A randomized study to evaluate the effect of a perioperative infusion of dopexamine on colonic mucosal ischemia after aortic surgery

Citation
Ms. Baguneid et al., A randomized study to evaluate the effect of a perioperative infusion of dopexamine on colonic mucosal ischemia after aortic surgery, J VASC SURG, 33(4), 2001, pp. 758-763
Citations number
36
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
JOURNAL OF VASCULAR SURGERY
ISSN journal
0741-5214 → ACNP
Volume
33
Issue
4
Year of publication
2001
Pages
758 - 763
Database
ISI
SICI code
0741-5214(200104)33:4<758:ARSTET>2.0.ZU;2-D
Abstract
Purpose: Colonic ischemia after aortic surgery is associated with increased mortality and morbidity rates. This study was conducted as a single-center side arm to a multicenter, randomized, placebo-controlled study to evaluat e the effect of dopexamine hydrochloride on its incidence. Methods: Thirty patients, mean age 65.1 years (range, 46-84), undergoing el ective infrarenal aortic surgery were entered. Preoperative hemodynamic and respiratory parameters were optimized. Patients were then randomly assigne d to receive a perioperative infusion of dopexamine at 2 mug/kg per minute (n = 12) or 0.9% saline placebo (n = 18). All patients underwent colonoscop y and biopsy preoperatively and 1 week postoperatively. Specimens were asse ssed for evidence of mucosal ischemia, presence of mast cell tryptase, myel operoxidase activity, and both the inducible and endothelial isoforms of ni tric oxide synthase. Results: There was no significant difference in perioperative fluid and blo od requirements or hemodynamic and respiratory parameters between the two g roups. However, there was significantly less evidence of mucosal ischemic c hanges in dopexamine-treated patients (n = 1) compared with placebo (n = 8) (P = .049). Furthermore, when preoperative biopsies were compared with tho se performed 1 week postoperatively, nine (50%) patients in the placebo gro up and two (16.7%) in the dopexamine group scored worse. Although there was no significant difference in inflammatory markers between the two groups, both mast fell tryptase and myeloperoxidase expression were increased in pa tients with histologic evidence of ischemia (P < .05). Furthermore, inducib le nitric oxide synthase staining within the vascular (P = .001) and lamina propria (P < .05) components of the mucosa was also significantly greater. Conclusion: A perioperative dopexamine infusion affords significant histolo gic protection to colonic mucosa after aortic surgery.