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Hemodynamic effects of dobutamine and dopexamine after cardiopulmonary bypass in pediatric cardiac surgery.
Paediatr Anaesth. 2009 Sep; 19(9):862-71.PA

Abstract

BACKGROUND

After surgical repair of congenital heart disease, inotropic support is sometimes necessary to wean from cardiopulmonary bypass. In pediatric cardiac surgery, dobutamine and dopamine are often used as inotropic support. Dopexamine is a synthetic catecholamine, which has positive inotropic and vasodilating properties. Because the hemodynamic effects of catecholamines are modified after cardiopulmonary bypass, the aim of this study was to investigate the effects of dobutamine and dopexamine on cardiac index and systemic vascular resistance index after cardiopulmonary bypass in pediatric cardiac surgery.

METHODS

The study was performed in a prospective, randomized, and double-blinded cross-over design. The investigation included 11 children for elective, noncomplex congenital heart surgery. After weaning from cardiopulmonary bypass and a 20-min period of steady state, children received either 2.5 microg x kg(-1) x min(-1) dobutamine or 1 microg x kg(-1) x min(-1) dopexamine for 20 min. Cardiac index (transpulmonary thermodilution), mean arterial pressure, central venous pressure, stroke volume, systemic vascular resistance, and central venous oxygen saturation were determined. The primary outcome variable was cardiac index.

RESULTS

No difference in cardiac index was observed between the two groups (P = 0.594). Both drugs increased cardiac index, dopexamine from 3.9 +/- 0.6 to 4.7 +/- 0.8 l x min(-1) x m(-2) (P = 0.003) and dobutamine from 4.1 +/- 0.7 to 4.8 +/- 0.7 l x min(-1) x m(-2) (P = 0.004). During treatment with dobutamine, children presented with significantly higher mean arterial pressure (P = 0.003) and systemic vascular resistance index (P = 0.026).

CONCLUSIONS

This trial demonstrates that low-dose dobutamine and dopexamine both increase cardiac index during pediatric cardiac surgery but with different hemodynamic effects.

Authors+Show Affiliations

Department of Anesthesia, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada. myron.kwapisz@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19650844

Citation

Kwapisz, Myron M., et al. "Hemodynamic Effects of Dobutamine and Dopexamine After Cardiopulmonary Bypass in Pediatric Cardiac Surgery." Paediatric Anaesthesia, vol. 19, no. 9, 2009, pp. 862-71.
Kwapisz MM, Neuhäuser C, Scholz S, et al. Hemodynamic effects of dobutamine and dopexamine after cardiopulmonary bypass in pediatric cardiac surgery. Paediatr Anaesth. 2009;19(9):862-71.
Kwapisz, M. M., Neuhäuser, C., Scholz, S., Welters, I. D., Löhr, T., Koch, T., Valeske, K., Akintürk, H., Thul, J., & Müller, M. (2009). Hemodynamic effects of dobutamine and dopexamine after cardiopulmonary bypass in pediatric cardiac surgery. Paediatric Anaesthesia, 19(9), 862-71. https://doi.org/10.1111/j.1460-9592.2009.03101.x
Kwapisz MM, et al. Hemodynamic Effects of Dobutamine and Dopexamine After Cardiopulmonary Bypass in Pediatric Cardiac Surgery. Paediatr Anaesth. 2009;19(9):862-71. PubMed PMID: 19650844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic effects of dobutamine and dopexamine after cardiopulmonary bypass in pediatric cardiac surgery. AU - Kwapisz,Myron M, AU - Neuhäuser,Christoph, AU - Scholz,Stephan, AU - Welters,Ingeborg D, AU - Löhr,Tobias, AU - Koch,Tillo, AU - Valeske,Klaus, AU - Akintürk,Hakan, AU - Thul,Josef, AU - Müller,Matthias, Y1 - 2009/07/24/ PY - 2009/8/5/entrez PY - 2009/8/5/pubmed PY - 2009/10/31/medline SP - 862 EP - 71 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 19 IS - 9 N2 - BACKGROUND: After surgical repair of congenital heart disease, inotropic support is sometimes necessary to wean from cardiopulmonary bypass. In pediatric cardiac surgery, dobutamine and dopamine are often used as inotropic support. Dopexamine is a synthetic catecholamine, which has positive inotropic and vasodilating properties. Because the hemodynamic effects of catecholamines are modified after cardiopulmonary bypass, the aim of this study was to investigate the effects of dobutamine and dopexamine on cardiac index and systemic vascular resistance index after cardiopulmonary bypass in pediatric cardiac surgery. METHODS: The study was performed in a prospective, randomized, and double-blinded cross-over design. The investigation included 11 children for elective, noncomplex congenital heart surgery. After weaning from cardiopulmonary bypass and a 20-min period of steady state, children received either 2.5 microg x kg(-1) x min(-1) dobutamine or 1 microg x kg(-1) x min(-1) dopexamine for 20 min. Cardiac index (transpulmonary thermodilution), mean arterial pressure, central venous pressure, stroke volume, systemic vascular resistance, and central venous oxygen saturation were determined. The primary outcome variable was cardiac index. RESULTS: No difference in cardiac index was observed between the two groups (P = 0.594). Both drugs increased cardiac index, dopexamine from 3.9 +/- 0.6 to 4.7 +/- 0.8 l x min(-1) x m(-2) (P = 0.003) and dobutamine from 4.1 +/- 0.7 to 4.8 +/- 0.7 l x min(-1) x m(-2) (P = 0.004). During treatment with dobutamine, children presented with significantly higher mean arterial pressure (P = 0.003) and systemic vascular resistance index (P = 0.026). CONCLUSIONS: This trial demonstrates that low-dose dobutamine and dopexamine both increase cardiac index during pediatric cardiac surgery but with different hemodynamic effects. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/19650844/Hemodynamic_effects_of_dobutamine_and_dopexamine_after_cardiopulmonary_bypass_in_pediatric_cardiac_surgery_ L2 - https://doi.org/10.1111/j.1460-9592.2009.03101.x DB - PRIME DP - Unbound Medicine ER -