Key result
Dopamine and dopexamine boost jejunal mucosal perfusion significantly more than dobutamine after cardiac surgery.
Why the study?
The differential effects of dopamine, dopexamine, and dobutamine on jejunal mucosal perfusion early after cardiac surgery were not well characterized.
Do dopamine, dopexamine, and dobutamine have differential effects on jejunal mucosal perfusion in postoperative cardiac surgical patients?
RCT (n=10)
blinded
randomized
No
Do dopamine, dopexamine, and dobutamine have differential effects on jejunal mucosal perfusion in postoperative cardiac surgical patients?
p-value: p=< .05
Dopamine and dopexamine provide a greater improvement in jejunal mucosal perfusion compared to dobutamine in postoperative cardiac surgical patients, despite producing similar increases in global cardiac output.
Objective To evaluate the potential differential effects of dopamine, dopexamine, and dobutamine on jejunal mucosal perfusion, assessed by endoluminal laser Doppler flowmetry in uncomplicated postcardiac surgical patients. Design A prospective, blinded, randomized, crossover study. Setting A cardiothoracic intensive care unit in a tertiary care center. Patients A total of ten postoperative cardiac surgical patients were studied. Interventions Each patient received sequentially, randomly, and in a blinded fashion 2.7+/-0.2 microg x kg(-1) x min(-1) dopamine, 0.7+/-0.1 microg x kg(-1) x min(-1) dopexamine, and 2.7+/-0.1 microg x kg(-1) x min(-1) dobutamine. Each inotropic agent was titrated to increase cardiac output by 25% from baseline. Data on jejunal mucosal perfusion, splanchnic lactate, and oxygen extraction were obtained during a 5-min control period and a 5-min drug infusion period after the target cardiac output was reached. The procedure was sequentially repeated for each agent, and there was a 20- to 30-min washout period between each agent. Measurements and main results Dopamine, dopexamine, and dobutamine increased jejunal mucosal perfusion by 27% (p < .01), 20% (p < .001), and 7% (p < .001), respectively. The increase in jejunal mucosal perfusion by dopamine and dopexamine were significantly more pronounced compared with dobutamine (p < .05 and p < .01, respectively), whereas there was no difference between dopamine and dopexamine. Splanchnic oxygen extraction decreased to the same extent with all three drugs. Splanchnic lactate extraction did not change for any of the drugs. The effects on central hemodynamics were similar for the three inotropic agents. Conclusions Endoluminal laser Doppler flowmetry is a new tool for the detection of perfusion changes at the local intestinal mucosal level. Dopamine, dopexamine, and dobutamine have differential effects on jejunal mucosal perfusion probably because of their different receptor stimulating properties. These findings may be of clinical importance when the therapeutic goal is to improve gut mucosal perfusion.
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Thorén et al. (2000) conducted an RCT in Postoperative cardiac surgery (n=10). Dopamine, dopexamine, and dobutamine vs. Baseline and cross-comparison among agents was evaluated on Jejunal mucosal perfusion (p=< .05). Dopamine and dopexamine increased jejunal mucosal perfusion significantly more (27% and 20%, respectively) than dobutamine (7%) in postoperative cardiac surgery patients (p<0.05 and p<0.01).
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