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Ephedrine, dopamine, or dobutamine to treat hypotension with propofol during epidural anesthesia

From the Department of Anesthesiology, Miyazaki Medical College, Kiyotake-Cho, Miyazaki, 889-1692, Japan.

Address correspondence to: Dr. T. Kasaba. Phone: 81-985-85-2970; Fax: 81-985-85-7179; E-mail: binjik{at}post1.miyazaki-med.ac.jp

Purpose: To compare the efficacy of ephedrine, dopamine and dobutamine for circulatory support during thoracic epidural anesthesia after anesthetic induction with propofol.

Methods: Forty patients undergoing lobectomy or mastectomy were divided into four groups of 10: a control group received no vasopressor; an ephedrine group received 5 mg ephedrine when the mean arterial pressure (MAP), measured every 2.5 min, decreased by 10% from baseline; dopamine and dobutamine groups received 5 µg•kg^–1•min^–1 dopamine or 3 µg•kg^–1•min^–1 dobutamine from five minutes after epidural injection of local anesthetic to the end of tracheal intubation. Anesthesia was induced with 2 mg•kg^–1 propofol. The MAP and heart rate (HR) were measured at baseline, 20 min after epidural injection, three minutes after propofol, and one minute after tracheal intubation.

Results: In the control group, MAP and HR decreased from 86 ± 9 mmHg, 74 ± 8 bpm to 62 ± 9 mmHg; P < 0.0001, 60 ± 8 bpm; P = 0.0003 after propofol. After tracheal intubation, MAP was restored to (81 ± 13 mmHg, 70 ± 13 bpm). In the ephedrine, dopamine, and dobutamine groups, MAP and HR remained unchanged during epidural anesthesia and propofol induction. However, after tracheal intubation, MAP and HR increased in the ephedrine (104 ± 11 mmHg; P = 0.004, 87 ± 11 bpm; P < 0.0001) and dobutamine (117 ± 13 mmHg; P = 0.0005, 100 ± 11 bpm; P < 0.0001) groups, but not in the dopamine group compared with baseline.

Conclusion: Dopamine is preferable to ephedrine and dobutamine in providing hemodynamic stability during propofol induction and tracheal intubation following epidural anesthesia.

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