What's the deal on Dobutamine???

[europeman]

I have heard different things on it. It's obviously an inotrope and chronotrope but at what doses does it have it's so-called vaso-dilation effects. Clinically I have rarely if ever seen patients pressure go down with it.... Presumably cuz the dilation is countered by the cardiac effects.

Anyway can someone explain. Do u get a relative vasodilation at low doses and more cardiac at high? Or vice versa?

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[redy]

As far as I am aware, the vasodilatory effects are not dose-dependent. I have seen it a couple of times drop the BP. I would imagine that it would be corrected by compensatory mechanisms of the body and by its inotropic and chronotropic effects but the times I have seen we just started norepi. I have always been reminded to make sure of norepi with dobutamine.

This paper (http://circ.ahajournals.org/content/121/15/1756.full) states 20% of patients had fall of > 20mm Hg

 

[ORL10]

There does not seem to be a dose dependent relationship with dobutamine, it is a B1 and alpha 1 agonist which increase inotropy, and at increasing doses chronotropy. However, some speculate that the main mechanism which dobutamine increases cardiac output is via afterload reduction (B2 stimulation) and via reduction in venous capacitance (alpha and beta stimulation), which increase venous return and filling pressures.

http://circ.ahajournals.org/content/84/3/1210.full.pdf