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Ann Thorac Surg 1983;35:643-650
© 1983 The Society of Thoracic Surgeons

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Articles

The Hemodynamic Effect of Phentolamine and Dobutamine after Open-Heart Operations in Children: Influence of the Underlying Heart Defect

From the Departments of Pediatrics and Genetics, and Anesthesiology, University of Geneva Medical School, Geneva, Switzerland

Accepted for publication July 23, 1982.

^* Address reprint requests to Dr. Berner, Clinique de Pédiatric, Hôpital Cantonal Universitaire, 30 boulevard de la Cluse, 1205 Geneva, Switzerland

The hemodynamic effects of phentolamine alone and in combination with dobutamine were studied in the immediate postoperative period in two groups of children. Group 1 (N = 6; mean age, 152 months) had open-heart operation for acquired mitral valve disease. Group 2 (N = 6; mean age, 60 months) had intracardiac repair for tetralogy of Fallot.

Before drug administration, cardiac index did not differ between groups, but patients with tetralogy of Fallot had a higher heart rate and smaller stroke volume index; systemic vascular resistance was high in both groups. With phentolamine (10 µg/kg/min), cardiac index and stroke volume index increased similarly in both groups (+ 13% for cardiac index in Group 1, + 9% in Group 2), while systemic vascular resistance, pulmonary vascular resistance, and pulmonary wedge pressure decreased. When dobutamine (5 µg/kg/min) was added, there was a further increase in cardiac index in both groups, but it was greater in Group 1 (+ 17% vs +12%, p < 0.01, compared with phentolamine alone; +33% vs + 22%, p < 0.01, compared with control). Systemic vascular resistance remained unchanged and heart rate increased in both groups, so that the left ventricular stroke work index increased. Although stroke volume index increased significantly with dobutamine in Group 1 (+ 11%, p < 0.01), it remained unchanged in Group 2 (+ 3%, not significant).

Thus in Group 2, dobutamine increased cardiac index only by increasing heart rate. This suggests that the relatively small, noncompliant left ventricle in patients with tetralogy of Fallot cannot further respond to inotropic drugs by increasing stroke volume index.

This article has been cited by other articles:

				V. J. DiSesa and L. H. Cohn Phentolamine and Dobutamine Ann. Thorac. Surg., April 1, 1984; 37(4): 355 - 355. [PDF]