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Sympathomimetic Amines: Actions and Uses
Published in Kenneth J. Broadley, Autonomic Pharmacology, 2017
Thus, these inotropic partial agonists, whether β1- or β2-selective, are of limited value in the long-term treatment of chronic heart failure because of the possibility of receptor down-regulation. However, β-adrenoceptor agonists do have application in acute cardiac failure, for example, associated with myocardial infarction and cardiogenic shock, where they may be used over a short period without risk of down-regulation. Dopamine was the prototype of this class of drug, which also includes dobutamine and dopexamine.
Cardiac surgery
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Although acute renal failure requiring dialysis is rare after uncomplicated cardiac surgery, degrees of oliguria are common. Although there is little scientific evidence, dopamine at ‘renal’ doses (e.g. 3 mg kg−1 h−1) is still used both intra- and postoperatively. Dopexamine has not been found to be useful. It is important to maintain a diuresis in the postoperative period so as to reverse the anaemia from haemodilution caused by the bypass prime and the cardioplegia. Good volume status, good cardiac output, good oxygen delivery, avoidance of acidosis and high mean blood pressure are the mainstay for management. If oliguria persists despite an adequate cardiac output, vascular volume and blood pressure, small doses of a loop diuretic are indicated. It is not unusual to see a doubling of serum creatinine in patients that have a history of renal dysfunction. Short-term renal replacement therapy with haemofiltration may be necessary in some patients, particularly if there is severe acidosis or hyperkalaemia.
Complications of Acute Fluid Loss and Replacement
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
David R. King, John O. Hwabejire
With the introduction of central venous and Swan–Ganz catheterization, clinicians sought to titrate resuscitation therapy to achieve “adequate” indices of ventricular preload, cardiac output, and systemic oxygen delivery. On the basis of extensive analyses of the hemodynamic profiles of survivors and nonsurvivors of critical illness, Shoemaker et al.17 proposed that patients suffering from trauma and shock develop an oxygen “debt” and therefore require supranormal levels of oxygen delivery to reestablish homeostasis. Tuchschmidt et al.18 later reported similar findings from a study of patients with sepsis. Subsequently, in three prospective, randomized trials,19–21 Shoemaker and coworkers obtained evidence that survival is improved by titrating resuscitative measures to achieve the target values established in earlier observational studies (specifically, a cardiac index >4.5 L/min/m2 of body area, a systemic oxygen delivery index >600 mL/min/m2, and systemic oxygen consumption >170 mL/min/m2). In another trial,22 a significant improvement in survival rates was achieved when high-risk surgical patients were treated with dopexamine, an inotrope and vasodilator that increases cardiac output during the perioperative period. No significant differences in systemic oxygen consumption or blood lactate concentration were found between patients who were and were not treated with dopexamine; this finding suggests that dopexamine has beneficial effects, independent of its hemodynamic actions. To complicate the picture, several subsequent clinical studies23–26 have failed to demonstrate that survival rates improve when resuscitation therapy is titrated to achieve supranormal values for oxygen delivery or cardiac output.
The effect of dexmedetomidine on the inflammatory response in children undergoing repair of congenital heart disease: a randomized controlled clinical trial
Published in Egyptian Journal of Anaesthesia, 2020
Khaled A Abdelrahman, Shimaa A Hassan, Ahmed A Mohammed, Essam E Abdelhakeem, Sayed K. Abd-Elshafy, Ragaa H Salama, Esam M Abdalla
Inflammatory response due to cardiopulmonary bypass (CBP) activates different pathways, resulting in cytokine production, cellular edema, endothelial injury, and organ ischemia [1] that affect multiple organs like lung, heart, brain, and kidneys [2–5]. This inflammatory response is exaggerated in pediatrics because of multiple factors such as; Major hemodilution due to small body surface area compared to the circuit area, which exposes them to more blood transfusion and abrupt temperature changes; need for higher perfusion rates due to higher metabolic demand increasing shear stress; and the immaturity of organs which increases the risk and severity of injury[6]. Several methods have been employed to decrease this inflammatory response. The effect of prophylactic corticosteroid infusion during CPB on inflammatory response and on postoperative course is controversial [7,8]. Other pharmacologic agents are also used in practice and at the experimental level. However, evidence of the effectiveness of these therapies requires further evaluation[9]. these agents include phosphodiesterase inhibitors[10], dopexamine[11], aprotinin[12], free radical scavengers, and antioxidants (such as allopurinol, N-acetyl-cysteine, mannitol), ketamine[13], angiotensin-converting enzyme inhibitors[14], H2 antagonists[15], and specific C5a monoclonal antibodies[16].