Pulmonary inactivation of vasopressors following cardiac operations

Vasoactive drugs were infused through catheters in the right atrium and then the left atrium of 34 patients who required either vasopressor or vasodilator support following cardiac operation to determine if the route of infusion affected the aortic blood concentration of these agents. Drugs were given through the right atrium for one hour and then the left atrium for an hour. Both central aortic and pulmonary arterial blood were assayed for drug concentrations, and hemodynamic measurements were made. Sixteen patients receiving dopamine hydrochloride through the left atrium had a 36 +/- 12% (+/- standard error of the mean) increase in aortic concentration of the drug (p less than 0.005) and a 37 +/- 14% increase in cardiac index (p less than 0.005) compared with administration through the right atrium. Seven patients receiving epinephrine showed a 59 +/- 21% increase in aortic concentration (p less than 0.05) and a 21 +/- 10% increase in cardiac index (p greater than 0.05, not significant). Eleven patients receiving sodium nitroprusside achieved a 99 +/- 25% increase in aortic concentration (p less than 0.005) and a 20 +/- 7% increase in cardiac index (p less than 0.05). In all instances, significantly higher central aortic blood concentrations were achieved during left atrial (LA) versus right atrial (RA) infusions. Changes in blood concentration of the drug between the pulmonary artery and the aorta during RA infusion suggest removal or inactivation of these drugs in the pulmonary vasculature.(ABSTRACT TRUNCATED AT 250 WORDS)