Abstract
Background:
Adequate gastrointestinal mucosa oxygenation appears to be significant for the prevention and treatment of sepsis and multiorgan failure [1]. Adrenaline (ADR) and noradrenaline (NOR) are used for perioperative hemodynamic stabilization. Unclear, however, are the per se effects of ADR and NOR on the microvascular hemoglobin oxygenation of the gastric mucosa (HbO2). The effects of ADR and NOR may depend on this of the anesthetic used. Therefore, we investigated the effects of ADR and NOR under sevoflurane (SEVO) or propofol- (PROPO) anesthesia on the regional HbO2 and the systemic O2 transport (DO2).
Material & Methods:
Chronically instrumented dogs (24 experiments, 27-35 kg, approved by animal protection commission) were repeatedly anesthetized (randomized with SEVO or PROPO), were ventilated, and were randomized NOR or ADR (0 / 0.05 / 0.1 / 0.2 g / kg / min). The measured values were HbO2 (spectrophotometry) and the DO2 [2].
Statistics:
Data are expressed as mean ± sem, ANOVA, Fisher PLSD; P <0.05.
Results:
Under SEVO, NOR significantly increased the HbO2 of 55 ± 1 to 67 ± 2%, and DO2 (from 12 ± 1 to 20 ± 2 ml / kg / Min). In contrast, ADR could not increase HbO2 (57 ± 1 vs. 57 ± 2%), despite a marked increase in DO2 (from 12 ± 1)
to 27 ± 3 ml / kg / min). In contrast to these significant and contrasting effects under SEVO, under PROPO none of catecholamines significantly alter HbO2: both ADR as well as NOR (in all dosages) the HbO2 stably held up (ADR: 58 ± 2 vs. 58 ± 3%, NOR: 56 ± 2 vs. 57 ± 3%). However, as under SEVO, doubled ADR also under PROPO the DO2 (From 16 ± 1 to 33 ± 2 ml / kg / min), whereas in turn NOR the DO2 only slightly changed (from 16 ± 1 to 19 ± 1 ml / kg / min).
Conclusions:
Regional effects of NOR and ADR depend on the used anesthetic, so to say SEVO or PROPO. This increases NOR, but not ADR, the HbO2 under SEVO, wohingegen both catecholamines cause no increase in HbO2 under PROPO.
When our data are transferred to the clinical situation, NOR appears to be appropriate to (depending on, for example, the anesthetic) the gastric mucosa oxygenation or even to increase.
References:
[1] Schwarte LA, Stevens M, Ince C, Vincent JL (ed)Yearbook of Intensive Care and Emergency Medicine 2006; 627–640.
[2] Schwarte LA, Picker O, Bornstein SR et al: Crit Care Med2005; 33:135–142
Adequate gastrointestinal mucosa oxygenation appears to be significant for the prevention and treatment of sepsis and multiorgan failure [1]. Adrenaline (ADR) and noradrenaline (NOR) are used for perioperative hemodynamic stabilization. Unclear, however, are the per se effects of ADR and NOR on the microvascular hemoglobin oxygenation of the gastric mucosa (HbO2). The effects of ADR and NOR may depend on this of the anesthetic used. Therefore, we investigated the effects of ADR and NOR under sevoflurane (SEVO) or propofol- (PROPO) anesthesia on the regional HbO2 and the systemic O2 transport (DO2).
Material & Methods:
Chronically instrumented dogs (24 experiments, 27-35 kg, approved by animal protection commission) were repeatedly anesthetized (randomized with SEVO or PROPO), were ventilated, and were randomized NOR or ADR (0 / 0.05 / 0.1 / 0.2 g / kg / min). The measured values were HbO2 (spectrophotometry) and the DO2 [2].
Statistics:
Data are expressed as mean ± sem, ANOVA, Fisher PLSD; P <0.05.
Results:
Under SEVO, NOR significantly increased the HbO2 of 55 ± 1 to 67 ± 2%, and DO2 (from 12 ± 1 to 20 ± 2 ml / kg / Min). In contrast, ADR could not increase HbO2 (57 ± 1 vs. 57 ± 2%), despite a marked increase in DO2 (from 12 ± 1)
to 27 ± 3 ml / kg / min). In contrast to these significant and contrasting effects under SEVO, under PROPO none of catecholamines significantly alter HbO2: both ADR as well as NOR (in all dosages) the HbO2 stably held up (ADR: 58 ± 2 vs. 58 ± 3%, NOR: 56 ± 2 vs. 57 ± 3%). However, as under SEVO, doubled ADR also under PROPO the DO2 (From 16 ± 1 to 33 ± 2 ml / kg / min), whereas in turn NOR the DO2 only slightly changed (from 16 ± 1 to 19 ± 1 ml / kg / min).
Conclusions:
Regional effects of NOR and ADR depend on the used anesthetic, so to say SEVO or PROPO. This increases NOR, but not ADR, the HbO2 under SEVO, wohingegen both catecholamines cause no increase in HbO2 under PROPO.
When our data are transferred to the clinical situation, NOR appears to be appropriate to (depending on, for example, the anesthetic) the gastric mucosa oxygenation or even to increase.
References:
[1] Schwarte LA, Stevens M, Ince C, Vincent JL (ed)Yearbook of Intensive Care and Emergency Medicine 2006; 627–640.
[2] Schwarte LA, Picker O, Bornstein SR et al: Crit Care Med2005; 33:135–142
| Translated title of the contribution | Dependence of the effects of noradrenaline and adrenaline on the microvascular mucosa oxygenation of the anesthetic used (sevoflurane vs. propofol) |
|---|---|
| Original language | German |
| Article number | I:61 |
| Journal | Intensivmedizin und Notfallmedizin |
| Volume | 45 |
| Issue number | Supplement 1 |
| Publication status | Published - 5-Dec-2008 |
| Event | Deutscher Interdisziplinärer Kongress für Intensiv- und Notfallmedizin (DIVI 2008) - Hamburg, Germany Duration: 3-Dec-2008 → 6-Dec-2008 Conference number: 9 |