTIVE
  Splanchnic hypoperfusion during abdominal surgery contributes to postoperative gut sepsis and mortality. Dobutamine is an inotrope with vasodilator properties that improve hepatosplanchnic perfusion. The aim of this study was to examine the effect of intraoperative dobutamine infusion during Whipple surgery on splanchnic perfusion, hemodynamic, and overall postoperative outcome.
  
  
  METHODS
  Sixty patients were randomly allocated to receive intraoperatively (3 μg/kg per minute or 5 μg/kg per minute) doses of dobutamine or saline. Baseline measurements included hemodynamic parameters, gastric tonometric parameters, and arterial and mixed venous gases. These patients had a follow-up for development for in-hospital morbidity and mortality.
  
  
  RESULTS
  Intraoperative use of dobutamine increased oxygen-derived parameters as evidenced by increased mixed venous oxygen saturation. Tonometered gastric mucosal pH, a surrogate for splanchnic perfusion, increased in patients who received intraoperative dobutamine. Patients in the dobutamine groups demonstrated significant higher heart rates, premature ventricular contraction arrhythmias, and electrocardiographic signs of ischemia. Mean arterial blood pressure demonstrated no significant difference among groups. The overall incidence of postoperative complications was higher in control group 70 % vs 20% to 40% in dobutamine groups.
  
  
  CONCLUSIONS
  Intraoperative use of dobutamine improved global oxygen delivery, splanchnic perfusion, and postoperative outcome after Whipple surgery. These findings may be of clinical importance when the therapeutic goal is to improve gut perfusion.
authors.affiliation: Department of Anesthesia and Intensive Care, Mansoura University Hospital, Mansoura, Egypt.
authors.forename: Amal Rashad
authors.initials: AR
authors.lastname: Reyad
authors.forename: Walaa
authors.initials: W
authors.lastname: Elkharboutly
authors.forename: Ashraf
authors.initials: A
authors.lastname: Wahba
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elmorshedi
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Hasaneen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004280:Dobutamine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007430:Intraoperative Care; D008297:Male; D016577:Pancreaticoduodenectomy; D010919:Placebos; D013152:Splanchnic Circulation / Q000187:drug effects*; D018709:Statistics, Nonparametric
chemical_list: D002316:Cardiotonic Agents; D010919:Placebos; D004280:Dobutamine
keywords: Dobutamine; Gastric mucosal tonometry; Splanchnic perfusion; Whipple's surgery