Anaes Vivas · Anaesthetic adjuncts

Data viva — dobutamine and dopamine among the inotropes

A data viva placing dobutamine against dopamine and adrenaline. The discriminating data points: dobutamine is a synthetic predominantly beta-1 inotrope with weak beta-2 and alpha-1 (beta-2 offsets alpha-1, so vasodilating at clinical dose — taught pharmacology), no indirect component, less tachyarrhythmia, lowers PVR, and is the standard stress-testing agent for dobutamine stress echocardiography (prognostic cohort-exact, Dippenaar 2026). Dopamine is the natural noradrenaline precursor with direct plus indirect action and dose-dependent selectivity (taught tiers; the porcine study owns no dosing claim, Routkevitch 2026), is more arrhythmogenic (indirect noradrenaline release), raises PVR, and has the trial-exact disproven renal-dose concept (328 patients, Bellomo 2000); it is one of the compared options in neonatal fluid-refractory septic shock with no superiority (4-RCT null, Yahya 2026). Adrenaline is the broadest agent (alpha-1, alpha-2, beta-1, beta-2) and the most arrhythmogenic (taught ranking). All three share a half-life of about 2 minutes, COMT metabolism, tachyphylaxis after 48 to 72 hours (taught pharmacology), and extravasation necrosis reversed by phentolamine (cohort-exact, Shyu 2025). Delirium null in older adults (Dong 2026) frames the selection logic.