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The use of dopexamine hydrochloride in patients with low cardiac output after cardiac surgery
TITLE
THE USE OF DOPEXAMINE SURGERY
AUTHORS
B. DU GRES, C. FLAMENS, M.C. GRUNER
AFFILIATION
HYDROCHLORIDE IN PATIENTS WITH LOW CARDIAC OUTPUT AFTER CARDIAC
- HGpital Cardiovasculaire : Dipartement d'Anesth&ie Rianimation PRADEL - BP LYON MONTCHAT - 69394 LYON CEDEX 03 - FRANCE
agents are often Inotropic and vasodilating administered in patients after cardiac surgery, either after valve replacement or after coronary bypass. Dopexamine hydrochloride is a new vasodilating agent with post-junctionnal dopaminergic and beta 2 adrenergic agonist properties. This study presents the results of an investigation of dopexamine hydrochloride in patients with postoperative low cardiac output.
et Pneumologique
Louis
DBP did not change from control to 4 pg/kg/min, but decreased at 6 pg/kg/min (60 to 58 mmHg) and MBP increased from 74 mmHg to 83 mmHg at 2 pg, but decreased to 77 mmHg at 4 Pi?. MBP did not change from control to rlpg/kg/min (23+4 mmHg). Car&ac index increased from $.5+0.4 l/min/m2 (control) to 1.80+0.2 l/min/m clpg/kg/min) and 2.4120.7 l/min/m (4pg/kg/min). to 1544 SVR decrease -# from 2316 (control) dynes/set/cm a-rd PVR (4 pg/kg/min), decreased from 234 to 193 dynes/set/cm in the same time. LVSWI increasad from 19.526.3 g/m/m' to 27.9+7.5g/m/m at the dose of 2 pghkg/min and RVSWI increased from 5.8 to 7.8g/m/m . HR increased from 79+18 (control) to 106+12 (4clglkg/minJ. At 24 hours, (mean dose 2 pg/kg/min), MBP was stable2at 80 mmHg, CI was increased at 2.86 l/min/m , SVR was still reduced. At 48 hours, MBP semained the same (79 mmHg) CI was 2.75 l/tin/m and SVR was 1214 dynes/set/cm .
Methods Ten patients undergoing cardiac surgery were included. They presented after cardiopulmonary bypass a low cardiac ou&put syndrome, with : cardiac index < 2 l/min/m , diastolic pulmonary artery pressure or mean wedge pressure over 15 mmHg, low urine output, and poor peripheral perfusion. All patients had adequate filling pressures before entering into the protocol. Haemodynamics parameters were monitored by Swan-Ganz catheter and arterial line. In the first dose titration phase, dopexamine was given by increasing doses from 1 to 8 every 15 minutes to determine Pg/kg/min, In the second phase, optimal optimal dose. dose was given for 48 hours. During the first phase, after control and each interval, systolic (SBP), diastolic (DBP) and mean (MBP) arterial blood pressure ; systolic diastolic (DPBP) and mean (MPBP) (SPBP), pulmonary artery presure, heart rate (HR), central venous pressure (CVP), pulmonary capillary wedge presure (PCWP) and cardiac index (CI) were recorded. Systemic (SVR) and pulmonary (PVR) vascular left (LVSWI) and right (RVSWI) resistances, ventricular stroke work index were calculated. During the second phase, the same haemodynamic measurements were made each hour during the and each six hour for the 42 first six hours, following hours. Statistics were performed using variance analysis and Wilcoxon test. (significance P
Discussion Dopexamine hydrochloride, administered as a continuous infusion in patients with postoperative low cardiac output improved significantly systolic and mean blood pressure,cardiac index and stroke work index, and reduced systemic and pulmonary vascular resistances. All these changes were considered to be beneficial. In contrast with the use of other adrenergic drugs which often increase DBP, dopexamine caused a decrease in diastolic arterial pressure and this may have contributed to the observed increase in heart rate. Dopexamine hydrochloride improved cardiac performance still at 24 and 48 hours, without a rebound after weaning.
Results During the dose titration phase, SBP increased from 101~12 mmHg (control) to 114+13 mmHg (lpg/kg/min) and to 121520 (2pg/kg/sn), but decreased to 115~22 mmHg at the dose of 4pg/kg/min.
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THE USE OF DOPEXAMINE SURGERY
AUTHORS
B. DU GRES, C. FLAMENS, M.C. GRUNER
AFFILIATION
HYDROCHLORIDE IN PATIENTS WITH LOW CARDIAC OUTPUT AFTER CARDIAC
- HGpital Cardiovasculaire : Dipartement d'Anesth&ie Rianimation PRADEL - BP LYON MONTCHAT - 69394 LYON CEDEX 03 - FRANCE
agents are often Inotropic and vasodilating administered in patients after cardiac surgery, either after valve replacement or after coronary bypass. Dopexamine hydrochloride is a new vasodilating agent with post-junctionnal dopaminergic and beta 2 adrenergic agonist properties. This study presents the results of an investigation of dopexamine hydrochloride in patients with postoperative low cardiac output.
et Pneumologique
Louis
DBP did not change from control to 4 pg/kg/min, but decreased at 6 pg/kg/min (60 to 58 mmHg) and MBP increased from 74 mmHg to 83 mmHg at 2 pg, but decreased to 77 mmHg at 4 Pi?. MBP did not change from control to rlpg/kg/min (23+4 mmHg). Car&ac index increased from $.5+0.4 l/min/m2 (control) to 1.80+0.2 l/min/m clpg/kg/min) and 2.4120.7 l/min/m (4pg/kg/min). to 1544 SVR decrease -# from 2316 (control) dynes/set/cm a-rd PVR (4 pg/kg/min), decreased from 234 to 193 dynes/set/cm in the same time. LVSWI increasad from 19.526.3 g/m/m' to 27.9+7.5g/m/m at the dose of 2 pghkg/min and RVSWI increased from 5.8 to 7.8g/m/m . HR increased from 79+18 (control) to 106+12 (4clglkg/minJ. At 24 hours, (mean dose 2 pg/kg/min), MBP was stable2at 80 mmHg, CI was increased at 2.86 l/min/m , SVR was still reduced. At 48 hours, MBP semained the same (79 mmHg) CI was 2.75 l/tin/m and SVR was 1214 dynes/set/cm .
Methods Ten patients undergoing cardiac surgery were included. They presented after cardiopulmonary bypass a low cardiac ou&put syndrome, with : cardiac index < 2 l/min/m , diastolic pulmonary artery pressure or mean wedge pressure over 15 mmHg, low urine output, and poor peripheral perfusion. All patients had adequate filling pressures before entering into the protocol. Haemodynamics parameters were monitored by Swan-Ganz catheter and arterial line. In the first dose titration phase, dopexamine was given by increasing doses from 1 to 8 every 15 minutes to determine Pg/kg/min, In the second phase, optimal optimal dose. dose was given for 48 hours. During the first phase, after control and each interval, systolic (SBP), diastolic (DBP) and mean (MBP) arterial blood pressure ; systolic diastolic (DPBP) and mean (MPBP) (SPBP), pulmonary artery presure, heart rate (HR), central venous pressure (CVP), pulmonary capillary wedge presure (PCWP) and cardiac index (CI) were recorded. Systemic (SVR) and pulmonary (PVR) vascular left (LVSWI) and right (RVSWI) resistances, ventricular stroke work index were calculated. During the second phase, the same haemodynamic measurements were made each hour during the and each six hour for the 42 first six hours, following hours. Statistics were performed using variance analysis and Wilcoxon test. (significance P
Discussion Dopexamine hydrochloride, administered as a continuous infusion in patients with postoperative low cardiac output improved significantly systolic and mean blood pressure,cardiac index and stroke work index, and reduced systemic and pulmonary vascular resistances. All these changes were considered to be beneficial. In contrast with the use of other adrenergic drugs which often increase DBP, dopexamine caused a decrease in diastolic arterial pressure and this may have contributed to the observed increase in heart rate. Dopexamine hydrochloride improved cardiac performance still at 24 and 48 hours, without a rebound after weaning.
Results During the dose titration phase, SBP increased from 101~12 mmHg (control) to 114+13 mmHg (lpg/kg/min) and to 121520 (2pg/kg/sn), but decreased to 115~22 mmHg at the dose of 4pg/kg/min.
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