Local metabolic effects of dopexamine on the intestine during mesenteric hypoperfusion

• Published in: Shock (Augusta, Ga.) Vol. 21; no. 3; p. 241
• Main Authors: Fröjse, Rolf, Lehtipalo, Stefan, Bergstrand, Ulf, Biber, Björn, Winsö, Ola, Johansson, Göran, Arnerlöv, Conny
• Format: Journal Article
• Language: English
• Published: United States 01.03.2004
• Subjects: Adrenergic beta-Agonists - pharmacology; Animals; Blood Pressure; Catecholamines - pharmacology; Dopamine - analogs & derivatives; Dopamine - pharmacology; Female; Intestinal Mucosa - drug effects; Intestinal Mucosa - pathology; Intestines - drug effects; Jejunum - pathology; Laser-Doppler Flowmetry; Mesenteric Arteries - pathology; Microdialysis; Oxygen - metabolism; Perfusion; Pressure; Receptors, Adrenergic, beta-2 - metabolism; Swine; Time Factors; Ultrasonics
• ISSN: 1073-2322; 1540-0514
• DOI: 10.1097/01.shk.0000111826.07309.8b

This self-controlled experimental study was designed to test the hypothesis that dopexamine, a synthetic catecholamine that activates dopaminergic (DA-1) and beta2-adrenergic receptors, improves oxygenation in the jejunal mucosa during intestinal hypotension. In six normoventilated barbiturate-anesthetized pigs, controlled reductions in superior mesenteric arterial pressure (PSMA) was obtained by an adjustable clamp around the artery. Dopexamine infusions (0.5 and 1.0 microg.kg(-1).min(-1)) were administered at a freely variable PSMA (i.e., with the perivascular clamp fully open) and at a PSMA of 50 mmHg and 30 mmHg. We continuously measured superior mesenteric venous blood flow (QMES; transit-time ultrasonic flowmetry), jejunal mucosal perfusion (laser Doppler flowmetry), and tissue oxygen tension (PO2TISSUE; microoximetry). Jejunal luminal microdialysate of lactate, pyruvate, and glucose were measured every 5 min. Measurements of mucosal PCO2 (air tonometry), together with blood sampling and end-tidal PCO2 measurements, enabled calculations of pHi and PCO2 gap. Dopexamine reduced mesenteric vascular resistance and increased QMES at a PSMA of 50 mmHg and 30 mmHg. At a PSMA of 30 mmHg, dopexamine increased mesenteric oxygen delivery but did not influence mesenteric oxygen uptake or extraction. In this situation, dopexamine had no beneficial effect on jejunal mucosal blood flow. On the contrary, dopexamine increased mesenteric net lactate production and PCO2 gap, whereas PO2TISSUE and pHi decreased. Jejunal luminal microdialysate data demonstrated an increased lactate concentration and a pattern of decreased glucose concentration and increased luminal lactate-pyruvate ratio. These negative metabolic effects of dopexamine should be taken into account in situations of low perfusion pressures.