Beta 2-adrenergic responsiveness in vivo during abdominal surgery

Ewaldsson, Carl-Arne; Hahn, Robert G.

doi:10.1093/bja/81.3.343

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Furthermore, the present study supports a graded coagulation response between a blood withdrawal of $5% and $15% of the blood volume as demonstrated in surgical patients [9]. Also, surgery increases responsiveness of b 2 -adrenoreceptors [31], which are the most likely mediator of adrenaline on coagulation [32]. Adrenaline accelerates the coagulation process [32,33], and the increased HR in response to controlled bleeding suggests that the acceleration of coagulation may be mediated by adrenaline-induced release of coagulation factors, such as coagulation factor VIII and von Willebrand factor from the spleen [34] and endothelial cells [32], as observed during orthostatic stress and exercise [2,3].…”

Section: Discussionsupporting

confidence: 87%

Coagulation competence and fluid recruitment after moderate blood loss in young men

Zaar

Mørkeberg

Pott

et al. 2014

Blood Coagulation &Amp; Fibrinolysis

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The coagulation system is activated by a reduction of the central blood volume during orthostatic stress and lower body negative pressure suggesting that also a blood loss enhances coagulation. During bleeding, however, the central blood volume is supported by fluid recruitment to the circulation and redistribution of the blood volume. In eight supine male volunteers (24 ± 3 years, blood volume of 6.9 ± 0.7 l; mean ± SD), 2 × 450 ml blood was withdrawn over ∼ 30 min while cardiovascular variables were monitored. Coagulation was evaluated by thrombelastography, and fluid recruitment was estimated by red blood cell count. Withdrawing 900 ml blood increased heart rate (62 ± 7 to 69 ± 13 bpm, P < 0.05; mean ± SD) and reduced stroke volume (113 ± 12 to 96 ± 14 ml, P < 0.05) leaving cardiac output, mean arterial pressure, and total peripheral resistance unchanged and, furthermore, reduced red blood cell count (4.80 ± 0.33 to 4.64 ± 0.37 × 10(12) cells l(-1), P < 0.05) indicating that 218 ± 173 ml fluid was recruited to the circulation. Withdrawing 450 ml blood reduced the time until initial fibrin formation (R: 6.5 ± 0.9 to 5.1 ± 1.0 min, P < 0.01), whereas the rate of clot formation increased after withdrawal of 900 ml blood (α-Angle: 66 ± 4 to 70 ± 3 deg, P < 0.01). Clot strength (maximal amplitude: 57 ± 4 mm), clot lysis 30 min after maximal amplitude (LY30: 0.8% [0-3.5%] (median [range])), and platelet count (218 ± 25 × 10(9) l(-1)) were unaffected. For supine males, ∼ 25% of a moderate blood loss is compensated by fluid recruitment to the circulation, which may explain the minor cardiovascular response. Yet, a blood loss of 450 ml accelerates coagulation, and this is further accentuated when blood loss is 900 ml.

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Section: Discussionsupporting

confidence: 87%

Coagulation competence and fluid recruitment after moderate blood loss in young men

Zaar

Mørkeberg

Pott

et al. 2014

Blood Coagulation &Amp; Fibrinolysis

View full text Add to dashboard Cite

show abstract

“…Under abdominal surgery, the expected increase in ST level and T‐wave amplitude for higher S‐K levels was in fact a decrease. The above mentioned lack of reduction in the S‐K level for increasing P‐epinephrine levels is another example, although this was not corroborated in another of our studies during abdominal surgery[11]. While these differences between the groups weakened the correlations when simple regressions analysis was applied to the pooled data ( Figs 2 and 3), multiple regression disclosed the effects that remained constant under the varying conditions under which regional anaesthesia was given.…”

Section: Discussionmentioning

confidence: 58%

Epinephrine, potassium and the electrocardiogram during regional anaesthesia

Hahn

Löfgren

2000

Eur J Anaesthesiol

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Epinephrine lowers the serum potassium level through an effect on the beta2-receptor. It is therefore difficult to evaluate whether depression of the ST level and the T wave on the electrocardiogram, during regional anaesthesia, is caused by a high plasma epinephrine level, a low serum potassium level, or both. For this purpose, we studied the relation between electrocardiogram and the plasma epinephrine and serum potassium concentrations during 20 intra-abdominal operations performed under combined epidural and general anaesthesia and in 18 subjects receiving intercostal nerve blockade. The results show that the hypokalaemic effect of epinephrine was reduced when the plasma epinephrine concentration exceeded 3 nmol L-1. A multiple regression analysis demonstrated that the ST level and the T-wave amplitude were most consistently affected by a low serum potassium level, while a high plasma epinephrine level correlated only to a depression in the T-wave amplitude. During surgery, only serum potassium correlated with these ECG variables.

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“…another example, although this was not corroborated in another of our studies during abdominal surgery [11]. While these differences between the groups weakened the correlations when simple regressions analysis was applied to the pooled data (Figs 2 and 3), multiple regression disclosed the effects that remained constant under the varying conditions under which regional anaesthesia was given.…”

Section: Discussionmentioning

confidence: 75%

Epinephrine, potassium and the electrocardiogram during regional anaesthesia

Hahn

Löfgren

2000

European Journal of Anaesthesiology

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Epinephrine lowers the serum potassium level through an effect on the b 2 -receptor. It is therefore difficult to evaluate whether depression of the ST level and the T wave on the electrocardiogram, during regional anaesthesia, is caused by a high plasma epinephrine level, a low serum potassium level, or both. For this purpose, we studied the relation between electrocardiogram and the plasma epinephrine and serum potassium concentrations during 20 intra-abdominal operations performed under combined epidural and general anaesthesia and in 18 subjects receiving intercostal nerve blockade. The results show that the hypokalaemic effect of epinephrine was reduced when the

show abstract

Beta 2-adrenergic responsiveness in vivo during abdominal surgery

Cited by 8 publications

References 18 publications

Coagulation competence and fluid recruitment after moderate blood loss in young men

Coagulation competence and fluid recruitment after moderate blood loss in young men

Epinephrine, potassium and the electrocardiogram during regional anaesthesia

Epinephrine, potassium and the electrocardiogram during regional anaesthesia

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