Comparative study of effects of Adrenaline, Dobutamine and Dopamine on systemic hemodynamics and renal blood flow in patients following open heart surgery.

Sato, Yoshitomo; Matsuzawa, H; Eguchi, Shoji

doi:10.1253/jcj.46.1059

Cited by 64 publications

(16 citation statements)

References 28 publications

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“…The lack of effects of dopamine at this dosage in children after cardiac surgery contrasts with report on adults (3,4). Interestingly, the renal response to low-dose dopamine is age dependent in animals.…”

Section: Discussioncontrasting

confidence: 61%

Effect of Low Dose Dopamine on Hemodynamic and Renal Function in Children

et al. 1989

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ABSTRACT. The purpose of the study was to investigate the effect of low doses of dopamine in children. Fourteen cases were studied after open heart surgery. Cardiac output and renal parameters were determined under baseline conditions and under continuous infusion of dopamine 2.5 and 5 ~g/kg/min. During the control period cardiac index was 2.62 f 0.19 L/min/m2, renal plasma flow was decreased at 269 f 41 mL/min/1.73 m2, GFR was 86.6 2 9.2 mL/min/ 1.73 m2, and filtration fraction was elevated at 37.1 f 1.9%. Plasma concentration of aldosterone correlated with the filtration fraction. At 5 pg/kg/min dopamine increased significantly cardiac output, renal plasma flow, and to a lesser extent GFR, thus decreasing the filtration fraction. At 2.5 pg/kg/min dopamine, increased renal plasma flow only in patients older than 5 y and had no effect on the other parameters. The increase of cardiac output in response to dopamine was abolished by propanolol pretreatment. By contrast, the hemodynamic renal response to dopamine was not altered by P-blockade. These results indicate that 5 wg/kg/min of dopamine could prevent renal failure after open heart surgery in children by increasing renal blood flow and attenuating renal compensatory mechanisms. (Pediatr Res 26:200-203,1989) Abbreviation PAH, para-aminohippurateIn the presence of reduced cardiac output, dopamine is frequently used for both its positive cardiac inotropic and its renal vasodilatory effects. A considerable amount of data supports its use in adults (1-5) but hemodynamic and renal effect of dopamine have not yet been assessed in children. Some animal (6-8) and clinical studies (9) suggest that differences in response to dopamine exist between adults and pediatric patients.After open heart surgery, cardiac output and systemic pressure are often depressed. Renal failure develops in 3 to 20% of patients depending on the criteria used and the patient population. It markedly influences the ultimate prognosis (10-1 5).Our study was designed to test the effect of a continuous infusion of dopamine, 2.5 and 5.0 pg/kg/min, on hemodynamic and renal function in children after open heart surgery. renal function before the operation. The group consisted of eight girls and six boys aged 18 mo to 15 y. The clinical characteristics and the preoperative plasma creatinine concentrations are given in Table I. All the patients had normal urinalysis with negative or trace proteinuria. Before the operation, six children with tetralogy of Fallot were treated with 1 to 4 mg/kg/day of propranolol to prevent hypoxic spells; the drug was stopped 8 h before the beginning of the operation. The surgery was performed with cardiopulmonary bypass, deep hypothermia (1 8 to 24"C), and moderate hemodilution (20 to 30%).Cold chemical cardioplegia was used to obtain asystole. When cardiopulmonary bypass was discontinued, blood was infused until the left atrial pressure reached 9.5 to 12.5 mm Hg, and a single dose of furosemide (1 mg/kg) was given.Method. After the operation, a Swan-Ganz catheter (5 F...

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Section: Discussioncontrasting

confidence: 61%

Effect of Low Dose Dopamine on Hemodynamic and Renal Function in Children

et al. 1989

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“…36,37 Epinephrine is most useful as an inotrope in patients who are hypotensive and free from myocardial ischemia, especially after cardiac surgery. 2,31,32,36,37,69 In patients with septic shock and MAP <70 mm Hg despite norepinephrine (0.1 mg/kg/min), adding epinephrine (0.05-0.3 mg/kg/min) increased MAP, HR, and CI more than adding dobutamine (3-20 mg/kg/min). 69 Higher epinephrine doses (>0.1 mg/kg/min) produce increasing A1R-mediated vasoconstriction leading to potent vasopressor and inotropic effects similar to the combination of norepinephrine plus dobutamine (Table 2).…”

Section: Goals Of Resuscitationmentioning

confidence: 99%

Pharmacotherapy Update on the Use of Vasopressors and Inotropes in the Intensive Care Unit

Jentzer

Coons

Link

et al. 2014

J Cardiovasc Pharmacol Ther

142

106

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This paper summarizes the pharmacologic properties of vasoactive medications used in the treatment of shock, including the inotropes and vasopressors. The clinical application of these therapies is discussed and recent studies describing their use and associated outcomes are also reported. Comprehension of hemodynamic principles and adrenergic and non-adrenergic receptor mechanisms are salient to the appropriate therapeutic utility of vasoactive medications for shock. Vasoactive medications can be classified based on their direct effects on vascular tone (vasoconstriction or vasodilation) and on the heart (presence or absence of positive inotropic effects). This classification highlights key similarities and differences with respect to pharmacology and hemodynamic effects. Vasopressors include pure vasoconstrictors (phenylephrine and vasopressin) and inoconstrictors (dopamine, norepinephrine, and epinephrine). Each of these medications acts as vasopressors to increase mean arterial pressure by augmenting vascular tone. Inotropes include inodilators (dobutamine and milrinone) and the aforementioned inoconstrictors. These medications act as inotropes by enhancing cardiac output through enhanced contractility. The inodilators also reduce afterload from systemic vasodilation. The relative hemodynamic effect of each agent varies depending on the dose administered, but is particularly apparent with dopamine. Recent large-scale clinical trials have evaluated vasopressors and determined that norepinephrine may be preferred as a first-line therapy for a broad range of shock states, most notably septic shock. Consequently, careful selection of vasoactive medications based on desired pharmacologic effects that are matched to the patient's underlying pathophysiology of shock may optimize hemodynamics while reducing the potential for adverse effects.

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“…It is true that dobutamine and milrinone have been shown to increase cardiac index and renal blood flow in most studies, 70 and after open heart surgery, the increase in renal blood flow is proportional to the increase in cardiac index. 71 However, the clinical consequences are not clear, with urine output and outcomes not having shown improvement in many studies. [72][73][74] The hypothesis that routine use of inotropic therapy will permit more effective diuresis and treatment in patients with HF was conclusively tested and rejected in the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME) study.…”

Section: Inotropesmentioning

confidence: 99%