Effect of intraoperative dobutamine on splanchnic tissue perfusion and outcome after Whipple surgery

Reyad, Amal Rashad; Elkharboutly, Walaa Safaa; Wahba, Ashraf; Elmorshedi, Mohamed; Hasaneen, Nadia A.

doi:10.1016/j.jcrc.2013.02.017

Cited by 9 publications

(14 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8,15e39 We excluded 84 studies that did not meet the inclusion criteria for various reasons. Thirteen studies 15e18,20,22,24,25,28,30,32,34,36 were conducted in Europe; four 8,19,33,38 in the UK; three 26,31,35 in the USA; two 21,29 in Canada; and one in each of China, 39 Egypt, 27 Brazil, 23 and Australia. 37 All studies were randomised, and 20 studies 15e21,23,25e28,30,32,33,35e39 recruited patients exclusively having elective surgery.…”

Section: Resultsmentioning

confidence: 99%

“…20 Vasoactive agents were used as part of a goal-directed protocol to achieve specified haemodynamic targets in 20 studies 8,15e18,20,21,23e25,28e32,35e39 and as an infusion in addition to standard care in six studies. 19,22,26,27,33,34 A variety of vasoactive drugs were used, including dobutamine, dopamine, dopexamine, norepinephrine, phenylephrine, ephedrine, and vasodilators (nitrates), either alone or in combination to achieve haemodynamic targets. Targeted haemodynamic parameters varied across studies (Table 1).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery

Deng

Bellomo

Myles

2020

British Journal of Anaesthesia

View full text Add to dashboard Cite

Background: The perioperative use of vasoactive drugs is ubiquitous in clinical anaesthesia; yet, the drugs, doses, and haemodynamic targets used are highly variable. Our objectives were to determine whether the perioperative administration of vasoactive drugs reduces mortality, morbidity, and length of stay in adult patients (aged 16 yr or older) undergoing major abdominal surgery. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for peer-reviewed RCTs with no language or date restrictions. Studies that assessed the intraoperative use of vasoactive drugs were included. Title, abstract, and full-text screening was performed. Risk of bias for each outcome measure was conducted. We calculated the risk ratio (RR) using the ManteleHaenszel random-effects model with corresponding 95% confidence interval (CI) for dichotomous outcomes, and mean difference using the inverse variance random-effects model with corresponding 95% CI for continuous outcomes. Results: Twenty-six studies (5561 participants) were included. There was no difference in mortality at the longest followup with an RR of 0.84 (95% CI: 0.63e1.12; P¼0.23). The intervention significantly reduced the number of patients with one or more postoperative complications; RR: 0.76 (95% CI: 0.66e0.88; P¼0.0002). Hospital length of stay was reduced by 0.91 days in the intervention group. Conclusions: This review is limited by the quality and sample size of individual studies, and the heterogeneity of the settings, interventions, and outcome measures. Perioperative administration of vasoactive drugs may reduce postoperative complications and hospital length of stay in adult patients having major abdominal surgery.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery

Deng

Bellomo

Myles

2020

British Journal of Anaesthesia

View full text Add to dashboard Cite

show abstract

“…However catecholaminergic inotropes increase cardiac oxygen consumption and can thus lead to side effects such as cardiac ischaemia, and some studies have found an overall negative effect of inotropes in patients undergoing cardiac surgery or in patients with heart failure. 73 While some studies report beneficial effects of inotropes in abdominal surgery, 74 Davies et al reported no benefit of the addition of a low dose of dopexamine to stroke-volume optimised patients, reflecting earlier findings by Takala et al 75 76 Pavlovich reported worse outcome in emergency surgical patients randomised to a GDFT protocol including a target CI of 2.5 -3 l/min/m 2 which necessitated dobutamine in about 50% of patients, compared to patients who were only fluid-optimised guided by the dynamic parameter PPV. 73 Therefore, although recommended by several reviews, 12 and part of ongoing trial protocols (https://optimiseii.org/ documents), the role of inotropes in GDFT remains unclear.…”

Section: Inotropesmentioning

confidence: 99%

Goal‐directed fluid therapy during major abdominal surgery

Bahlmann

2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

“…Further, previous randomized control trials reported that maintaining higher CI than normal with dobutamine did not affect mortality while dobutamine successfully elevated CI even in patients with normal CI [ 10 , 14 ]. Although dobutamine leads to an increase in CI and splanchnic blood flow [ 15 ], myocardial oxygen demand also increases, thus increasing the risk of myocardial ischemia and tachyarrhythmia [ 16 ]. It is well known that the mortality in sepsis complicated with atrial fibrillation (AFib) is worse than that in sepsis without AFib [ 17 ].…”

Section: Manuscriptmentioning

confidence: 99%

Time to re-think the use of dobutamine in sepsis

Sato

Nasu²

2017

j intensive care

View full text Add to dashboard Cite

Dobutamine is commonly used worldwide and included in the protocol for early goal-directed therapy (EGDT). Since the use of dobutamine in EGDT was reported, it has been considered to be an important component, especially in the treatment of septic patients with myocardial dysfunction. However, it is questionable whether dobutamine improves the mortality of sepsis and septic shock.In three recent randomized controlled trials (ProCESS, ProMISe, and ARISE trials), the frequency of dobutamine use was significantly higher in the EGDT group than in the standard care group, but there were no significant differences in the mortality between the groups. These results suggested that dobutamine use may have been overemphasized despite its insignificant effect on the mortality in septic patients. Further, a propensity score analysis revealed that dobutamine use was associated with higher mortality in patients with septic shock.Although dobutamine leads to an increase in cardiac index, myocardial oxygen demand also increases, thus increasing the risk of myocardial ischemia and tachyarrhythmia. It is well known that the mortality in sepsis complicated with atrial fibrillation (AFib) is worse than that in sepsis without AFib. A propensity score-matched analysis reported that β-blockers were associated with better survival in patients with sepsis complicated with AFib. Further, a randomized controlled trial reported that a short-acting β-blocker improved the survival in patients with septic shock. These studies also indicated the risk of β-stimulation during sepsis.Notably, improvements in surrogate markers, such as CI, do not always indicate improvements in patient-centered outcomes, such as mortality. Conversely, some evidence indicates the worsening of patient-centered outcomes despite improvements in surrogate markers.Thus, available evidence suggests that the benefits of dobutamine in patients with sepsis are unclear, but its use might be harmful rather than beneficial, considering the beneficial effects of β-blockers in sepsis that have been reported in recent clinical studies. From this perspective, we will soon have to rethink regarding dobutamine use in patients with sepsis.

show abstract

Effect of intraoperative dobutamine on splanchnic tissue perfusion and outcome after Whipple surgery

Cited by 9 publications

References 39 publications

Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery

Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery

Goal‐directed fluid therapy during major abdominal surgery

Time to re-think the use of dobutamine in sepsis

Contact Info

Product

Resources

About