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British Journal of Anaesthesia, 1995, Vol. 74, No. 3 277-282
© 1995 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

Dobutamine-induced dissociation between changes in splanchnic blood flow and gastric intramucosal pH after cardiac surgery

I. PARVIAINEN, MD, E. RUOKONEN, MD, PHD and J. TAKALA, MD, PHD

Critical Care Research Program, Department of Intensive Care, Kuopio University Hospital FIN-70210 Kuopio, Finland

Correspondence to J.T.

Gastric intramucosal acidosis, a sign of splanchnic tissue hypoxia, is common after cardiac surgery. We tested the hypothesis that an increase in splanchnic blood flow induced by dobutamine improves splanchnic tissue oxygenation after cardiac surgery. We measured changes in gastric intramucosal pH, splanchnic blood flow and oxygen transport in response to increased systemic flow induced by dobutamine (mean 4.4 (range 3.0–7.0) µg kg–1 min–1) after coronary artery bypass. We studied 22 stable postoperative patients who were allocated randomly to receive dobutamine (n = 11) or to serve as controls (n = 11). Dobutamine was given also to a separate group with a low cardiac index after operation (n = 6). The end-point was to increase cardiac index by at least 25% and to exceed 2 litre min–1 m–2. Dobutamine consistently increased mean splanchnic blood flow (control 0.6 (SD0.2) vs 0.7 (0.2) litre min–1 m–2 (P<0.05); normal cardiac output and dobutamine 0.7 (0.2) vs 1.1 (0.4) litre min–1 m–2 (P<0.01); low cardiac output and dobutamine 0.4 (0.1) vs 0.7 (0.1) litre min–1 m–2 (P<0.05)) and oxygen delivery (control 102 (29) vs 111 (28) ml min–1 m–2 (ns); normal cardiac output and dobutamine 106 (27) vs 156 (47) ml min–1 m–2 (P < 0.01); low cardiac output and dobutamine 75 (21) vs 110 (26) ml min–1 m–2 (P<0.05)) but had no effect on splanchnic oxygen consumption (control 44 (10) vs 49 (10) ml min–1 m–2 (ns); normal cardiac output and dobutamine 45(12) vs 51 (17) ml min–1 m–2 (ns); low cardiac output and dobutamine 37 (9) vs 40 (9) ml min–1 m–2 (ns)). Despite this, dobutamine reduced gastric intramucosal pH in all patients with low cardiac output (7.33 (0.12) vs 7.25(0.06) (P<0.05)) and in 50% of patients with stable haemodynamics (7.37(0.07) vs 7.34(0.06) (ns)). In contrast, gastric intramucosal pH remained stable in the control group (7.34 (0.05) vs 7.34 (0.04) (ns)).We conclude that dobutamine resulted in a dissociation between splanchnic oxygen delivery and gastric mucosal tissue oxygenation, suggesting inappropriate distribution of blood flow within the splanchnic region. (Br. J. Anaesth. 1995; 74: 277–282)


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