Haemodynamic effects of dobutamine with special reference to myocardial blood flow. A comparison with dopamine and isoprenaline.

Abstract

SUMMARY The haemodynamic effects of dobutamine (2.5 to 10 ug/min per kg) were determined in 5 patients without cardiac failure who were undergoing cardiac catheterisation for suspected coronary disease. Myocardial blood flow was determined by the coronary sinus thermodilution technique. Data were compared with those from two groups of 5 patients who received dopamine (4-8 ,ug/min per kg) and isoprenaline (0.005-0.025 ,ug/min per kg). Each drug was given in a lower and a higher dose, and all increased mean cardiac index (dobutamine, 18% and 39%; dopamine, 11% and 23%; isoprenaline, 15% and 44%). These increases were associated with significant increases in mean myocardial oxygen consumption (dobutamine, 38% and 61%; dopamine, 25% and 62%; isoprenaline, 20% and 45%). Mean myocardial blood flow was increased by each drug but mean myocardial oxygen extraction was decreased by isoprenaline, was increased by dopamine, and was unchanged by dobutamine. Each inotropic agent has a similar effect on myocardial oxygen consumption, but isoprenaline has a direct coronary vasodilator action while dopamine has a coronary vasoconstrictor action. Dobutamine has no direct effect upon coronary vascular tone.

Isoproternenol Increases Vascular Volume Expansion And Urinary Output After a Large Crystalloid Bolus in Healthy Volunteers

“…MAP was not altered due to reduced systemic vascular resistance. The observed hemodynamic effects of isoproterenol were in concurrence with previous reports of other β-adrenergic and inotropic agents (11,28) and anticipated, since isoproterenol is a non-specific β-adrenergic agonist. On the other hand, isoproterenol resulted in a surprising effect on systolic function.…”

Adverse Effects of Dopamine on Systemic Hemodynamic Status and Oxygen Transport in Neonates After the Norwood Procedure

“…Furthermore, because different organs have different distribution of adrenergic receptor subtypes, regional VO 2 -DO 2 mismatch might be non-uniform with dopamine treatment. Future studies should analyze the potential differential effects on the heart (29,30), splanchnic organs (31), and the brain (32). However, such an assessment of regional effects would likely require direct instrumentation of the target organ, which is impractical in a clinical study.…”

Cardiac Autonomic Nerve Stimulation in the Treatment of Heart Failure

“…The SNS at the subclavian artery also increased the adrenergic neural tone of the heart [7]. Unfortunately, SNS also significantly increases HR, leading to a significant increase in MVo 2 , the same adverse effect associated with the use of inotropic drugs such as dobutamine to override beta-receptor downregulation and acutely augment LV contractility in patients with acute and endstage HF [45, 46]. The mortality rate for inotrope-dependent patients at 6 months is more than 50%, with few survivors at 1 year [44, 47].…”