INFLUENCE OF DOPEXAMINE HYDROCHLORIDE ON HEMODYNAMICS AND REGULATORS OF CIRCULATION IN PATIENTS UNDERGOING MAJOR ABDOMINAL-SURGERY

Background: Catecholaminergic support is often used to improve haemody namics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory p roperties. Methods: The influence of perioperative administration of d opexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple p ancreaticduodenectomy. The patients received randomized and blinded ei ther 2 mu g . kg(-1) . min(-1) of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesi a and continued until the morning of the first postoperative day. Endo thelin-l (ET-1), vasopressin, atrial natriuretic peptide (ANP), and ca techolamine plasma levels were measured from arterial blood samples. M easurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on th e morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61+/-0.41 to 4 .57+/-0.78 I . min(-1) . m(-2)) and remained elevated until the mornin g of the first postoperative day. Oxygen delivery index ((D) over dot O2I) and oxygen consumption index ((V) over dot O2I) were also signifi cantly increased in the dopexamine group ((D) over dot O2I: from 416+/ -91 to 717+/-10 ml/m(2) . m(2); (V) over dot O2I: from 98+/-25 to 157/-22 ml/m2 m2), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequa te splanchnic perfusion. Vasopressive regulators of circulation increa sed significantly only in the untreated control patients (vasopressin: from 4.37+/-2.1 to 35.9+/-12.1 pg/ml; ET-1: from 2.88+/-0.91 to 6.92/-1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexami ne hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ bloo d flow.