Hemodynamic Effects of Dobutamine and Epinephrine in Patients during Coronary Surgery

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Abstract
The cardiovascular effects of intravenous infusions of epinephrine (0.075 and 0.15 μg/kg/kg·min) and dobutamine (2.5 and 5.0 μg/kg · min) have been compared in four groups of eight patients each with coronary artery disease before aortocoronary bypass grafting. After sternotomy and pericardiotomy in neuroleptanalgesia all measurements were recorded before and during a ten-minute period of drug infusion. The higher doses were chosen to produce obvious hemodynamic effects without precepitating tachycardia or dysrhythmia. Control values of measured parameters proved to be in the same range (Cardiac index: epinephrine: 1.7 and 1.71/min ·m2; dobutamine 1.6 and 1.5 1/min · m2. Mean arterial pressure: about 70 mmHg for each group. Heart rate: control values between 80 and 88 min-1. Left ventricular filling pressure: between 8.5 and 9.5 mmHg. Right atrial pressure: between 6.5 and 7.6 mmHg. Mean pulmonary artery pressure: between 15.4 and 16.8 mmHg). Dobutamine produced significant increases in mean values of mean arterial pressure (27 %; 35 %), pulmonary pressure (8%; 14%), heart rate (14%; 24%), cardiac index (30%; 50%), stroke index (16%; 27%) and left ventricular dp/dtmax (72%; 121 %). Right atrial and left ventricular enddiastolic pressures and total systemic resistance did not change significantly, whereas total pulmonary resistance was slightly reduced. Epinephrine caused significant increases in mean arterial pressure (16 %; 27 %), mean pulmonary pressure (21 %; 38 %), heart rate (18 %; 25 %), cardiac index (47 %; 69 %), stroke index (26%; 37%) and left ventricular dp/dtmax (83%; 131 %). Small increases in right and left ventricular filling pressures and total pulmonary resistance were not significant. Total systemic resistance decreased significantly by 20 % and 26 %. In patients with coronary artery disease during neuroleptanalgesia epinephrine caused a greater change in stroke index, cardiac index and myocardial contractility and a greater decrease in total systemic resistance in comparison to dobutamine, especially when these changes are related to almost equal changes in heart rate. Though both drugs have been shown to improve the circulatory state, it is concluded from this study that from the hemodynamic point of view epinephrine is the more satisfactory drug to use in coronary surgical patients during anesthesia.

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