Changes in cardiac rhythm in children treated with dopamine

Guller, Barbara; Ai, Fields; Mg, Coleman; Pr, Holbrook

doi:10.1097/00003246-197805000-00006

Cited by 20 publications

(6 citation statements)

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“…Coronary artery resistance increases with larger doses of dopamine and myocardial oxygen consumption rises as the inotropic effects increase (7). Arrhythmias have been noted with dopamine administration in both lambs and children (4,9).…”

Section: Methodsmentioning

confidence: 99%

The Effect of Alpha-Adrenergic Blockade on the Pulmonary Vascular Response to Dopamine in Neonatal Lambs

Williams

Drummond

1983

Pediatr Res

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SummaryThe effect of alpha-adrenergic blockade by phentolamine on the pulmonary vascular response to dopamine was studied in chronically prepared newborn lambs. Dopamine was administered at doses of 2.7 pg kg-' min-', 27 pg kg-'. mind' and 270 pg kg-'. min-' with and without alpha-adrenergic blockade. Dopamine infusion at 270 pg kg-' emin-' caused a rise in the mean pulmonary artery pressure from 22 f 3.2 mmHg (mean f S.E.) at baseline to 36 + 4.1 mmHg ( P < 0.001). This rise was unaffected by alpha-adrenergic blockade. Dopamine infusion alone did not change pulmonary blood flow, but, in the presence of alpha-adrenergic blockade, pulmonary blood flow rose from 190 f 12 mlmin-'. kg-' at baseline to 280 + 13 damin-'0 kg-' at the maximum dopamine infusion rate ( P < 0.001). Pulmonary vascular resistance was the same before and after alpha-adrenergic blockade and did not change from the baseline value during dopamine infusion.Abbreviations LAP, mean left atrial pressure N.S., not significant PAP, mean pulmonary artery pressure PVR, pulmonary vascular resistance QP, pulmonary blood flow SAP, mean systemic arterial pressure Neonates often have increased pulmonary vascular resistance and systemic hypotension complicating hyaline membrane disease, perinatal asphyxia, meconium aspiration syndrome, and diaphragmatic hernia. Dopamine has recently been used to improve systemic arterial pressure in newborns with pulmonary vasospasm (2, 5, 6, 11). Dopamine increases pulmonary artery pressure, presumably through alpha-adrenergic vasoconstriction (15). For this reason, some investigators have advised caution in the use of dopamine in patients with elevated pulmonary vascular resistance (3, 13).For treatment of patients with elevated pulmonary vascular resistance, it would be beneficial if the alpha-adrenergic mediated pulmonary vasoconstriction could be eliminated while maintaining dopamine's positive inotropic cardiac effect and the renal and mesenteric vasodilating action. An alpha-adrenergic blocking agent such as phentolamine in combination with dopamine might offer a therapeutic advantage to neonates with pulmonary vasoconstriction and systemic hypoperfusion. To test this hypothesis, we studied the effect of alpha-adrenergic blockade on the response to dopamine in the pulmonary and systemic circulations of chronically prepared newborn lambs. MATERIALS AND METHODSSix lambs underwent surgery at ages 1-6 days using halothane anesthesia. Catheters were placed in hind leg vessels and advanced into the abdominal aorta and inferior vena cava. Through a left thoracotomy, the ductus arteriosus was ligated and a pre-calibrated electromagnetic flow probe (C & C Instruments, Culver City, CA, and Howell Instruments, Camarillo, CA) was placed around the main pulmonary artery. Catheters were placed by direct puncture in the left atrium and in the main pulmonary artery distal to the flow probe. All catheter ends and the flow probe cable were exteriorized to the flank and were secured in a fabric pouch. The lambs were allowed to recover at...

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Section: Methodsmentioning

confidence: 99%

The Effect of Alpha-Adrenergic Blockade on the Pulmonary Vascular Response to Dopamine in Neonatal Lambs

Williams

Drummond

1983

Pediatr Res

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“…4 However, Lang and coworkers,' in a study of the hemodynamic effects of dopamine in infants after corrective surgery, found no significant changes in the left atrial pressure, right atrial pressure, pulmonary artery pressure, pulmonary vascular resistance, systemic vascular resistance, or stroke volume. Intravenous dopamine has been associated with cardiac dysrhythmia, 6 vasoconstriction, ischemic necrosis, pedal gangrene, 2 and gangrene of the fingers. 7 In our patient, dopamine had been infused into the right branch of the portal vein and we believe that the injury in the posterior right lobe of the liver was related to the infusion.…”

Section: Discussionmentioning

confidence: 99%

Hepatic Injury: A Possible Complication of Dopamine Infusion Through an Inappropriately Placed Umbilical Vein Catheter

Ps¹,

Ds²,

Rc³

et al. 1984

Amer J Perinatol

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A 34-week preterm infant was evaluated for direct hyperbilirubinemia and hepatomegaly at 2 weeks of age. Dopamine had been used in the management of hypotension in the early neonatal period; the drug had been inappropriately infused into the right branch of the portal vein. Ultrasonography of the abdomen at 2 weeks showed mild hepatomegaly and a hypoechoic area in the right lobe of the liver posteriorly. Follow-up ultrasonogram at 3 months showed the liver to be of normal size and echogenicity. Hyperbilirubinemia was resolved by 3 1/2 weeks. No other problems were specifically related to the hepatic injury.

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“…Even if administration of vasopressors and inotropes may be justified when balancing, for instance, a low SVR/CO (which requires reliable monitoring of such parameters), the use of these substances still increases the risk of arrhythmia and may intensify strain on the myocardium. 22,23 Using repeated volume boluses may also be associated with unwanted effects. Not only may this result in unnecessary retention of water with associated tissue edema that potentially could interfere with, for example, enteric anastomoses, but volume over-expansion can also lead to damage of the glycocalyx system and can thereby interfere with the normal reparative postoperative process.…”

Section: Risks With Acting On Nondangerous Low Blood Pressurementioning

confidence: 99%