Effects of Dopexamine on Creatinine Clearance, Systemic Inflammation, and Splanchnic Oxygenation in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Impairment of splanchnic and peripheral tissue perfusion during cardiopulmonary bypass (CPB) may be responsible for endotoxin-mediated systemic inflammation and acute phase responses. We examined the effects of dopexamine on hemodynamic parameters, creatinine clearance, systemic and splanchnic oxygenation, gastric mucosal pH (pHi), and mixed and hepatic venous plasma levels of endotoxin, interleukin-6 (IL-6), serum amyloid A (SAA), and C-reactive protein (CRP) in 44 patients scheduled for coronary artery bypass grafting. Patients were randomized to receive continuous infusions of 0.5, 1.0, or 2 micrograms.kg-1.min-1 dopexamine (n = 10 per group) or placebo (n = 14) prior to surgery, intraoperatively, and postoperatively. Dopexamine infusion increased systemic oxygen delivery (P < or = 0.01). Hepatic venous oxygen saturation did not change, and pHi decreased during and after CPB in all patients (P < or = 0.01). Postoperative increases in IL-6 were smallest in patients who received 2.0 micrograms.kg-1.min-1 dopexamine (P < or = 0.02). SAA and CRP increases during the postoperative period were less pronounced with dopexamine throughout the study. Creatinine clearance was elevated in all dopexamine groups (P < or = 0.025). This elevation was higher with lower dopexamine doses (P < or = 0.025). We conclude that dopexamine improves creatinine clearance and reduces systemic inflammation without affecting splanchnic oxygenation.

Impact of Preoperative Renal Dysfunction on Cardiac Surgery Results

“…These patients may benefit from implementation of greater renal protective measures during CPB (discontinuation of nephrotoxic antibiotics and use of mannitol, loop diuretics, and low-dose dopamine) with closer monitoring of renal function afterwards. 11 –16…”

Effects of olprinone, a new phosphodiesterase inhibitor, on gastric intramucosal acidosis and systemic inflammatory responses following hypothermic cardiopulmonary bypass

“…Previous studies have attributed the fall of pHi in cardiac surgical patients to splanchnic hypoperfusion during CPB, as demonstrated by a decrease in the hepatic venous haemoglobin saturation (14) or in the hepatic venous blood flow (15). However, other studies have also shown that this decrease in pHi is not necessarily associated with a decrease in the hepatic venous haemoglobin saturation (24, 33). Therefore, a decrease in pHi seems to reflect a reduction in the regional intramucosal perfusion rather than that in the global splanchnic blood flow (34).…”

Prevention and Treatment of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Systematic Review

“…1). A total of 70 studies (5,554 patients) met eligibility criteria [17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86] (table 1). …”