A reply

Differences in the findings between our own meta-analysis on the effects of dopexamine [1] and those of the meta-reggression analysis by Dr Pearse et al. [2] are pointed out above. Possible reasons for the discrepancy have been explored [3]. A common thread in both analyses was the need for further studies. Dr Pearse and colleagues are to be commended for attempting to answer the question of the efficacy of low dose dopexamine in high risk surgical patients dopexamine, through the OPTIMISE trial. This trial, however, is yet to begin recruitment and it will be some time before we have any answers to our questions. In the mean time the use of low dose dopexamine is being promoted by a recently published national guideline [4]. Recommendation 20 of the GIFTASUP guideline states ‘In high risk patients undergoing major abdominal surgery, postoperative treatment with intravenous fluid and low dose dopexamine should be considered, in order to achieve a predetermined value of systemic oxygen delivery, as this may reduce postoperative complication rates and duration of hospital stay’. The recommendation is graded as Ib (analysis based on systematic reviews of the evidence). The strengths and limitations of these guidelines have already been highlighted in recent editorials [5, 6]. That a randomised clinical trial that will evaluate an intervention (low dose dopexamine) is about to commence recruitment, is tantamount to the fact that sufficient doubt exists on the efficacy of dopexamine. Surely it would be prudent to avoid the use of dopexamine pending the results of the OPTIMISE trial?