A 62-year-old woman with a history of coronary aery disease presents with a pancreatic head tumor and undergoes a pancreaticoduodenectomy. Postoperatively, she develops a leak from the pancreaticojejunostomy anastomosis and becomes septic. A Swan-Ganz catheter is placed, which demonstrates an increased cardiac output and decreased systemic vascular resistance. She also develops acute renal failure and oliguria. Which of the following is an indication to sta dopamine?
Dopamine has a variety of pharmacologic characteristics that make it useful in critically ill patients. At all doses, the diastolic blood pressure can be expected to rise; since coronary perfusion is largely a result of the head of pressure at the coronary ostia, coronary blood flow should be increased. In low doses (1-5 mg/), dopamine affects primarily the dopaminergic receptors. Activation of these receptors causes vasodilation of the renal and mesenteric vasculature and mild vasoconstriction of the peripheral bed, which thereby redirects blood flow to kidneys and bowel. At these low doses, the net effect on the overall vascular resistance may be slight. As the dose rises (2-10 mg/), b1 -receptor activity predominates and the inotropic effect on the myocardium leads to increased cardiac output and blood pressure. Above 10 mg/(kg*min), a-receptor stimulation causes peripheral vasoconstriction, shifting of blood from extremities to organs, decreased kidney function, and hypeension.
To increase splanchnic flow
To increase coronary flow
To decrease hea rate
To lower peripheral vascular resistance
Miscellaneous