Dopamine Concentration and Hemodynamic Effects according to the Methods of Dopamine Dilution / 대한구급학회지

BACKGROUND: Incorrect infusion of dopamine can be potentially life threatening. If the actual volume of a 100 ml intravenous bag or bottle used to mix dopamine solutions is greater than the labeled volume, overdilution of dopamine can occur, resulting in ineffective hemodynamic response. To determine the significance of dopamine overdilution induced by the excessive volume, dopamine concentration and hemodynamic effect were compared in the manually mixed dopamine and the manufactured premixed dopamine. METHODS: For 5% dextrose water (D5W) 100 ml intravenous bottle mixed with 160 mg (4 ml) of dopamine (group 1), D5W 96 ml mixed with 160 mg of dopamine (group 2), premixed dopamine with 1.6 mg/ml of concentration manufactured 2 months ago (group 3), premixed dopamine with 1.6 mg/ml of concentration manufactured 6 months ago (group 4), and D5W 100 ml intravenous bottle mixed with 160 mg (4 ml) of dopamine after removal of 4 ml dextrose water (group 5), dopamine concentration was measured by High performance liquid chromatography (HPLC). Hemodynamic data was obtained from 10 mongrel dogs for each group at baseline (T1), 15 minutes after dopamine infusion at a rate of 3 microgram/kg/min (T2), 8 microgram/kg/min (T3), and 15 microgram/kg/min (T4). RESULTS: Dopamine concentrations of group 1, 2, 3, 4, and 5 were 1.51+/- 0.09, 1.60 +/- 0.10, 1.63 +/- 0.06, 1.57+/- 0.08 and 1.57+/- 0.07 mg/ml, respectively. Group 1 showed a significantly low concentration (p< 0.05). There was no significant differences in all hemodynamic data between group 1, 2, 3, and 4. In group 1, however, there was no significant increase in both mean blood pressure at T4 and mixed venous oxygen saturation at T3 compared with T1. CONCLUSIONS: The actual volume of D5W in 100 ml intravenous bottle is greater than the labeled, and therefore can cause significant overdilution of dopamine. Premixed dopamine, however, has the same concentration and hemodynamic effects as the dopamine mixed manually but precisely.

Endoventricular Circular Patch Plasty and Intra-operative and Post-operative Care for Patients with Ischemic Cardiomyopathy / 대한구급학회지

BACKGROUND: Endoventricular circular patch plasty (EVCPP)was introduced as an effective reconstructive procedure for ventricular aneurysm and diffuse dilated cardiomyopathy after myocardial infarction.We report the 4-year results of EVCPP in Seoul National University Hospital, the experiences of anesthesia and intensive care for EVCPP in patients with ischemic cardiomyopathy. METHODS: EVCPP has been performed on 31 patients (22 men and 9 women wit h a mean age of 62 years)during 4 years from March 1998 to March 2002.Six patients (19%)were NYHA cl ass II,24 pat i ent s were cl ass III,and 1 pat i ent was cl ass I V.Preoperative and postoperative left ventricular end-diastolic volume (LVEDV),left ventricular end-systolic volume (LVESV),ejection fraction (EF)were determined and compared.Transesoghageal echocardiograghy (TEE)was used to measure the distance between aortic annulus and ventricular aneurysm during EVCPP.Milrinone combined with beta -adrenergics was infused during separation from cardiopulmonary bypass (CPB) and in the intensive care unit. RESULTS: Three patients (10%)needed an intra-aortic balloon pump to wean from CPB and one patient (3%)died in the hospital.Out of 30 survivors,29 patients returned to NYHA class I or II and one patient to class III.Out of 30 patients who underwent echocardiographic study before and after EVCPP,EF increased from 34 +/-9%to 38 +/-10%,and LVEDV and LVESV decreased from 139 +/-43 ml to 94 +/-20 ml and from 90 +/-34 ml to 59 +/-17 ml,respectively. CONCLUSIONS: EVCPP is effective to exclude the akinetic left ventricular segment,thus improving left ventricular function and clinical status of patients with ischemic cardiomyopathy.However, studies concerning postoperative intensive care are warranted to reduce the postoperative complications and morbidity.