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Ann Thorac Surg 1976;22:50-57
© 1976 The Society of Thoracic Surgeons

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Articles

A Comparison of the Hemodynamic Effects of Inotropic Agents

Department of Surgery, Section of Thoracic Surgery, The University of Michigan Medical Center, Ann Arbor, MI

^* Address reprint requests to Dr. Kirsh, Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI 48109

This experimental study was conducted to compare and contrast the cardiovascular effects of the drugs most commonly used to alleviate low-cardiac-output syndrome. Twenty-five adult mongrel dogs were infused with sodium pentobarbital (60 mg/min) until their cardiac output fell to 50 ± 5% of the average control values determined by thermodilution technique prior to pentobarbital infusion. The dogs were then divided into six groups, and one of the following agents or combinations of agents was administered to each group: isoproterenol, glucagon, dopamine, dobutamine, levarterenol and phentolamine, or levarterenol and nitroprusside.

All drugs, except for glucagon and the combination of levarterenol and nitroprusside, produced an increase in cardiac output above the nonfailure baseline values. However, this increase was accompanied by an undesirable, pronounced tachycardia except when levarterenol was used simultaneously with phentolamine. Both dopamine and the combined infusion of levarterenol and phentolamine proved the most effective in restoring systemic arterial pressure to near baseline values, and both were able to increase renal blood flow above the failure baseline values. While renal blood flow remained elevated with all dosages of levarterenol and phentolamine, it tended to decrease with larger doses of dopamine.

These experiments demonstrate that there are major advantages in the use of simultaneously infused levarterenol and phentolamine for control of low-cardiac-output syndrome: increased cardiac output without elevated peripheral vascular resistance, restoration of systemic arterial pressure and consequent improved coronary flow, absence of tachycardia, and augmented renal blood flow.

This article has been cited by other articles:

				J. H. Lemmer, M. J. Botham, P. McKenney, R. A. Gerren, M. M. Kirsh, and K. P. Gallagher Norepinephrine plus Phentolarnine Improves Regional Blood Flow during Experimental Low Cardiac Output Syndrome Ann. Thorac. Surg., August 1, 1984; 38(2): 108 - 116. [Abstract] [PDF]

				M. M. Kirsh, E. Bove, M. Detmer, A. Hill, and P. Knight The Use of Levarterenol and Phentolamine in Patients with Low Cardiac Output Following Open-Heart Surgery Ann. Thorac. Surg., January 1, 1980; 29(1): 26 - 31. [Abstract] [PDF]

				G. Benzing III, J. A. Helmsworth, J. T. Schreiber, and S. Kaplan Nitroprusside and Epinephrine for Treatment of Low Output in Children after Open-Heart Surgery Ann. Thorac. Surg., June 1, 1979; 27(6): 523 - 528. [Abstract] [PDF]

				A. Peterson, B. Lucchesi, and M. M. Kirsh The Effect of Glucagon in Animals on Chronic Propranolol Therapy Ann. Thorac. Surg., April 1, 1978; 25(4): 340 - 345. [Abstract] [PDF]