Efficacy of dopamine, dobutamine, and epinephrine during emergence from cardiopulmonary bypass in man.

Steen, P A; Tinker, J.; Pluth, James R.; Barnh, D A; rst,; Tarhan, Sait

doi:10.1161/01.cir.57.2.378

Cited by 99 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The therapeutic use of epinephrine infusions has also been reported in the postoperative period after cardiac surgery in adults who usually receive low doses, i.c. approximately 0.06 pg/kg/min epinephrine (8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

The Circulatory Effects of Epinephrine Infusion in the Anesthetized Piglet

Barrington

Chan

1993

Pediatr Res

View full text Add to dashboard Cite

ABSTRAn. There are few published data regarding the circulatory effects of systemic epinephrine infusions in newborn subjects. We therefore instrumented six piglets aged 5 to 10 d while they were under pentobarbitone anesthesia for determination of cardiac output, left anterior descending coronary artery flow, systemic and pulmonary pressures, and mixed venous, arterial and coronary sinus gases. Systemic, coronary, and pulmonary vascular resistances, coronary oxygen consumption, and myocardial oxygen extraction ratio were calculated. Epinephrine was infused at doses from 0.2 to 3.2 pg/kg/min doubling at 15-min intervals, and measurements were taken after stability had been obtained. Cardiac o u t~u t increased at the lowest dose investigated, i.e. 0.2 pg/kg/min, and progressively increased as the dose was advanced up to 1.6 pglkglrnin, decreasing significantly at 3.2 pg/kg/min. Blood increased progressively, being significantly above baseline at 0.8, 1.6, and 3.2 pg/kg/min and having increased by approximately 81% at the highest dose investigated. Pulmonary arterial pressures were also increased at 1.6 and 3.2 pg/kg/min, but only by 35% at the highest dose of 3.2 pg/kg/min. Systemic and pulmonary vascular resistances both decreased at the three lower doses investigated and then began to increase progressively; however, the systemic vascular resistance increased to a significantly greater degree than pulmonary vascular resistance. Coronary oxygen consumption increased progressively as the epinephrine dose was increased; however, coronary blood flow and coronary oxygen delivery increased more than oxygen consumption, leading to a progressive reduction in myocardial oxygen extraction ratio and a progressive increase in coronary sinus oxygen content. Whole-body oxygen consumption was increased, but to a lesser extent than systemic oxygen transport. We conclude that, at low doses, epinephrine is a potent inotrope and a systemic and pulmonary vasodilator in the newborn piglet. With progressive increases in the dose, systemic vasoconstriction is significantly greater than pulmonary. Increasing cardiac oxygen demands are oversupplied by increases in coronary blood flow. fusions are occasionally used as a back-up inotropic therapy for sick newborn infants (l), particularly those with persistent pulmonary hypertension of the newborn. In such infants, pulmonary vascular resistance is elevated and cardiac output is low (2). A drug that has selective pulmonary vasodilating or selective systemic pressor and positive inotropic properties would therefore be of great value. One previous study of the effects of highdose epinephrine infusions (3.5, 7, and 15 pg/kg/min) (3) in newborn piglets with group B streptococcus-induced pulmonary hypertension suggested a selective systemic pressor effect. To obtain additional information regarding the effects of this mode of therapy, the following study was performed to determine the effects of epinephrine infusions at lower, clinically applicable doses in healthy, acutely instrumented pigle...

show abstract

Section: Discussionmentioning

confidence: 99%

The Circulatory Effects of Epinephrine Infusion in the Anesthetized Piglet

Barrington

Chan

1993

Pediatr Res

View full text Add to dashboard Cite

show abstract

“…The SNS at the subclavian artery also increased the adrenergic neural tone of the heart [7]. Unfortunately, SNS also significantly increases HR, leading to a significant increase in MVo 2 , the same adverse effect associated with the use of inotropic drugs such as dobutamine to override beta-receptor downregulation and acutely augment LV contractility in patients with acute and endstage HF [45, 46]. The mortality rate for inotrope-dependent patients at 6 months is more than 50%, with few survivors at 1 year [44, 47].…”

Section: Cardiac Autonomic Nerve Stimulation Therapymentioning

confidence: 99%

Cardiac Autonomic Nerve Stimulation in the Treatment of Heart Failure

Kobayashi

Massiello

Karimov

et al. 2013

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Research on the therapeutic modulation of cardiac autonomic tone by electrical stimulation has yielded encouraging early clinical results. Vagus nerve stimulation has reduced the rates of morbidity and sudden death from heart failure, but therapeutic vagus nerve stimulation is limited by side effects of hypotension and bradycardia. Sympathetic nerve stimulation that has been implemented in the experiment may exacerbate the sympathetic-dominated autonomic imbalance. In contrast, concurrent stimulation of both sympathetic and parasympathetic cardiac nerves increases myocardial contractility without increasing heart rate. This review assesses the current state of electrical stimulation of the cardiac autonomic nervous system to treat heart failure.

show abstract

“…Further evidence for an altered response to inotropes after bypass surgery may be pro vided by a study performed by Steen et al [5], In this study, cardiac index failed to increase in some of the patients, in response to either dobutamine or dopamine, 10pg/ kg/min each. However, all the patients re sponded normally to adrenaline, 0.04 pg/kg/ min.…”

Section: Altered Response To Inotropes After Cardiac Bypassmentioning

confidence: 62%

Effects of Intravenous Enoximone following Coronary Artery Bypass Surgery

Oduro

Latimer²,

Davies³

1990

Cardiology

View full text Add to dashboard Cite

The effects of intravenous enoximone were investigated in patients with reduced left ventricular ejection fraction following coronary artery bypass graft surgery. Pulmonary capillary wedge pressure was maintained at its original level during therapy. Results showed an improvement in cardiac index of approximately 35% and a reduction of systemic vascular resistance of approximately 30% in 10 out of 16 patients. In an attempt to explain the failure of 6 patients to respond to enoximone therapy, preliminary studies revealed that a repeat dose of enoximone may elicit a response. It is further suggested that postsurgical trauma may change the behaviour of the heart in response to this agent, perhaps due to a reduction in high-energy phosphate levels.

show abstract

Efficacy of dopamine, dobutamine, and epinephrine during emergence from cardiopulmonary bypass in man.

Cited by 99 publications

References 23 publications

The Circulatory Effects of Epinephrine Infusion in the Anesthetized Piglet

The Circulatory Effects of Epinephrine Infusion in the Anesthetized Piglet

Cardiac Autonomic Nerve Stimulation in the Treatment of Heart Failure

Effects of Intravenous Enoximone following Coronary Artery Bypass Surgery

Contact Info

Product

Resources

About