Effect of dopexamine on calculated low gastric intramucosal pH following valve replacement.

Abstract

Gastric tonometry was used to study the possible effect of dopexamine infusion on a low calculated intramucosal pH (pHi) as a sign of splanchnic ischemia. Measurements were made during surgery and for approximately 18 hours postoperatively on 19 non-selected adult patients undergoing valve replacement. Patients developing a postoperative pHi > 7.30 were randomized to receive dopexamine (2 micrograms.kg-1 min-1) or placebo in a double blind fashion. Eighteen patients were randomized, 10 to receive dopexamine and 8 to placebo. The calculated pHi remained unchanged for the first 2 hours in both groups. After 4 hours a significant (P < 0.05) decrease in pHi was noted in the dopexamine group which remained significantly below the placebo group during the monitoring period. The dopexamine treated patients had a significantly longer period of low pHi but the pH-gap i.e. the difference between arterial pH and pHi did not differ between the two groups. Patients with postoperative complications, defined as infections (2), myocardial infarction (1), single- (2) or multiple organ failure and death (1), did not have longer periods with pHi below 7.30. In these patients, however, a pH-gap > 0.12 occurred more often than in those without complications, indicating that an increased incidence of complications was related to a pH-gap > 0.12. It is our opinion that true mucosal ischemia is best detected by estimating the difference in carbon dioxide tension between arterial blood and mucosa. This can be expressed either directly as PCO2-gap (PtonCO2-PaCO2) or indirectly as pH-gap.