HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Svedjeholm, R. Articles by Ronquist, G. Search for Related Content PubMed PubMed Citation Articles by Svedjeholm, R. Articles by Ronquist, G.

The Annals of Thoracic Surgery, Vol 51, 262-270, Copyright © 1991 by The Society of Thoracic Surgeons

ARTICLES

Dopamine and high-dose insulin infusion (glucose-insulin-potassium) after a cardiac operation: effects on myocardial metabolism

R Svedjeholm, S Hallhagen, R Ekroth, PO Joachimsson and G Ronquist
Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden.

Myocardial insulin resistance, in association with surgical stress, restricts the availability of carbohydrates and increases the load of free fatty acids (FFAs) on the heart. On theoretical grounds adrenergic drugs may be expected to aggravate this situation, whereas the opposite is expected from insulin. The influence of dopamine and a combination of dopamine (7 micrograms/kg body weight/min) and high-dose insulin (7 IU/kg) on myocardial energy metabolism was studied in 19 patients 4 to 6 hours after a coronary operation. Infusion of dopamine (7 micrograms/kg body weight/min) induced metabolic changes that may be unfavorable to the strained myocardium. There was an increase of the myocardial FFA load and a rise in myocardial oxygen expenditure by 60% to 70%. There changes were, however, not matched by an increase in myocardial substrate uptake. "Oxygen wastage" of FFA metabolism at high circulating catecholamine levels is suggested. There were also signs suggesting an amplified systemic trauma response: systemic oxygen consumption increased by 15%, and an increase in the arterial levels of FFAs, glucose, and ketones was observed. Divergent metabolic effects of dopamine and insulin were demonstrated. The most prominent metabolic effects of adding high-dose insulin to dopamine were a marked reduction of arterial FFA levels and a shift toward myocardial carbohydrate utilization at the expense of FFAs. Myocardial uptake of FFAs ceased. Myocardial insulin resistance may thus to a significant extent be overcome by supraphysiological doses of insulin, even during infusion of adrenergic drugs.

This article has been cited by other articles:

				W. Bothe, M. Olschewski, F. Beyersdorf, and T. Doenst Glucose-Insulin-Potassium in Cardiac Surgery: A Meta-Analysis Ann. Thorac. Surg., November 1, 2004; 78(5): 1650 - 1657. [Abstract] [Full Text] [PDF]

				M. Hynninen, M. A. Borger, V. Rao, R. D. Weisel, G. T. Christakis, J.-A. Carroll, and D. C. H. Cheng The Effect of Insulin Cardioplegia on Atrial Fibrillation After High-Risk Coronary Bypass Surgery: A Double-Blinded, Randomized, Controlled Trial Anesth. Analg., April 1, 2001; 92(4): 810 - 816. [Abstract] [Full Text] [PDF]

				R. Svedjeholm, E. Hakanson, and Z. Szabo Routine SvO2 measurement after CABG surgery with a surgically introduced pulmonary artery catheter Eur. J. Cardiothorac. Surg., October 1, 1999; 16(4): 450 - 457. [Abstract] [Full Text] [PDF]

				B. Tunerir, R. Aslan, S. Isiksoy, O. Colak, Y. Besogul, and T. Kural Benefits of Glucose-Insulin-Potassium Before Mitral Valve Replacement Asian Cardiovasc Thorac Ann, December 1, 1998; 6(4): 273 - 278. [Abstract] [Full Text] [PDF]

				U. W. Kjellman, K. Bjork, R. Ekroth, H. Karlsson, R. Jagenburg, F. N. Nilsson, G. Svensson, and J. Wernerman Addition of {{alpha}}-Ketoglutarate to Blood Cardioplegia Improves Cardioprotection Ann. Thorac. Surg., June 1, 1997; 63(6): 1625 - 1633. [Abstract] [Full Text]

				H. L. Lazar, G. Philippides, C. Fitzgerald, D. Lancaster, R. J. Shemin, and C. Apstein GLUCOSE-INSULIN-POTASSIUM SOLUTIONS ENHANCE RECOVERY AFTER URGENT CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., February 1, 1997; 113(2): 354 - 362. [Abstract] [Full Text]

				T. S. Larsen, O. Irtun, T. K. Steigen, T. V. Andreasen, and D. Sorlie Myocardial Substrate Oxidation During Warm Continuous Blood Cardioplegia Ann. Thorac. Surg., September 1, 1996; 62(3): 762 - 768. [Abstract] [Full Text]