Influences of Cardiopulmonary Bypass and Fentanyl Anesthesia on Hepatic Circulation and Oxygen Metabolism in Beagles

Koizumi, Miiko; Matsumoto, Nobuyuki; Ueda, Keisuke

doi:10.1213/00000539-199806000-00007

Cited by 11 publications

(11 citation statements)

References 15 publications

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“…This could explain the decreasing efficacy of the HABR in controls and, partly, also in tamponade animals. Alternatively, surgery and anesthesia might have caused these effects (9). Our results also demonstrate that the same absolute change in hepatic arterial conductance can have very different effects on absolute flow changes.…”

Section: G823 Cardiac Tamponade: Effects On Splanchnic Vasoregulationmentioning

confidence: 52%

Effects of systemic arterial hypoperfusion on splanchnic hemodynamics and hepatic arterial buffer response in pigs

Jakob¹,

Tenhunen²,

Laitinen³

et al. 2001

American Journal of Physiology-Gastrointestinal and Liver Physi

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The hepatic arterial buffer response (HABR) tends to maintain liver blood flow under conditions of low mesenteric perfusion. We hypothesized that systemic hypoperfusion impairs the HABR. In 12 pigs, aortic blood flow was reduced by cardiac tamponade to 50 ml. kg(-1). min(-1) for 1 h (short-term tamponade) and further to 30 ml. kg(-1). min(-1) for another hour (prolonged tamponade). Twelve pigs without tamponade served as controls. Portal venous blood flow decreased from 17 +/- 3 (baseline) to 6 +/- 4 ml. kg(-1). min(-1) (prolonged tamponade; P = 0.012) and did not change in controls, whereas hepatic arterial blood flow decreased from 2 +/- 1 (baseline) to 1 +/- 1 ml. kg(-1). min(-1) (prolonged tamponade; P = 0.050) and increased from 2 +/- 1 to 4 +/- 2 ml. kg(-1). min(-1) in controls (P = 0.002). The change in hepatic arterial conductance (DeltaC(ha)) during acute portal vein occlusion decreased from 0.1 +/- 0.05 (baseline) to 0 +/- 0.01 ml. kg(-1). min(-1). mmHg(-1) (prolonged tamponade; P = 0.043). In controls, DeltaC(ha) did not change. Hepatic lactate extraction decreased, but hepatic release of glutathione S-transferase A did not change during cardiac tamponade. In conclusion, during low systemic perfusion, the HABR is exhausted and hepatic function is impaired without signs of cellular damage.

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Section: G823 Cardiac Tamponade: Effects On Splanchnic Vasoregulationmentioning

confidence: 52%

Effects of systemic arterial hypoperfusion on splanchnic hemodynamics and hepatic arterial buffer response in pigs

Jakob¹,

Tenhunen²,

Laitinen³

et al. 2001

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Third, the significant and sustained reduction of the aortic blood flow to 50% might have limited the potential compensatory increase of hepatic artery blood flow during PVBF reduction. We also cannot exclude the extensive surgical procedure and anesthesia, which could have induced significant changes in the hepatic artery buffer response as previously demonstrated by different experimental studies [15,17].…”

Section: Discussionmentioning

confidence: 91%

Hepatosplanchnic Vasoregulation and Oxygen Consumption During Selective Aortic Blood Flow Reduction and Reperfusion

Cruz

Garrido

Caly³

et al. 2011

Journal of Surgical Research

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“…The 30 -48% reduction in hepatic blood flow resulting from CPB will, in turn, cause a lower biliary excretion of vecuronium and necessitate a decrease in the infusion rate to maintain a suitable degree of muscle relaxation. [36][37][38] In addition to these physiological changes, hypothermia may also affect muscle relaxation by further altering vecuronium distribution/excretion pattern and by reducing acetylcholine release and/or muscle contractility. 39 During hypothermic CPB, vecuronium ceases to be a short-acting muscle relaxant and behaves like pancuronium.…”

Section: Resultsmentioning

confidence: 99%

Vecuronium pharmacokinetics and pharmacodynamics during hypothermic cardiopulmonary bypass in infants and children

Withington

Ménard

Harris

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To determine the effect of moderate and deep hypothermic cardiopulmonary bypass (CPB) on the pharmacokinetic and pharmacodynamic behaviour of vecuronium in infants and children. Methods:We studied 12 patients undergoing surgery for congenital heart disease under narcotic-nitrous oxide anesthesia. Neuromuscular blockade was maintained constant (T1 4-10% by Datex electromyograph) by adjusting a vecuronium infusion. Plasma vecuronium concentrations (Cpss) were analysed by HPLC to describe a pseudosteadystate during each of the pre-CPB, CPB and post-CPB phases. Paired arterial blood samples were taken 20 min apart after at least 20 min of constant infusion.Results: Nine cases were analysed, mean age 20 mo, mean weight 9 kg. Three patients had deep and six moderate hypothermia. In the pre-CPB phase Cpss fell into two groups (mean ± SD: 330 ± 42 ng·ml -1 ; 127 ± 27 ng·ml -1 ; P < 0.001); similarly the clearances showed a bimodal distribution (mean ± SD: 5.08 ± 0.94; 11.51 ± 0.2 ml·min -1 ·kg -1 P < 0.001), although in different patients. During CPB this bimodal distribution disappeared. Vecuronium infusion rate (VIR) decreased by 84% and 92% from pre-CPB to CPB phase in deep and moderate hypothermia groups respectively (P < 0.05), paralleled by decreases in Cpss of 36% (P > 0.05) and 52% (P < 0.05). Conclusion: Changes in vecuronium requirements and plasma concentrations during CPB demonstrate that vecuronium pharmacokinetics and pharmacodynamics are both affected by hypothermic CPB in infants. The finding of bimodal distributions for plasma vecuronium and vecuronium clearance highlights the need for individual monitoring of neuromuscular blockade in this age group.Objectif: Déterminer l'effet d'une circulation extracorporelle (CEC) avec hypothermie modérée ou profonde sur les paramètres pharmacocinétiques et pharmacodynamiques du vécuronium chez des nourrissons et des enfants.Méthode : Nous avons étudié 12 patients opérés pour cardiopathie congénitale sous anesthésie avec un mélange de narcotique et de protoxyde d'azote. Le blocage neuromusculaire a été maintenu constant (T1 4-10 % avec un élec-tromyographe Datex) en ajustant une perfusion de vécuronium. Les concentrations plasmatiques de vécuronium (Cpss) ont été analysées par chromatographie liquide haute performance (CLHP) afin de définir l'état pseudo-équilibre pendant chacune des étapes pré-CEC, CEC et post-CEC. Des échantillons appariés de sang artériel ont été prélevés à intervalles de 20 min, après au moins 20 min de perfusion constante.Résultats: Neuf cas ont été analysés, âgés de 20 ms et pesant 9 kg en moyenne. Trois patients avaient une hypothermie profonde et six, une modérée. Pendant la pré-CEC, les Cpss se séparent en deux groupes (moyenne ± écart type : 330 ± 42 ng·ml -1 ; 127 ± 27 ng·ml -1 ; P < 0,001); les clairances ont affiché une distribution bimodale (moyenne ± écart type : 5,08 ± 0,94; 11,51 ± 0,2 ml·min -1 ·kg -1 P < 0,001), chez différents patients cependant. Pendant la CEC, cette distribution bimodale a disparu. La vitesse de perfus...

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Influences of Cardiopulmonary Bypass and Fentanyl Anesthesia on Hepatic Circulation and Oxygen Metabolism in Beagles

Cited by 11 publications

References 15 publications

Effects of systemic arterial hypoperfusion on splanchnic hemodynamics and hepatic arterial buffer response in pigs

Effects of systemic arterial hypoperfusion on splanchnic hemodynamics and hepatic arterial buffer response in pigs

Hepatosplanchnic Vasoregulation and Oxygen Consumption During Selective Aortic Blood Flow Reduction and Reperfusion

Vecuronium pharmacokinetics and pharmacodynamics during hypothermic cardiopulmonary bypass in infants and children

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