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Endocrine effects of dopexamine vs. dopamine in high-risk surgical patients
T Schilling1, C M Strang, L Wilhelm
1Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Leipziger Strasse 44, 39120 Magdeburg, Germany.
Objectives:
To compare the endocrine effects of dopexamine and dopamine on prolactin (PRL), dihydroepiandrosterone sulfate (DHEAS), cortisol, thyrotropin (TSH), and peripheral thyroid hormone serum concentrations in surgical patients at risk of developing postoperative complications because of hypoperfusion of various organ systems.
Design And Setting:
A prospective, randomized, placebo-controlled, blinded clinical trial in an adult surgical intensive care unit in a university hospital.
Patients:
Thirty-two male surgical risk patients undergoing elective major abdominal surgery.
Interventions:
Patients were randomized to receive placebo ( n=8), dopexamine (0.5 microg kg(-1) min(-1), n=8), dopexamine (1 microg kg(-1) min(-1), n=8) or dopamine (5 microg kg(-1) min(-1), n=8) on the first postoperative day.
Measurements And Results:
All patients received either a placebo or catecholamine infusion for 24 h. Blood samples were obtained every 2 h for the next 2 days. PRL, DHEAS, cortisol, TSH, triiodothyronine, thyroxin, free triiodothyronine, and free thyroxin serum concentrations were determined by radioimmunoassay or luminescence immunoassay. Dopexamine (0.5 microg kg(-1) min(-1)) had no effects on serum concentrations of PRL or TSH. Higher doses of dopexamine (1 microg kg(-1) min(-1)) suppressed PRL secretion significantly, but not TSH. In contrast, infusion of dopamine (5 microg kg(-1) min(-1)) completely inhibited PRL and TSH secretion. DHEAS, cortisol, and thyroid hormone serum concentrations were not affected by either dopexamine or dopamine infusion. Measurements of hemodynamic parameters, peripheral oxygen saturation, diuresis, blood gases, and standard laboratory parameters were repeated hourly. Significant differences were not found between placebo, dopexamine (0.5 microg kg(-1) min(-1)) and dopamine (5 microg kg(-1) min(-1)) group. Dopexamine at 1 microg kg(-1) min(-1) increased the heart rate significantly.
Conclusions:
Routine postoperative optimizing of men undergoing abdominal surgical procedures with dopexamine at higher doses or dopamine induces at least partial hypopituitarism, which may possibly affect postoperative morbidity.