Comparative study of effects of Adrenaline, Dobutamine and Dopamine on systemic hemodynamics and renal blood flow in patients following open heart surgery.

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Abstract
In 10 patients following open heart surgery, adrenaline [epinephrine], dobutamine and dopamine were administered, and the changes in hemodynamic parameters and renal blood flow (RBF) were examined. RBF was determined by the local thermodilution method. Prior to the application of this method in clinical measurement, reliability of the method was checked using a model circuit. The correlation between the actual flow and flow obtained with this method was high (r = 0.999, P < 0.005, n [n] = 8). Reproducibility in repeated measurements was excellent, r = 0.997 (P < 0.005, n = 8) in the model circuit and r = 0.985 (P < 0.005, n = 89) in the clinical measurement. Adrenaline at rates of 0.02-0.08 .mu.g/kg per min showed a marked inotropic action without any significant change in RBF. With 0.04 .mu.g/kg per min of adrenaline, the RBF/CO (cardiac output) ratio declined significantly. Adrenaline apparently is often effective in patients following open heart surgery, but renal vasoconstriction is the major disadvantage. After a 10-min administration of 2, 4 and 8 .mu.g/kg per min of dobutamine, cardiac index (CI) and stroke volume index (SVI) showed a stepwise increase in accordance with an increase of dosage, and RBF increased with CO. No significant change in RBF/CO was found. Mean left atrial pressure (LAP) or mean pulmonary arterial wedge pressure (PAWP) decreased in 4 of 7 patients with 8.0 .mu.g/kg per min of dobutamine. Dobutamine is an excellent .beta.1-adrenergic agonist with a weak .alpha.-action on both peripheral and renal vessels. With 2.0-2.5 .mu.g/kg per min of dopamine, RBF increased by 15.5% (P < 0.05), while no significant increase appeared in CI. With 4.0 .mu.g/kg per min or more of dopamine, CI and SVI increased. With 1.6-20 .mu.g/kg per min of dopamine, RBF increased by up to 44.8%. Significance increase of mean LAP or mean PAWP was observed with 8.0-10.0 .mu.g/kg per min or more of dopamine. The potential increase of LVEDP (left ventricular end-diastolic pressure) with 8-10 .mu.g/kg per min or more of dopamine evidently exerts a disadvantageous effect in patients following open heart surgery. The effect on the renal hemodynamics, especially with small doses of dopamine, is unique and not observed with adrenaline or dobutamine.