Catecholamines are often used for optimisation of cardiac index and oxygen delivery in high-risk surgical patients; however, infusions of dopamine and dopexamine are associated with dose-dependent hypophysiotropic and thyreotropic properties. The objective was to compare endocrine effects of equipotent inotropic doses of dopexamine, dobutamine and dopamine on prolactin and thyreotropin release perioperatively.
A prospective, randomised, blinded clinical trial.
Adult surgical intensive care unit in a university hospital.
Thirty male patients (ASA III) undergoing elective major abdominal surgery.
Patients were randomised to receive dopexamine (DX, n=10), dobutamine (DO, n=10) or dopamine (DA, n=10) on the first postoperative day for 8 h.
Measurements and results
All patients received a catecholamine infusion in doses adjusted to increase cardiac index by 35% within the first hour. Blood samples were obtained and prolactin and thyreotropin serum concentrations were determined by radioimmunoassays. Mean doses of dopexamine, dobutamine and dopamine used were 0.73±0.27, 4.06±1.95 and 5.0±1.84 µg kg−1min−1, respectively. Cardiac index was increased by 36% (DX group), 38% (DO group) and 38% (DA group). Alterations of oxygen delivery and oxygen consumption were not significantly different between the study groups. Dopexamine and dobutamine had no hypophysiotropic effects. In contrast, dopamine suppressed prolactin and thyreotropin secretion with a maximal effect after 4 h. After dopamine withdrawal, a rebound release of prolactin and thyreotropin was observed.
In high-risk surgical patients dopexamine or dobutamine produced fewer effects on prolactin and thyreotropin serum concentrations in comparison with DA when used in equivalent dosages.
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Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186
Boyd O, Grounds RM, Bennett ED (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. J Am Med Assoc 270:2699–2707
Wilson J, Woods I, Fawcett J, Whall R, Dibb W, Morris C, McManus E (1999) Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. Br Med J 318:1099–1103
Van den Berghe G, de Zegher F, Lauwers P (1994) Dopamine suppresses pituitary function in infants and children. Crit Care Med 22:1747–1753
Van den Berghe G, de Zegher F (1996) Anterior pituitary function during critical illness and dopamine treatment. Crit Care Med 24:1580–1590
Van den Berghe GH, De Zegher FE (1996) A senescent pattern of pituitary function during critical illness and dopamine treatment. Verh K Acad Geneeskd Belg 58:383–411
Baue AE, Gunther B, Hartl W, Ackenheil M, Heberer G (1984) Altered hormonal activity in severely ill patients after injury or sepsis. Arch Surg 119:1125–1132
Byers RJ, Eddleston JM, Pearson RC, Bigley G, McMahon RF (1999) Dopexamine reduces the incidence of acute inflammation in the gut mucosa after abdominal surgery in high-risk patients. Crit Care Med 27:1787–1793
Baguneid MS, Welch M, Bukkari M, Fulford PE, Howe M, Bigley G, McMahon RF, Eddleston J, Walker MG (1999) Vascular surgical society of great britain and ireland: randomized double-blind study of dopexamine versus placebo in aortic surgery. Br J Surg 86:698
Brown RA, Dixon J, Farmer JB, Hall JC, Humphries RG, Ince F, O’Connor SE, Simpson WT, Smith GW (1985) Dopexamine: a novel agonist at peripheral dopamine receptors and beta 2-adrenoceptors. Br J Pharmacol 85:599–608
Smithies M, Yee TH, Jackson L, Beale R, Bihari D (1994) Protecting the gut and the liver in the critically ill: effects of dopexamine. Crit Care Med 22:789–795
Maynard ND, Bihari DJ, Dalton RN, Smithies MN, Mason RC (1995) Increasing splanchnic blood flow in the critically III. Chest 108:1648–1654
Boldt J, Papsdorf M, Piper S, Padberg W, Hempelmann G (1998) Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery. Acta Anaesthesiol Scand 42:941–947
Muller M, Boldt J, Schindler E, Sticher J, Kelm C, Roth S, Hempelmann G (1999) Effects of low-dose dopexamine on splanchnic oxygenation during major abdominal surgery. Crit Care Med 27:2389–2393
Scheeren TW, Schwarte LA, Loer SA, Picker O, Fournell A (2002) Dopexamine but not dopamine increases gastric mucosal oxygenation during mechanical ventilation in dogs. Crit Care Med 30:881–887
Schilling T, Strang CM, Wilhelm L, Moritz KU, Siegmund W, Grundling M, Hachenberg T (2001) Endocrine effects of dopexamine vs dopamine in high-risk surgical patients. Intensive Care Med 27:1908–1915
Yu M, Burchell S, Hasaniya NW, Takanishi DM, Myers SA, Takiguchi SA (1998) Relationship of mortality to increasing oxygen delivery in patients ≥50 years of age: a prospective, randomized trial. Crit Care Med 26:1011–1019
Missale C, Nash SR, Robinson SW, Jaber M, Caron MG (1998) Dopamine receptors: from structure to function. Physiol Rev 78:189–225
Viquerat CE, Daly P, Swedberg K, Evers C, Curran D, Parmley WW, Chatterjee K (1985) Endogenous catecholamine levels in chronic heart failure. Relation to the severity of hemodynamic abnormalities. Am J Med 78:455–460
Van den Berghe G, de Zegher F, Lauwers P (1994) Dopamine and the sick euthyroid syndrome in critical illness. Clin Endocrinol 41:731–737
Van den Berghe G, de Zegher F, Wouters P, Schetz M, Verwaest C, Ferdinande P, Lauwers P (1995) Dehydroepiandrosterone sulphate in critical illness: effect of dopamine. Clin Endocrinol 43:457–463
Tan LB, Littler WA, Murray RG (1991) Comparison of the haemodynamic effects of dopexamine and dobutamine in patients with severe congestive heart failure. Int J Cardiol 30:203–208
Bayliss J, Thomas L, Poole-Wilson P (1987) Acute hemodynamic and neuroendocrine effects of dopexamine, a new vasodilator for the treatment of heart failure: comparison with dobutamine, captopril, and nitrate. J Cardiovasc Pharmacol 9:551–554
MacGregor DA, Butterworth JFT, Zaloga CP, Prielipp RC, James R, Royster RL (1994) Hemodynamic and renal effects of dopexamine and dobutamine in patients with reduced cardiac output following coronary artery bypass grafting. Chest 106:835–841
Russell DH, Kibler R, Matrisian L, Larson DF, Poulos B, Magun BE (1985) Prolactin receptors on human T and B lymphocytes: antagonism of prolactin binding by cyclosporine. J Immunol 134:3027–3031
Russell DH (1989) New aspects of prolactin and immunity: a lymphocyte-derived prolactin-like product and nuclear protein kinase C activation. Trends Pharmacol Sci 10:40–44
Perez Castro C, Penalva R, Paez Pereda M, Renner U, Reul JM, Stalla GK, Holsboer F, Arzt E (1999) Early activation of thyrotropin-releasing-hormone and prolactin plays a critical role during a T cell-dependent immune response. Endocrinology 140:690–697
Devins SS, Miller A, Herndon BL, O’Toole L, Reisz G (1992) Effects of dopamine on T-lymphocyte proliferative responses and serum prolactin concentrations in critically ill patients. Crit Care Med 20:1644–1649
Bernton EW, Meltzer MS, Holaday JW (1988) Suppression of macrophage activation and T-lymphocyte function in hypoprolactinemic mice. Science 239:401–404
Bernton E, Bryant H, Holaday J, Dave J (1992) Prolactin and prolactin secretagogues reverse immunosuppression in mice treated with cysteamine, glucocorticoids, or cyclosporin-A. Brain Behav Immun 6:394–408
Dohi K, Kraemer WJ, Mastro AM (2003) Exercise increases prolactin-receptor expression on human lymphocytes. J Appl Physiol 94:518–524
Fabris N, Mocchegiani E, Provinciali M (1995) Pituitary–thyroid axis and immune system: a reciprocal neuroendocrine–immune interaction. Horm Res 43:29–38
Sumita S, Ujike Y, Namiki A, Watanabe H, Kawamata M, Watanabe A, Satoh O (1994) Suppression of the thyrotropin response to thyrotropin-releasing hormone and its association with severity of critical illness. Crit Care Med 22:1603–1609
Van den Berghe G, de Zegher F, Vlasselaers D, Schetz M, Verwaest C, Ferdinande P, Lauwers P (1996) Thyrotropin-releasing hormone in critical illness: from a dopamine-dependent test to a strategy for increasing low serum triiodothyronine, prolactin, and growth hormone concentrations. Crit Care Med 24:590–595
Fidian-Green RG, Antonsson JB (1991) The role of the gut in shock and multiple system organ failure. Eur J Surg 157:3–12
Rosseel PM, Santman FW, Bouter H, Dott CS (1997) Postcardiac surgery low cardiac output syndrome: dopexamine or dopamine? Intensive Care Med 23:962–968
Sun Q, Tu Z, Lobo S, Dimopoulos G, Nagy N, Rogiers P, De Backer D, Vincent JL (2003) Optimal adrenergic support in septic shock due to peritonitis. Anesthesiology 98:888–896
Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J (2000) Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 356:2139–2143
The authors thank P. Radermacher for critically reading the manuscript and providing valuable comments. This work was supported in part by IPSEN Pharma Ltd., Ettlingen, Germany, and by institutional sources.
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Schilling, T., Gründling, M., Strang, C.M. et al. Effects of dopexamine, dobutamine or dopamine on prolactin and thyreotropin serum concentrations in high-risk surgical patients. Intensive Care Med 30, 1127–1133 (2004). https://doi.org/10.1007/s00134-004-2279-4
- High-risk surgical patients