좌심실 기능부전을 동반한 만성 관상동맥질환에서 Dobutamine 심초음파의 역할

정보영,임세중,최승혁,고충원,하종원,정남식,유경종,강면식 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8

정상성인의 Dobutamine심초음파시 투여시간에 따른 혈역학적 반응의 비교연구

김현철,오영재,김수미,이은미,황교승,안정천,송우혁,임도선,박창규,김영훈,서홍석,심완주,오동주,노영무 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.8

도부타민 주입 화자의 정맥염 발생율과 온·냉 요법의 효과 비교

신순자 병원간호사회 1996 임상간호연구 Vol.2 No.-

The purpose of the study is to compare the phlebitis rate between general infusate and dobutamine, determine the effect of warm versus cold applications to the sites of edema and phlebitis caused by dobutamine. All subjects were observed during the study period from June 1st to September 15th of 1996, in the hospital at cardiology medical ward and continued to infuse general infusate and dobutamine intravenously. The sample was compared of 92 Ⅳ cases. Of the 92 cases studies, 62 cases were dobutamine and 30cases were general infusate, and among the number of 62 cases the warm aaplications were 32, the cold applications were 30. Nurses inserted the proper catheter according to the method of management when pheriperal Ⅳ catheter inserted, then described the general informtions of patients, characteristics of catheters, conditions of catheter inserted patients, the reasons of catheter removal on the Ⅳ catheter information sheet. The catheters were changed regularly when there are no symptoms of phlebitis at the site of inserted catheters, The sites of inserted catheters were observed 2 times, per every duty, The phlebitis was observed with the assessment tool about the phlebitis of Intravenous Nurses Society. When the catheters were removed because the symptoms of phlebitis at the site of inserted catheter for dobutamine Ⅳ therapy, the symptoms of phlebitis were assessed and decribed on the observation sheet of symptoms at every 9AM, After the catheters were removed, warm applications were done at A ward and cold applications were done at B ward 4 times a day for 3days, one times was 20 mins. The size of phlebitis or edema was assessed and described by measuring the width and length for 3 days. The pain and itching sense at the catheter removal site were assessed and described. For data analysis, SPSS/PC program was utilized : t-test, chisquare test, paired t-test, percentage. The summary of this study is as follows : 1. The comparison of the phlebitis rate between general infusate and dobutamine. (1) There was significant difference in the phlebitis rate between general infusate(26.6%) and dobutamine(74.2%). (2) In the phlebitis rate of general infusate, grade 2 was 3.3%, grade 3 was 3.3%. In the phlebitis rate of dobutamine, grade 2 was 12.9%, grade 3 was 4.8%. 2. The comparison of the the effect of warm verus cold applications to the site of edema and phlebitis caused by dobutamine. (1) The width and length of phlebitis descreased significantly from the 1st to 3rd day of warm applications on the site of phlebitis. (2) The width of phlebitis decreased on the 1st day of cold applications. But there was no significance. The width of phlebitis decreased significantly from the 2nd to 3rd day. (3) The length of phlebitis decreased significantly from the 1st to 2nd day of cold applications on the site of phlebitis, but not decreased significantly on the 3rd day. (4) There was no significant difference on the pain of phlebitis between the effect of warm and cold applications on the 1st day. But on the 2nd and 3rd day, the warm applications were more effective significantly than cold applications. (5) There was no significant difference in the redness of the phlebitis between the effect of warm and cold applications at the 1st day. But the warm applications were more effective significantly than cold applications on 2nd and 3th day. (6) There was no significant difference in the itching sense of phlebitis between the effect of warm and cold applications from the 1st and 3rd day. According to this study, the phlebitis rate of dobutamine was higher than general infusates and the degree of phlebitis was more serious. Though the complications caused by dobutamine can not be avoided, we should observe the dobutamine infused site periodically and closely. It was difficult to make the conclusion clearly about the effects of cold applications on the decrease of diameter of phlebitis including edema, pain, and itching sense. But considering the positive effects of warm applications, active warm applications were needed on the phlebitis sites caused by dobutamine.

Dobutamine-Induced Perioperative Anaphylaxis in a Dog

정영은,장윤설,문창환,정재민,노윤호,이해범,정성목 한국임상수의학회 2020 한국임상수의학회지 Vol.37 No.3

A 9-years old spayed female Maltese was referred for the treatment of mass on the right 1st mammary gland and acute weight bearing lameness of right hindlimb. It was diagnosed as malignant mammary tumor and cranial cruciate ligament rupture of right stifle joint. Right upper regional mastectomy followed by cranial closing wedge osteotomy (CCWO) of the right tibia were planned for the present problems. Preanesthetic work-up did not show any remarkable abnormalities. Forty-five minutes after induction of anesthesia dobutamine was administered at a rate of 5 μg/kg/min by constant rate infusion due to gradual decrease of blood pressure below MAP 60 mmHg during surgical procedure. Despite of the increase of dobutamine infusion rate up to 20 μg/kg/min, blood pressure didn’t recover. At the end of regional mastectomy generalized skin redness and eyelid edema were identified. Anesthesia was stopped and CCWO procedure was cancelled. To recover from the anaphylactic reactions dexamethasone and diphenhydramine were administered. After about one hour, the patient completely recovered from hypotension and anaphylactic reactions. After 4 weeks, intradermal skin test (IDST) was performed for all the drugs used during anesthesia. Only dobutamine showed positive reaction in IDST. Therefore, dobutamine was considered as the causative agent of anaphylaxis in this patient during the anesthesia. In case of perioperative anaphylactic reaction, postoperative investigation should be performed to identify causative agent and to provide safe recommendations for future anesthetic procedure.

Dobutamine 투여 후 발생한 개의 서맥 1례

장민,손원균,황혜신,조상민,이강재,윤정희,이인형 한국임상수의학회 2014 한국임상수의학회지 Vol.31 No.4

A 13-year-old, castrated male, Shih Tzu dog with a history of acute ataxia was referred to veterinary medicalteaching hospital and anesthetized for diagnostic magnetic resonance imaging of cervical intervertebral disk disease. After preanesthetic evaluation including physical examination, blood chemistry, radiography and ultrasound, the patientwas premedicated with intravenous butorphanol (0.2 mg/kg). Anesthesia was induced by intravenous propofol (6 mg/kg) and maintained with isoflurane at 1.2 minimal alveolar concentrations. Because the mean arterial pressure (MAP)decreased from 70 to 58 mmHg at 70 minutes after induction, dobutamine was administered by constant rate infusion(5 μg/kg/min) to treat hypotension. However MAP did not increase, and heart rate rapidly decreased from 100 to 55beats per minute (bpm). To treat bradycardia, intravenous glycopyrrolate (5 μg/kg) was administered, and heart rateincreased to 165 bpm. After extubation of endotracheal tube, the patient showed normal recovery without any problemsrelated to cardiovascular system. Unexpected dobutamine-induced bradycardia was considered as Bezold-Jarisch reflex. It is recommended that clinicians know and prepare the possibility of bradycardia during dobutamine therapy undergeneral anesthesia.

Safety of Stress Cardiac Magnetic Resonance in Patients With Moderate to Severe Aortic Valve Stenosis

Janek Salatzki,Andreas Ochs,Nadja Kirchgäßner,Jannick Heins,Sebastian Seitz,Hauke Hund,Derliz Mereles,Matthias G. Friedrich,Hugo A. Katus,Norbert Frey,Florian André,Marco M. Ochs 한국심초음파학회 2023 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.31 No.1

BACKGROUND: Dobutamine and adenosine stress cardiac magnetic resonance (CMR) imaging is relatively contraindicated in patients with moderate to severe aortic valve stenosis (AS). We aimed to determine the safety of dobutamine and adenosine stress CMR in patients with moderate to severe AS. METHODS: In this retrospective study patients with AS who underwent either dobutamine or adenosine stress CMR for exclusion of obstructive coronary artery disease were enrolled. We recorded clinical data, CMR and echocardiography findings, and complications as well as minor symptoms. Patients with AS were compared to matched individuals without AS. RESULTS: A total of 187 patients with AS were identified and compared to age-, gender- and body mass index-matched 187 patients without AS. No severe complications were reported in the study nor the control group. The reported frequency of non-severe complications and minor symptoms were similar between the study and the control groups. Nineteen patients with AS experienced non-severe complications or minor symptoms during dobutamine stress CMR compared to eighteen patients without AS (p = 0.855). One patient with AS and two patients without AS undergoing adenosine stress CMR experienced minor symptoms (p = 0.562). Four examinations were aborted because of chest pain, paroxysmal atrial fibrillation and third-degree atrioventricular block. Inducible ischaemia, prior coronary artery bypass grafting, prior stroke and age were associated with a higher incidence of complications and minor symptoms. CONCLUSIONS: Moderate to severe AS was not associated with complications during CMR stress test. The incidence of non-severe complications and minor symptoms was greater with dobutamine.

Dobutamine과 Salbutamol 투여에 의한 흰쥐의 심혈관계 반응에 미치는 Imipramine과 전기경련처치의 효과

장인석,손의동,김중영 慶北大學校 醫科大學 1991 慶北醫大誌 Vol.32 No.4

마취된 흰쥐를 사용하여 β_1-효현제인 우선성 dobutamine(DT)과 β_2-효현제인 salbutamol(ST)을 정맥투여하여 나타나는 심박동수 증가작용과 혈압하강 작용에 미치는 imipramine(IMI)이나 전기경련충격(ECS)의 영향을 검토하였다. 약물투여전의 기저혈압(확장기압과 수축기압)과 심박동수가 reserpine처치(kg당 5㎎을 24시간전에 복강으로 주사)에 의해서 유의성있게 감소되었으나, IMI단회(㎏당 20㎎을 4-5시간전에 복강주사)나 IMI장기처치(하루2번 14일 동안), ECS단회(20㎐, 120V의 전류를 1초 동안 2시간전에 처치)나 ECS반복처치(12일간처치)에 의해서는 변동이 없었다. DT를 축적용량으로 투여시 용량에 비례해서 심박동수 증가작용을 나타내었다. 이러한 심박동수 증가작용이 IMI장기처치군에서 유의성있게 감약되었고, 나머지 군에서는 별영향이 없었다. 그리고 DT투여에 의한 반사적인 혈압하강작용은 확장기압과 수축기압 모두 IMI장기처치에 의해서 감약되었으나(1, 3㎍/㎏), 고용량에서는 감약되지 않았다. ST를 축적용량으로 투여시 용량에 비례하여 확장기압, 수축기압 그리고 맥압을 감소시켰다. 이러한 ST의 확장기압 감소작용은 ECS나 IMI단회처치에 의해서 영향이 없었으나 ECS반복처치에 의해서 현저히 감약되었고, reserpine처치에 의해서는 고용량(30㎍이상)에서 약화되었고, IMI장기처치에 의해서는 3이나 10㎍/㎏에서 약화되었다. 또한 ST의 수축기압의 감소작용도 ECS반복처치(ST모든 용량에서)와 reserpine(10㎍/㎏)처치에 의해서 감약되었으며, 맥압의 감소작용은 ECS장기처치에(0.3, 1㎍/㎏에서) 의해서만 약화되었고, ST에 의한 반사적으로 유도된 심박동수 증가작용도 ECS반복처치에 의해서 약화되는 경향을 나타내었다. DT(ST)투여에 의한 심박동수 증가작용(혈압하강작용)과 반사적인 혈압하강(심박동수증가작용)은 서로 밀접한 관련성이 있었으며, DT에 의한 곡선의 기울기는 IMI장기처치에 의해서 별변화가 없었으나 ST에 의한 곡선의 기울기는 ECS반복처치에 의해서 현저히 낮아졌다. 이상의 결과로 미루어보아 DT투여에 의한 심박동수 증가작용이 IMI장기처치로 약화된 것은 아마도 β_1-수용체의 감수성이 저하된 것이고, ST투여에 의한 혈압하강작용이 ECS반복처치에 의해서 약화된 것은 β_2-수용체의 감수성이 저하되어 기인되는 것으로 사료되며, 또한 반사적인 효과는 DT보다 ST에 의한 심박동수증가작용이 ECS반복처치에 의해서 더 많이 약화되었음을 알 수 있었다. This study was designed to investigate the influence of imipramine(IMI) or electroconvulsive shock(ECS) on the cardiovascular response i.e. positive chronotopic action and vasodepressive action in anesthetized rats, which was produced by adminstration of cumulative doses of D-dobutamine(DT) and salbutamol(ST). The basal value of diastolic blood pressure(DBP), systolic blood pressure(SBP) and heart rate (HR) significantly reduced by reserpine treatment(5 ㎎/㎏ i.p. 24 hr before) but not by acute IMI (20 ㎎/㎏ i.p. 4-5hr before), chronic IMI(same dose twice a day for 14 days), single ECS(20 ㎐, 1 20 V for 1 sec 2 hr before) or repeated ECS(treatment for 12 days). When DT injected with intravenous cumulative doses, which displayed the increase of HR in a dose-related manner. These chronotropic action of DT was attenuated with chronic treatment of IMI, and reflex-induced hypotension(DBP and SBP) of DT was attenuated by low dose(1, 3㎍/㎏) but not by high dose injection in chronic IMI group. Administration with cumulative i.v. doses of ST dose dependently resuted in the decrease of DBP, SBP and pulse pressure(PP). The decrease of DBP by ST was attenuated by either repeated ECS (all dose of ST) or reserpine(300 ㎍/㎏ over) or chronic IMI(3, 10㎍/㎏) treatment, but either ECS or single IMI had no effect. The diminution of SBP by ST was also attenuated in repeated ECS and resrpine(10 ㎍/㎏ over)-treated group irrespective of other 3 groups. And the reduction of PP and reflex-induced tachycardia with an increase in dose of DT had a tendency to decrease by repeated ECS. There was a correlationship between tachycadia(hypotension) and reflex-resulted hypotedsion(tachycardia) by DT(ST) administration, and the slope of line by DT was not changed by chronic IMI, but that by ST was largely reduced by repeated ECS. These results indicate that the attenuation of DT-induced chronotropic activity by chronic IMI is related to the reduction of beta-1 receptor sensitivity and that the attenuation of ST-mediated vaso-depression result, from beta-2 sensitivity, and that the decrease of reflex effect of ST by repeated ECS was more potent than of DT by chronic IMI.

급성 심근경색후 생존심근 진단에서 Dobutamine 심초음파도와 Thallium 심근스캔의 정확성 비교

이근,강덕현,송재관,이철환,최기준,홍명기,김재중,박성욱,박종훈,박승정 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.2

관동맥 우회로술 중 경식도 심초음파도로 관찰한 도부타민 투여후와 우회로술후의 좌심실 국소벽운동

김희열,김종진,윤호중,유기동,박지원,이길환,노태호,채장성,김재형,홍순조,최규보 대한순환기학회 1997 Korean Circulation Journal Vol.27 No.8

Original Article : Dobutamine stress echocardiography for evaluating cirrhotic cardiomyopathy in Liver cirrhosis

( Moon Young Kim ),( Soon Koo Baik ),( Chan Sik Won ),( Hong Jun Park ),( Hyo Keun Jeon ),( Hyun Il Hong ),( Jae Woo Kim ),( Hyun Soo Kim ),( Sang Ok Kwon ),( Jang Young Kim ),( Byung Su Yoo ),( Seung 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.4

Background/Aims: The blunted ventricular systolic and diastolic contractile responses to physical and pharmacological stress in cirrhosis are termed cirrhotic cardiomyopathy (CCM). CCM has been known to involve multiple defects in the β-adrenergic signaling pathway. The aim of this study was to determine whether cirrhotic patients have blunted cardiac responses to catecholamine stimulation through dobutamine stress echocardiography (DSE). Methods: Seventy-one cirrhotic patients with normal left ventricular (LV) chamber size and ejection fraction were enrolled. The LV systolic and diastolic functions were evaluated by two-dimensional and Doppler echocardiography at rest and during peak dobutamine infusion (40 μg/kg/min). An abnormal response was defined as a decrease of less than 10% in LV end-diastolic volume, a decrease of less than 20% in end-systolic volume, and an increase of less than 10% in LV ejection fraction (EF) at peak dobutamine infusion, based on previously used criteria. The early/late diastolic flow (E/A) ratio and diastolic parameters were also measured. Results: A blunted LV response to dobutamine was observed in 18 of 71 cirrhotic patients (25.4%). The baseline EF was significantly higher in 18 patients with a blunted DSE response than that of those with a normal DSE response (P<0.05). The baseline and peak E/A ratios, which are common diastolic dysfunction markers, were higher in the cirrhosis group than in the control group (P<0.001). No adverse events associated with DSE were observed. Conclusions: Blunted cardiac responses to dobutamine stimulation, which are implicated in defects in the β-adrenergic signaling pathway, might contribute to the pathogenesis of CCM in patients with cirrhosis. (Korean J Hepatol 2010;16:376-382)