Abstract
Purpose: 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±5.5vs92±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) did not enhance hemodynamic function and tissue oxygenation values during elective infrarenal abdominal aortic aneurysm repair.
Résumé
Objectif: Évaluer les effets d’une perfusion peropératoire de dopexamine, un agonist edes adrénorécepteurs DA-1 et B2, sur l’heémodynamie, l’apport et la consommation d’oxygène tissulaire, la perfusion splanchnique et la perméabilité intenstinale à la suite d’un clampage total de l’aorte et de son retrait.
Méthode: Il s’agit d’un essai ranomisé, 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 tissuulaire et la permeábilité 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) a stimulé la fonction hémodynamique (TAM 65±5,5vs 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 réduitl l’indice de résistance vasculaire générale, la tension artŕielle moyenne ou la consommation d’oxygène, ce sdonnées étant comparées avec celles du groupe témoin. Le ratio de dissémination de lactulose / rhamnose s’est élevé au-dessus de la normale dans les deux groupes (0,22 et 0,29 dans les groupes I et II respectivement).
Conclusion: La perfusion de dopexamine (0,5 –µg·kg−1·min−1) n’a pas amélioré l’hémodynamie ni haussé les valeurs d’oxygénation tissulaire pendant la réparation d’un anévrysme aortique abdominal sous-rénal.
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McGinley, J., Lynch, L., Hubbard, K. et al. Dopexamine hydrochloride does not modify hemodynamic response or tissue oxygenation or gut permeability during abdominal aortic surgery. Can J Anesth 48, 238–244 (2001). https://doi.org/10.1007/BF03019752
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DOI: https://doi.org/10.1007/BF03019752