Hemodynamic advantages of left atrial epinephrine administration in open heart operations

Background. It is often necessary to administer a catecholamine to patients who have undergone cardiac operations. However, there are some potential disadvantages to using the central venous circulation, a routine route for catecholamine infusion. The advantages of the left atrial infusion of epinephrine were investigated in 21 patients. Methods. The first group received epinephrine through the central venous route (central venous group), and the second group received adrenaline through the left atrial route (left atrial group). Hemodynamic studies were performed in all patients before and after the infusions. Blood samples were also taken from the radial and pulmonary arteries to determine the epinephrine concentrations. Results. The average pulmonary arterial pressure and pulmonary vascular resistance were higher in the central venous group, whereas higher cardiac indices and average blood pressures were noted in the left atrial group (p < 0.05). There was a statistically significant difference in the epinephrine concentrations in the pulmonary arterial and radial arterial samples between the two groups. Conclusions. We conclude that epinephrine infusion through the left atrial route is associated with greater hemodynamic advantages than infusion through the central venous route. (C) 1997 by The Society of Thoracic Surgeons.