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Chapter: Clinical Anesthesiology: Clinical Pharmacology: Adrenergic Agonists & Antagonists

Adrenergic Agonists: Dobutamine

Dobutamine is a racemic mixture of two isomers with affinity for both β1 and β2 receptors, with rela-tively higher selectivity for β1 receptors.

DOBUTAMINE

Clinical Considerations

Dobutamine is a racemic mixture of two isomers with affinity for both β1 and β2 receptors, with rela-tively higher selectivity for β1 receptors. Its primary cardiovascular effect is a rise in cardiac output as a result of increased myocardial contractility. A decline in peripheral vascular resistance caused by β2-activation usually prevents much of a rise in arte-rial blood pressure. Left ventricular filling pressure decreases, whereas coronary blood flow increases.Favorable eff ects on myocardial oxygen bal-ance are believed to make dobutamine a choicefor patients with the combination of congestive heart failure and coronary artery disease, particularly if peripheral vascular resistance is elevated. However, because it has been shown to increase myocardial oxygen consumption, such as during stress testing (rationale for its use in perfusion imaging), some concern remains regarding its use in patients with myocardial ischemia. Moreover, dobutamine should not be routinely used without specific indications to facilitate separation from cardiopulmonary bypass.

Dosing & Packaging

Dobutamine is administered as an infusion at a rate of 2–20 mcg/kg/min. It is supplied in 20-mL vials containing 250 mg.

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Clinical Anesthesiology: Clinical Pharmacology: Adrenergic Agonists & Antagonists : Adrenergic Agonists: Dobutamine |


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