Comparison of the Inotropic Action of Morphine and Ketamine Studied in Canine Cardiac Muscle

Urthaler, Ferdinand; Walker, Alfred A.; James, Thomas N.

doi:10.1097/00132586-197704000-00007

Cited by 5 publications

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“…For this reason ketamine is commonly recommended for hypotension‐prone patients and in patients with dilative cardiomyopathy; it is not recommended in hypertrophic cardiomyopathy. Ketamine is a direct myocardial depressant, however, and this effect may manifest in larger dosages or in sicker patients 20 . Muscle tone is always high and spontaneous movement is common, and an adjunctive tranquilizer/sedative is routinely utilized 20 .…”

Section: Relative Merits and Precautions Of Common Sedative And Anestmentioning

confidence: 99%

“…Ketamine is a direct myocardial depressant, however, and this effect may manifest in larger dosages or in sicker patients 20 . Muscle tone is always high and spontaneous movement is common, and an adjunctive tranquilizer/sedative is routinely utilized 20 . Cerebral electrical and metabolic activity is enhanced with ketamine and this, in combination with the increase in arterial blood pressure (increases cerebral blood flow and intracranial pressure [ICP]) is why ketamine is not recommended in patients with intracranial disease.…”

Section: Relative Merits and Precautions Of Common Sedative And Anestmentioning

confidence: 99%

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Comparative cardiovascular and pulmonary effects of sedatives and anesthetic agents and anesthetic drug selection for the trauma patient

Haskins

2006

J Vet Emergen Crit Care

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Objective: To integrate and compare the effects of tranquilizer/sedatives and anesthetic drugs on various parameters of cardiovascular function in normal dogs and in dogs stressed by hypovolemia, anemia, and endotoxemia, and to discuss the relative merits and appropriate precautions of anesthetic drugs with respect to specific patient physiologic complications. Data sources: Personal data and experiences in conjunction with veterinary and human clinical and research studies. Human and veterinary data synthesis: Drugs that produce calming, sedation, muscle relaxation, analgesia, and loss of consciousness have the potential to produce marked cardiorespiratory effects particularly in hemorrhaged, hypovolemic‐traumatized animals. Acute but key cardiovascular components that are affected by sedative and anesthetic drugs include heart rate and rhythm, venous return (preload), systemic vascular resistance (afterload), and myocardial contractile (inotropic) and relaxation (lusitropic) properties. In addition, all sedative and anesthetic drugs alter or depress normal baroreceptor reflex activity, thereby inhibiting or eliminating the animal's normal physiologic response to decreases in arterial blood pressure and predisposing to tissue hypoperfusion, decreased oxygen delivery, and oxygenation. Oxygen delivery needs to be adequate to meet the metabolic (oxygen) requirements of the patient. Decreases in oxygen delivery to tissues increases oxygen extraction, thereby maintaining tissue oxygenation (supply‐independent oxygen consumption phase) until compensatory processes reach their limit and any further decrease in oxygen delivery causes a decrease in oxygen consumption (supply‐dependent oxygen consumption phase). The critical oxygen delivery that defines the transition between these 2 phases is generally higher in the anesthetized state than in the awake state. The effect of anesthetics on critical oxygen delivery at comparable anesthetic dosages is pentobarbital=ketamine>alfentanil>etomidate=propofol>inhalational anesthetics. Anesthetics generally decrease oxygen consumption from the awake, baseline state; exceptions are ketamine and ether. Ketamine, however, increases oxygen delivery and oxygen extraction. Conclusions: The transition from the awake to the anesthetized state is a huge imposition on the physiology of animals and, therefore, should be accomplished with great care and proper vigilance. Rapid, ‘crash’ induction of anesthesia should be avoided in hypotension‐prone animals and slow, prolonged induction should be avoided in animals with respiratory disorders. It is not recommended to implement an unfamiliar protocol in critical patients, even if it might be pharmacologically preferable. Familiarity with an anesthetic drug is a very important reason for its selection.

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Section: Relative Merits and Precautions Of Common Sedative And Anestmentioning

confidence: 99%

Section: Relative Merits and Precautions Of Common Sedative And Anestmentioning

confidence: 99%

Comparative cardiovascular and pulmonary effects of sedatives and anesthetic agents and anesthetic drug selection for the trauma patient

Haskins

2006

J Vet Emergen Crit Care

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“…It stimulates the cardiovascular system and increases blood pressure, heart rate, and cardiac output. However, ketamine has negative inotropic effects in isolated hearts [6,7]. Our results showed inhibition of I Ca induced by ketamine between 10 Ϫ6 and 10 Ϫ3 M in bullfrog single atrial myocytes.…”

Section: Discussionmentioning

confidence: 60%

“…Ketamine has been reported to have a negative inotropic effect in vitro and several papers demonstrated myocardial depression induced by ketamine [6][7][8]. L-Type calcium channel current (I Ca ) was inhibited by ketamine in single smooth muscles of rabbit portal vein [9].…”

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confidence: 99%

Effects of ketamine on voltage-dependent calcium currents and membrane potentials in single bullfrog atrial cells

Hatakeyama

Yamazaki

Shibuya

et al. 2001

Journal of Anesthesia

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“…6 2 Le choix de l'agent anesthésique et du BB n'est pas indifférent. Ainsi, l'effet inotrope négatif intrinsèque de la kétamine 63,64 peut être démasqué par les BB. Expérimentalement, une dépression myocardique a été observée avec l'association enflurane et propranolol, 6 5 mais l'oxprénolol prévient la dysfonction régionale myocardique engendrée par l'enflurane.…”

Section: Bêta-bloquants En Anesthésie 61 Interférences Avec L'anesthunclassified

Intérêt des bêta-bloquants en médecine périopératoire. Première partie: notions fondamentales

Piriou

Aouifi

Lehot

2000

Can J Anesth/J Can Anesth

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Objectif : Rappeler les notions de pharmacologie et de physiopathologie nécessaires à l'utilisation des bêta-bloquants (BB) en médecine périopératoire.Sources : Recherche manuelle et informatisée de la littérature. (mots-clés : anesthesia and beta-blocker, surgery and beta-blocker).Constatations principales : Les BB cardiosélectifs bloquent préférentiellement les bêta-1 récepteurs, induisant une diminution de la fréquence cardiaque et de l'inotropisme, conduisant à la diminution de la consommation d'oxygène myocardique. Les BB non cardiosélectifs bloquent également les bêta-2 récepteurs, induisent une élé-vation des résistances vasculaires périphériques et bronchiques et augmentent les contractions utérines. Cependant, certains BB possèdent des effets vasodilatateurs (carvédilol, céliprolol, labétalol). Les contre-indications des BB résultent logiquement de leurs effets pharmacologiques. Le traitement BB tend à augmenter la densité des bêta-récepteurs membranaires, expliquant les manifestations d'hyperactivité du système nerveux sympathique observées lors de leur sevrage. Depuis la découverte du propranolol en 1964, les BB ont connu des fortunes diverses en anesthésie. Initialement, la sympatholyse partielle qu'ils induisent a été redoutée dans les situations de stress provoquées par les agents anesthésiques et surtout les manipulations chirurgicales. Cependant, les travaux publiés à partir de 1973 ont suggéré un effet hémodynamique protecteur. Conclusion :Les travaux récents ont démontré le caractère bénéfique de la poursuite des traitements BB jusqu'à l'anesthésie à l'exception des manifestations d'intolérance telles que l'hypotension ou la bradycardie sévère.Purpose: To review the pharmacologic and pathophysiologic information necessary to prescribe beta-blockers (BB) in perioperative medicine. Data source: Manual retrieval and electronic research of the literature using MEDLINE (key-words: anesthesia and beta-blocker; surgery and beta-blocker).Data synthesis: Cardioselective BB inhibit preferentially beta-1 receptors, inducing a decrease in heart rate and cardiac inotropism leading to reduction of oxygen myocardial consumption. Non-cardioselective BB inhibit also beta-2 receptors, increasing bronchial and peripheral vascular resistances and uterine contractions. However, some BB are also vasodilators (carvedilol, celiprolol, labetalol). Contraindications to BB result logically from their pharmacological effects. Treatment with BB increases membrane beta-receptor density; this explains sympathetic overactivity observed during weaning of treatment. Since the discovery of propranolol in 1964, the use of BB has been controversial in anesthesia. Formerly, the adverse effects of partial sympatholysis during anesthesia and surgery were feared. However, since 1973, experimental and clinical data have suggested a protective hemodynamic effect.Conclusion: Continued administration of BB up to the time of anesthesia has been encouraged except in patients with signs of intolerance such as hypotension or excessive bradyca...

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Comparison of the Inotropic Action of Morphine and Ketamine Studied in Canine Cardiac Muscle

Cited by 5 publications

References 0 publications

Comparative cardiovascular and pulmonary effects of sedatives and anesthetic agents and anesthetic drug selection for the trauma patient

Comparative cardiovascular and pulmonary effects of sedatives and anesthetic agents and anesthetic drug selection for the trauma patient

Effects of ketamine on voltage-dependent calcium currents and membrane potentials in single bullfrog atrial cells

Intérêt des bêta-bloquants en médecine périopératoire. Première partie: notions fondamentales

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