EFFECTS OF DOPEXAMINE ON CREATININE CLEARANCE, SYSTEMIC INFLAMMATION,AND SPLANCHNIC OXYGENATION IN PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-GRAFTING

Impairment of splanchnic and peripheral tissue perfusion during cardio pulmonary bypass (CPB) may be responsible for endotoxin-mediated syste mic inflammation and acute phase responses. We examined the effects of dopexamine on hemodynamic parameters, creatinine clearance, systemic and splanchnic oxygenation, gastric mucosal pH (pHi), and mixed and he patic venous plasma levels of endotoxin, interleukin-6 (IL-6), serum a myloid A (SAA), and C-reactive protein (CRP) in 44 patients scheduled for coronary artery bypass grafting. Patients were randomized to recei ve continuous infusions of 0.5, 1.0, or 2 mu g.kg(-1) min(-1) dopexami ne (n = 10 per group) or placebo (n = 14) prior to surgery, intraopera tively, and postoperatively. Dopexamine infusion increased systemic ox ygen delivery (P less than or equal to 0.01). Hepatic venous oxygen sa turation did not change, and pi-Ii decreased during and after CPB in a ll patients (P less than or equal to 0.01). Postoperative increases in IL-6 were smallest in patients who received 2.0 mu g.kg(-1).min(-1) d opexamine (P less than or equal to 0.02). SAA and CRP increases during the postoperative period were less pronounced with dopexamine through out the study. Creatinine clearance was elevated in all dopexamine gro ups (P less than or equal to 0.025). This elevation was higher with lo wer dopexamine doses (P less than or equal to 0.025). We conclude that dopexamine improves creatinine clearance and reduces systemic inflamm ation without affecting splanchnic oxygenation.