A RANDOMIZED, CLINICAL-STUDY OF THE EFFECT OF LOW-DOSE DOPAMINE ON CENTRAL AND RENAL HEMODYNAMICS IN INFRARENAL AORTIC-SURGERY

Objective: To determine whether dopamine prevents deterioration of cen tral haemodynamics and renal function in aortoiliac surgery. Design: P rospective, randomised and placebo-controlled. Setting: University hos pital. Materials: Thirty patients for elective vascular surgery with i mplantation of an aortobifemoral or an aortobiiliac graft due to aorto iliac arteriosclerosis had infusion of dopamine 3 mu g/kg/min or place bo during the operation and 24 h postoperatively. Thoracic epidural an algesia and general anaesthesia were used. Chief outcome measures: Cen tral haemodynamic measurements were registered. The effective renal pl asma flow (ERPF), the glomerular filtration rate (GFR), angiotensin II , aldosterone, arginine vasopressin (AVP), atrial natriuretic peptide (ANP), endothelin and excretion of Water and electrolytes were measure d preoperatively 1 h postoperatively and 24 h postoperatively. Main re sults: During the operation the dopamine group had higher cardiac inde x and heart rate together with lower pulmonary artery wedge blood pres sure. ERPF and GFX did not differ between the groups. In the dopamine group ERPF was increased in all patients at the fir sl postoperative c learance. The fractional excretion of sodium, the per- and postoperati ve diuresis and AVP were increased in the dopamine group as compared t o tile placebo group. Postoperatively, ANP in the placebo group was I raised as compared to the preoperative level. Conclusions: Peroperativ ely, dopamine counteracted depression of left ventricular function. Th e increased ERPF at the first postoperative clearance in the dopamine group indicates either improved peroperative haemodynamics or a synerg istic effect between dopamine and epidural sympathetic blockade. Dopam ine also improved diuresis and natriuresis.