Plasma Catecholamine and Cortisol Responses to Fentanyl-Oxygen Anesthesia for Coronary-Artery Operations

Stanley, T. H.; Berman, Lawrence S.; Green, O.; Robertson, David; Tinker, J. H.

doi:10.1097/00132586-198110000-00026

Cited by 40 publications

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“…When PLA2 acts upon lipids containing arachidonic acid in the sn-2 position the resulting free arachidonic acid can serve as a substrate for cyclooxygenases and lipoxygenases. Platelet damage or excess secretion of humoral factors such as catecholamines or angiotensin II during cardiac surgery (14)(15)(16) has been implicated in the elevation of cellular PLA2 activity. Complement activation during CPB (17) causes chemotaxis and leukosequestration, together with the production of oxygen free-radicals by neutrophils, which is thought to affect PLA2 activity (18).…”

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confidence: 99%

“…For CPB, a bubble oxygenator and nonpulsatile flow pump were used and systemic hypothermia (24°C) was maintained. 10 serial measurements were performed as follows: period 1, Control: after placement of monitoring catheters before induction of anesthesia; period 2, Anesthesia: 10 min after induction of anesthesia before incision; period 3, Before heparin: after incision, before heparin administration; period 4: 5 min after heparin administration (300 U/kg intravenously); periods 5-7: at 15,30, and 60 min on CPB, respectively; period 8: Before protamine administration; period 9: 5 min after protamine administration (3 mg/kg); and period 10: at the end of the operation. At each point, hemodynamic determinations and arterial blood gas measurements were performed.…”

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confidence: 99%

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Heparin-enhanced plasma phospholipase A2 activity and prostacyclin synthesis in patients undergoing cardiac surgery.

Nakamura

Kim²,

Philbin³

et al. 1995

J. Clin. Invest.

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Although eicosanoid production contributes to physiological and pathophysiological consequences of cardiopulmonary bypass (CPB), the mechanisms accounting for the enhanced eicosanoid production have not been defined. Plasma phospholipase A2 (PLA2) activity, 6-keto-prostaglandin Fla (6-keto-PGF1,), and thromboxane B2 (TXB2) levels were measured at various times during cardiac surgery. Plasma PLA2 activity increased after systemic heparinization, before CPB. This was highly correlated with concurrent increases in plasma 6-keto-PGF,.. TXB2 concentrations did not increase with heparin administration but did increase significantly after initiation of CPB. High plasma PLA2 activity, 6-keto-PGF,., and TXB2 concentrations were measured throughout the CPB period. Protamine, administered to neutralize the heparin, caused an acute reduction of both plasma PLA2 activity and plasma 6-keto-PGF1,r, but no change in plasma TXB2 concentrations. Thus the ratio of TXB2 to 6-keto-PGFia increased significantly after protamine administration. Enhanced plasma PLA2 activity was also measured in patients with lower doses of heparin used clinically for nonsurgical applications. Human plasma PLA2 was identified as group II PLA2 by its sensitivity to deoxycholate and dithiothreitol, its substrate specificity, and its elution characteristics on heparin affinity chromatography.Heparin addition to PMNs in vitro resulted in dose-dependent increases in cellular PLA2 activity and release of PLA2. The PLA2 released from the PMN had characteristics similar to those of post-heparin plasma PLA2.In conclusion, plasma PLA2 activity and 6-keto-PGF1, concentrations are markedly enhanced with systemic heparinization. Part of the anticoagulant and vasodilating effects of heparin may be due to increased plasma prostacyclin (PGI2) levels. In addition the pulmonary vasoconstriction sometimes associated with protamine infusion during car- diac surgery might be due to decreased plasma PLA2 activity, with an associated increased TXB2I6-keto-PGFia ratio.(J. Clin. Invest. 1995Invest. . 95:1062Invest. -1070

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confidence: 99%

mentioning

confidence: 99%

Heparin-enhanced plasma phospholipase A2 activity and prostacyclin synthesis in patients undergoing cardiac surgery.

Nakamura

Kim²,

Philbin³

et al. 1995

J. Clin. Invest.

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“…Although triggering drugs and calcium salts can be avoided, the stress response to CPB can be considerable, resulting in significant elevation of stress-related hormones (endogenous cortisol and catecholamines). 13 The use of a technique with pancuronium and "high dose fentanyl ''13 would appear to offer the advantage of a reduced endogenous catechol response to CPB.…”

Section: Discussionmentioning

confidence: 99%

Management of a malignant hyperthermia patient during cardiopulmonary bypass

Byrick

Rose

Ranganathan

1982

Canad. Anaesth. Soc. J.

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The anaesthetic management of cardiopulmonary bypass (CPB) for a patient with biopsy-proven malignant hyperthermia is reported. Specific changes in the technique used, such as venting the oxygenator before use, monitoring mixed venous Po: and Pco2, as well as the safety of cold hyperkalaemic cardioplegia are described. Controversial aspects of malignant hypet~hermia management such as the safety of calcium and catechol inotropes are discussed in relationship to the successful use of eardio-pulmonary bypass in our patient. We chose to treat left ventricular dysfunction by aggressive vasodilator (nitroglycerine) therapy. We detected no myocardial or respiratory depression secondary to dantrolene therapy either before or after operation.KEY WORDS" CARDIAC SURGERY, COMPLICATIONS, malignant hyperthermia.MALIGNANT HYPERTHERMIA (MH) is a pharmacogenetic myopathy I involving both skeletal 2 and cardiac muscle. 3 Affected patients are susceptible to acute hyperthermia and/or myotonic reactions triggered by several specific drugs, potent inhalational anaesthetics, some muscle relaxants, and the amide type of local anaesthetics. Reactions can be aggravated by sympathomimetics, parasympatholytics, cardiac glycosides and calcium salts. 4 Stressful environmental situations such as high temperatures, infections, muscle injury, exercise and emotional excitement may also precipitate a reaction. The pathophysiology of the hyperthermic crisis has been investigated and recently reviewed.4 The clinical and laboratory findings of human and porcine MH support the theory that the control of myoplasmic ionized calcium levels is lost, causing an increase in aerobic and anaerobic metabolism which characterizes the respiratory and metabolic acidosis of this syndrome.The purpose of this report is to outline the anaesthetic implications in a patient with MH and coronary artery disease requiring cardio- CASE REPORTA 54 year old male who had incapacitating angina at rest (Canadian Cardiovascular Society Class IV) 6 despite medical therapy (propranolal 160 mg/day) was admitted for coronary arteriography and elective triple aortocoronary bypass grafting. This patient had a strong family history of hyperthermic anaesthetic catastrophes and previously had been studied by muscle biopsy. The result 7 of both the caffeine contracture test and the ATP depletion test on the muscle biopsy specimen confirmed the diagnosis of MH.Cardiac catheterization was done using procaine for local anaesthesia while the patient was sedated with diazepam given intravenously. Temperature, electrocardiogram and arterial pressure were recorded continuously and precautions were taken to prevent and, if necessary, to treat an MH crisis during the heart catheterization. The selective coronary arteriograms showed severe triple vessel coronary artery disease including a lesion (>90 per cent occlusion) of the left main and right coronary artery. Left ventricular end diastolic pressure was 1.46 kPa (11 mm Hg) and the left ventricular ejection fraction was 67 per cent. T...

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“…Increase of plasma catecholamines during extracorporeal circulation in adults has been reported during anaesthesia with nitrous 1 oxide-thio!~entone-gallamine, diethyl 4 4-7 ether, 2 halothane, enflurane, morphine, neurotept anaesthesia 7'8 and massive doses of fentanyl. 9 Others have reported that there was no increase in plasma catecholamine concentrations during extracorporeal circulation in adults anaesthetized with halothane, 2 neurolept anaes-14 thesia and phenoperidine or fentanyl combined with less than 0.5 per cent halothane, t5 However, little is known about catecholamine responses to extracorporeal circulation in children.…”

Section: Discussionmentioning

confidence: 99%

Plasma catecholamine levels during extracorporeal circulation in children

Yamashita

Wakayama

Matsuki

et al. 1982

Canad. Anaesth. Soc. J.

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Plasma adrenaline and noradrenaline concentrations have been measured in nine children undergoing cardiac operations involving extracorporeal circulation under neuroleptanaesthesia.Compared to control values, plasma adrenaline increased 34-fold and noradrenaline, 2.2-fold during extracorporeal circulation.The increase in plasma catecholamines reported in adults has been confirmed in these children and changes in plasma adrenaline concentrations during extracorporeal circulation were found to be much greater in paediatric patients.

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Plasma Catecholamine and Cortisol Responses to Fentanyl-Oxygen Anesthesia for Coronary-Artery Operations

Cited by 40 publications

References 0 publications

Heparin-enhanced plasma phospholipase A2 activity and prostacyclin synthesis in patients undergoing cardiac surgery.

Heparin-enhanced plasma phospholipase A2 activity and prostacyclin synthesis in patients undergoing cardiac surgery.

Management of a malignant hyperthermia patient during cardiopulmonary bypass

Plasma catecholamine levels during extracorporeal circulation in children

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