Sympathetic Nervous System Tonicity and Post‐Coronary Artery Bypass Hypertension

Pratilas, Vasilios; Pratija, M. G.; Vlachakis, Nicolas D.; Owitz, Sidney; Dimich, Ivan

doi:10.1111/j.1399-6576.1980.tb01508.x

Cited by 17 publications

(1 citation statement)

References 15 publications

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“…The suggestion by Prys-Roberts [4] that 'sympathetic nervous activation induced either by anaesthetic manoeuvres or by surgical stimulation may lead to reflex cardiovascular responses which, by increasing myocardial oxygen demand, lead to episodes of myocardial ischaemia' was later substantiated by the work of Pratilas and colleagues [5] and Slogoff and Keats [6] in patients undergoing elective coronary artery bypass grafting (CABG). Additional clinical research by Mangano and colleagues [7] established that cardiac risk arising from intraoperative myocardial ischaemia applied to patients (or at least to men, as no women participated in this study) with, or at high risk for, myocardial infarction (MI), particularly when they were undergoing non-cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

Aantaa

Jalonen

2006

European Journal of Anaesthesiology

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The centrally acting alpha2-adrenoceptor agonists clonidine and dexmedetomidine have been used with success to provide haemodynamic stability for patients undergoing surgery. Particularly in the case of patients with overt or underlying cardiac disease the actions of alpha2-adrenoceptor agonists, which include maintenance of stable systemic blood pressure and low heart rate and a reduction in overall oxygen consumption, can be expected to reduce the risk of procedure-related cardiac events. This expectation has been corroborated in clinical trials with clonidine, dexmedetomidine and mivazerol and meta-analyses; additional large controlled trials would be instructive in establishing a robust estimate of the scale of the benefit. In addition, alpha2-adrenoceptor agonists used as premedication have been shown to substantially reduce anaesthetic requirements among surgical patients, and the use of these agents has been associated with a reduced risk of postoperative delirium, which may be expected to improve considerably the postoperative course for at-risk patients. Dexmedetomidine is the only alpha2-adrenoceptor agonist currently approved for use in the intensive care unit. A distinctive feature of dexmedetomidine in that setting is that in addition to haemodynamic stability it confers a distinctive and advantageous quality of sedation: patients are tranquil but responsive to requests from attending staff. This review examines the pharmacological principles underlying the use of alpha2-adrenoceptor agonists as adjuncts to surgery and clinical experience in that indication.

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Section: Introductionmentioning

confidence: 99%

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

Aantaa

Jalonen

2006

European Journal of Anaesthesiology

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α₂‐Agonisten in Anästhesie und Intensivmedizin

Tonner

Paris

2011

Pharmazie in unserer Zeit

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Abstractα2‐Agonisten spielen heute eine wichtige Rolle in der Anästhesie und Intensivmedizin. Bei sachgemäßem Einsatz sind die Nebenwirkungen substanzspezifisch und vorhersehbar. Die Kombination aus sedierenden und analgetischen Eigenschaften bei gleichzeitig fehlender Atemdepression und Glättung des hämodynamischen Profils durch sympatholytische Eigenschaften machen dies Substanzklasse heute zu einer wichtigen Bereicherung des pharmakologischen Armamentariums in der Anästhesie und Intensivmedizin.

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Pathophysiology of hypertension following coronary artery bypass surgery: An experimental dog model for postoperative hypertension

1985

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Immediate postoperative hypertension has been reported to occur during the first 3-6 h in 30%-75% of patients who have undergone aortocoronary bypass operations. Although some causes and potential predisposing factors of this type of hypertension have been cited, the mechanisms involved still remain unclear. Some studies have implicated the involvement of nerve reflexes originating from the heart, great vessels, and coronary arteries, but they do not explain the exact role of such impulses. The paucity of data in humans is, needless to say, due primarily to the invasive nature of the experimental procedure. To further our knowledge on the involvement of nerve reflexes as a factor in initiating immediate postoperative hypertension, we used a dog model and devised a modified form of surgery by inserting a soft catheter into the left coronary artery to form a stenosis; we measured several factors usually involved in hypertension. We succeeded in performing this modified form of surgery in 10 of 81 dogs. Our model showed that the mean aortic pressure significantly increased from 81 +/- 5.5 to 102 +/- 7.0 mmHg (P less than 0.05), systemic vascular resistance from 7604 +/- 833 to 9648 +/- 1101 dyn.s.cm-5 (P less than 0.05), and plasma noradrenaline levels from 0.45 +/- 0.092 to 0.51 +/- 0.087 ng/ml (P less than 0.01) immediately after restoration of blood flow to the distal area behind the stenosis. These dynamic and humoral characteristics are similar to ones documented in current clinical reports. To our knowledge, this is the first experimental animal model of hypertension after coronary artery bypass graft surgery.

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Sympathetic Nervous System Tonicity and Post‐Coronary Artery Bypass Hypertension

Cited by 17 publications

References 15 publications

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

α₂‐Agonisten in Anästhesie und Intensivmedizin

Pathophysiology of hypertension following coronary artery bypass surgery: An experimental dog model for postoperative hypertension

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Sympathetic Nervous System Tonicity and Post‐Coronary Artery Bypass Hypertension

Cited by 17 publications

References 15 publications

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

Perioperative use of α2-adrenoceptor agonists and the cardiac patient

α2‐Agonisten in Anästhesie und Intensivmedizin

Pathophysiology of hypertension following coronary artery bypass surgery: An experimental dog model for postoperative hypertension

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Product

Resources

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α₂‐Agonisten in Anästhesie und Intensivmedizin