Dopexamine hydrochloride does not modify hemodynamic response or tissue oxygenation or gut permeability during abdominal aortic surgery

Abstract

GENERAL ANESTHESIAPurpose: To assess the effects of intraoperative infusion of dopexamine (a DA-1 and B2 adrenoreceptor agonist) on hemodynamic function, tissue oxygen delivery and consumption, splanchnic perfusion and gut permeability following aortic cross-clamp and release.Methods: In a randomised double blind controlled trial 24 patients scheduled for elective infrarenal abdominal aortic aneurysm repair were studied in two centres and were assigned to one of two treatment groups. Group I received a dopexamine infusion starting at 0.5 µg·kg -1 ·min -1 increased to 2 µg·kg -1 ·min -1 maintaining a stable heart rate; Group II received a placebo infusion titrated in the same volumes following induction of anesthesia. Measured and derived hemodynamic data, tissue oxygen delivery and extraction and gut permeability were recorded at set time points throughout the procedure.Results: Dopexamine infusion (0.5 -2 µg·kg -1 ·min -1 ) was associated with enhanced hemodynamic function (MAP 65 ± 5.5 vs 92 ± 5.7 mm Hg, P =<0.05) only during the period of aortic cross clamping. However, during the most part of infrarenal abdominal aortic surgery, dopexamine did not reduce systemic vascular resistance index, mean arterial pressure nor oxygen extraction compared with the control group. The lactulose/ rhamnose permeation ratio was elevated above normal in both groups (0.22 and 0.29 in groups I and II respectively).Conclusions: Dopexamine infusion (0.5 -2 µg·kg -1 ·min -1 ) did not enhance hemodynamic function and tissue oxygenation values during elective infrarenal abdominal aortic aneurysm repair.Objectif : Évaluer les effets d'une perfusion peropératoire de dopexamine, un agoniste des adrénorécepteurs DA-1 et B2, sur l'hémodynamie, l'apport et la consommation d'oxygène tissulaire, la perfusion splanchnique et la perméabilité intestinale à la suite d'un clampage total de l'aorte et de son retrait. Méthode : Il s'agit d'un essai randomisé, contrôlé et à double insu auprès de 24 patients, provenant de deux centres et répartis en deux groupes, qui ont subi la réparation d'un anévrysme aortique abdominal sous-rénal. Le groupe I a reçu une perfusion de dopexamine amorcée à 0,5 µg·kg -1 ·min -1 , augmentée à 2 µg·kg -1 ·min -1 , maintenant une fréquence cardiaque stable; le groupe II a reçu une perfusion placebo de même volume après l'induction de l'anesthésie. Les données hémodynamiques mesurées et dérivées, l'apport et la consommation d'oxygène tissulaire et la perméabilité intestinale ont été notés à des moments de mesure déterminés au cours de l'intervention.Résultats : La perfusion de dopexamine (0,5 -2µg·kg -1 ·min -1 ) a stimulé la fonction hémodynamique (TAM 65 ± 5,5 vs 92 ± 5,7 mm Hg, P = <0,05) pendant le clampage aortique seulement. Cependant, pendant la majeure partie de l'intervention aortique abdominale sous-rénale, la dopexamine n'a pas réduit l'indice de résistance vasculaire générale, la tension artérielle moyenne ou la consommation d'oxygène, ces données étant comparées avec celles du groupe témoin. Le ratio de diss...

Effects of dopexamine on the intestinal microvascular blood flow and leucocyte activation in a sepsis model in rats

“…In patients in septic shock, a combination of dopexamine and noradrenaline enhanced gastric mucosal blood flow (estimated using LDF) to an extent greater than that with adrenaline alone, and the authors concluded that this combination could be an interesting option in the treatment of septic shock [20]. On the other hand, dopexamine was unable to improve gastric intramucosal partial carbon dioxide tension [21] and could not enhance haemodynamic function and tissue oxygenation [22] during major abdominal surgery.…”

Effects of Dopexamine on Lipid Peroxidation During Aortic Surgery in Pigs: Comparison with Dopamine

“…Dopexamine at low dose (2 mg kg K1 min K1 ) does not seem to modify significantly the haemodynamic response, as McGinley et al also observed in humans undergoing infrarenal abdominal aneurysm repair surgery. 18 Dopexamine used at a high dose (8 mg kg K1 min K1 ) in our study may have positive effects during cross-clamping (attenuation of the increase in MAP) but produces unwanted effects (hypotension, very low pH) during reperfusion despite the elevated cardiac output. Studer et al reported similar findings when using a high dose of dopexamine (10 mg kg K1 min K1 ) during supraceliac aortic cross-clamping in a rat model.…”

Dopexamine and its role in the protection of hepatosplanchnic and renal perfusion in high-risk surgical and critically ill patients

“…McGinley and colleagues, 20 in a small two-centre study, assessed postoperative gut permeability using the dual sugar absorption method and found it increased in all patients, including those randomized to receive dopexamine. Although well conducted, this trial limited the period of dopexamine treatment to the duration of surgery.…”