High-dose insulin improves the efficacy of dopamine early after cardiac surgery. A study of myocardial performance and oxygen consumption.
The influence of dopamine (7 micrograms/kg b.w./min) and of combined high-dose insulin (7 IU/kg) and dopamine on the relationship between haemodynamic performance and myocardial oxygen consumption was studied 4-6 hours after aortocoronary bypass surgery. The ten patients in the 'dopamine' group and the nine in the 'insulin-dopamine' group responded equally to dopamine alone. In a second study period the cardiac output was increased 41.8 +/- 4.7% by insulin-dopamine and 25.9 +/- 6.7% by dopamine alone (p less than 0.05). As the heart-rate response was similar in both groups, the difference was mainly due to greater response of stroke volume in the insulin-dopamine group. Systemic vascular resistance decreased 27.4 +/- 5.1% in the insulin-dopamine group but was unchanged in the dopamine group (p less than 0.05). Myocardial oxygen consumption increased 70.7 +/- 15.6% in the dopamine group and 78.8 +/- 18.4% in the insulin-dopamine group (NS). The addition of high-dose insulin to dopamine thus improved the haemodynamic efficacy of dopamine without further increasing myocardial oxygen expenditure.
Svedjeholm
R
R
Department of Thoracic Surgery, University Hospital, Uppsala, Sweden.
Ekroth
R
R
Joachimsson
P O
PO
Tydén
H
H
D000328:Adult; D001026:Coronary Artery Bypass; D004298:Dopamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D010101:Oxygen Consumption / Q000187:drug effects; D011182:Postoperative Care
D007328:Insulin; D004298:Dopamine