Dopexamine Has No Additional Benefit in High-Risk Patients Receiving Goal-Directed Fluid Therapy Undergoing Major Abdominal Surgery

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BACKGROUND:Dopexamine has been shown to reduce both mortality and morbidity in major surgery when it is used as part of a protocol to increase oxygen delivery in the perioperative period. A European multicenter study has examined the use of dopexamine in patients undergoing major abdominal surgery, showing a trend toward improved survival and reduced complications in high-risk patients when receiving low-dose dopexamine (0.5 μg · kg−1 · min−1). A reduced oxygen uptake at the anaerobic threshold (AT) has been shown to confer a significant risk of mortality in patients undergoing major abdominal surgery and allows objective identification of a high-risk operative group. In this study, we assessed the effects of low-dose dopexamine on morbidity after major abdominal surgery in patients who were at increased risk by virtue of a reduced AT.METHODS:Patients undergoing elective major colorectal or urological surgery who had an AT of <11 mL · kg−1 · min−1 or an AT of 11 to 14 mL · kg−1 · min−1 with a history of ischemic heart disease were recruited. Before surgery, a radial arterial cannula was placed and attached to an Edwards Lifesciences FloTrac/Vigileo™ system for measuring cardiac output. Patients were given a 250-mL bolus of Voluven® (6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride) until the stroke volume no longer increased by 10%, then received either dopexamine (0.5 μg · kg−1 · min−1) or saline 0.9% for 24 hours. During surgery, fluid boluses of Voluven were given if the stroke volume variation was >10%. No crystalloid was given during surgery. A standardized postoperative fluid regime with Hartmann solution was prescribed at 1.5 mL · kg−1 · h−1 for 24 hours. The primary outcome measure was postoperative morbidity measured by the Postoperative Morbidity Survey.RESULTS:One hundred twenty-four patients were recruited over a 23-month period. The incidence of morbidity as measured by the Postoperative Morbidity Survey on day 5 was 55% in the control group versus 47% in the dopexamine group (P = 0.14). There was no significant reduction in morbidity on any measured postoperative day. Complication rates, mortality, and hospital length of stay were similar between the 2 groups; however, administration of dopexamine was associated with earlier return of tolerating an enteral diet.CONCLUSION:With the effective use of goal-directed fluid therapy in elective surgical patients, the routine use of dopexamine does not confer an additional clinical benefit.

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