The effect of different bypass flow rates and low-dose dopamine on gut mucosal perfusion and outcome in cardiac surgical patients

• Published in: Anaesthesia and intensive care Vol. 27; no. 1; pp. 13 - 19
• Main Authors: SCHNEIDER, M, VALENTINE, S, HEGDE, R. M, PEACOCK, J, MARCH, S, DOBB, G. J
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Edgecliff Anaesthesia and Intensive Care 01.02.1999; Sage Publications Ltd
• Subjects: Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiopulmonary Bypass - methods; Coronary Artery Bypass; Dopamine - administration & dosage; Dopamine - therapeutic use; Double-Blind Method; Endotoxemia - prevention & control; Female; Gastric Mucosa - blood supply; Gastric Mucosa - drug effects; Humans; Hydrogen-Ion Concentration - drug effects; Ischemia - prevention & control; Male; Medical sciences; Middle Aged; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Vascular Resistance - drug effects; Vasodilator Agents - administration & dosage; Vasodilator Agents - therapeutic use; Heart; Human; Stomach; Dopamine; Vasodilator agent; Digestive system; Low dose; Mucosa; Cardiovascular disease; General anesthesia; Blood flow; Cardiopulmonary bypass; Vascular resistance; Perfusion; Heart disease; Surgery; pH; Hemodynamics
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X9902700103

The aim of this double-blind, randomized, placebo-controlled trial was to investigate the effects of different cardiopulmonary bypass flow rates and low-dose dopamine on gastric mucosal pH (pHi) and outcome. We hypothesized that by minimizing gut mucosal hypoperfusion during and after cardiac surgery endotoxin translocation may be prevented, resulting in an improved clinical outcome. Four groups of 25 patients each receiving high or low flows during bypass and low-dose dopamine or saline for 24 hours after induction of anaesthesia were studied. The pHi was measured at six time intervals over 24 hours. The combination of low-dose dopamine and a low bypass flow rate was associated with a significantly greater frequency and severity of low pHi. This group also demonstrated a significantly lower vascular resistance on admission to the intensive care unit. There may be an association between low pHi and low vascular resistance.