Abstract
Purpose: To compare the efficacy of ephedrine, dopamine and dobutamine for circulatory support during thoracic epidural anesthesia after anesthetic induction with propofol.
Methods: Forty patients undergoing lobectomy or mastectomy were divided into four groups of 10: a control group received no vasopressor; an ephedrine group received 5 mg ephedrine when the mean arterial pressure (MAP), measured every 2.5 min, decreased by 10% from baseline; dopamine and doubtamine groups received 5 µg·kg−1·min−1 dopamine or 3µg·kg−1·min−1 doubtamine from five minutes after epidural injection of local anesthetic to the end of tracheal intubation. Anesthesia was induced with 2 mg·kg−1 propofol. The MAP and heart rate (HR) were measured at baseline, 20 min after epidural injection, three minutes after propofol, and one minute after tracheal intubation.
Results: In the control group, MAP and HR decreased from 86±9 mmHg, 74±8 bpm to 62±9 mmHg;P<0.0001, 60±98 bpm;P=0.003 after propofol. After tracheal intubation, MAP was restored to (81±13 mmHg, 70±13 bpm). In the ephedrine, dopamine, and doubtamine groups, MAP and HR remained unchanged during epidural anesthesia and propofol induction. However, after tracheal intubation, MAP and HR increased in the ephedrine (104±11 mmHg;P=0.004, 87±11 bpm;P<0.0001) and doubtamine (117±13 mmHg;P=0.0005, 100±11 bpm;P<0.0001) groups, but not in the dopamine group compared with baseline.
Conclusion: Dopamine is preferable to ephedrine and doubtamine in providing hemodynamic stability during propofol induction and tracheal intubation following epidural anesthesia.
Résumé
Objectif: Comparer les qualités cardiotoniques de l’éphédrine, de la dopamine et de la doubtamine pendant l’anesthésie péridurale thoracique suivant une induction au propofol.
Méthode: Quarante patients devant subir une lobectomie ou une mastectomie sont répartis en quatre groupes de 10: un groupe témoin, sans vasopresseur; un groupe éphédrine, avec 5 mg d’éphédrine quand la tension artérielle moyenne (TAM), mesurée toutes les 2,5 min, baisse de 10 % comparée à la mesure de base; des groupes dopamine et dobutamine, avec 5 µg·kg−1·min−1 de dopamine ou 3 µg·kg−1·min−1 de doubtamine 5 minutes après l’injection péridurale d’anesthésique local et jusqu’à la fin de l’intubation endotrachéale. L’anesthésie est induite avec 2 mg·kg−1 de propofol. La TAM et la FC sont mesurées du début, 20 min après l’injection péridurale, 3 minutes après la dose de propofol et une minute après l’intubation.
Résultats: Dans le groupe témoin, la TAM et la FC diminuent de 86±9 mm Hg, 74±8 bpm à 62±9 mmHg;P<0,0001, 60±8 bpm;P=0,0003 après le propofol. Après l’intubation, la TAM revient aux valeur de base (81±13 mmHg, 70±13 bpm). Avec l’éphédrine, la dopamine et la dobutamine, la TAM et la FC ne changent pas pendant l’anesthésie péridurale et l’induction au propofol. Mais, après l’intubation, la TAM et la FC s’élèvent, comparées aux mesures de base, avec l’éphédrine (104±11 mmHg;P=0,004, 87±11 bpm;P<0,0001) et la dobutamine (117±13 mmHg;P=0,0005, 100±11 bpm;P<0,0001), mais non avec la dopamine.
Conclusion: À la suite d’une anesthésie péridurale, la dopamine est préférable à l’éphédrine et à la dobutamine pour assurer la stabilité hémodynamique pendant l’induction au propofol et l’intubation.
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Kasaba, T., Yamaga, M., Iwasaki, T. et al. Ephedrine, dopamine, or doubtamine to treat hypotension with propofol during epidural anesthesia. ja]Can J Anaesth 47, 237–241 (2000). https://doi.org/10.1007/BF03018919
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DOI: https://doi.org/10.1007/BF03018919