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Hopster K, Wittenberg-Voges L, Geburek F, Hopster-Iversen C, Kästner SBR. Effects of controlled hypoxemia or hypovolemia on global and intestinal oxygenation and perfusion in isoflurane anesthetized horses receiving an alpha-2-agonist infusion. BMC Vet Res 2017; 13:361. [PMID: 29183321 PMCID: PMC5706348 DOI: 10.1186/s12917-017-1265-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/09/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Aim of this prospective experimental study was to assess effects of systemic hypoxemia and hypovolemia on global and gastrointestinal oxygenation and perfusion in anesthetized horses. Therefore, we anesthetized twelve systemically healthy warmblood horses using either xylazine or dexmedetomidine for premedication and midazolam and ketamine for induction. Anesthesia was maintained using isoflurane in oxygen with either xylazine or dexmedetomidine and horses were ventilated to normocapnia. During part A arterial oxygen saturation (SaO2) was reduced by reducing inspiratory oxygen fraction in steps of 5%. In part B hypovolemia was induced by controlled arterial exsanguination via roller pump (rate: 38 ml/kg/h). Mean arterial blood pressure (MAP), heart rate, pulmonary artery pressure, arterial and central venous blood gases and cardiac output were measured, cardiac index (CI) was calculated. Intestinal microperfusion and oxygenation were measured using laser Doppler flowmetry and white-light spectrophotometry. Surface probes were placed via median laparotomy on the stomach, jejunum and colon. RESULTS Part A: Reduction in arterial oxygenation resulted in a sigmoid decrease in central venous oxygen partial pressure. At SaO2 < 80% no further decrease in central venous oxygen partial pressure occurred. Intestinal oxygenation remained unchanged until SaO2 of 80% and then decreased. Heart rate and pulmonary artery pressure increased significantly during hypoxemia. Part B: Progressive reduction in circulating blood volume resulted in a linear decrease in MAP and CI. Intestinal perfusion was preserved until blood loss resulted in MAP and CI lower 51 ± 5 mmHg and 40 ± 3 mL/kg/min, respectively, and then decreased rapidly. CONCLUSIONS Under isoflurane, intestinal tissue oxygenation remained at baseline when arterial oxygenation exceeded 80% and intestinal perfusion remained at baseline when MAP exceeded 51 mmHg and CI exceeded 40 mL/kg/min in this group of horses. TRIAL REGISTRY NUMBER 33.14-42,502-04-14/1547.
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Affiliation(s)
- Klaus Hopster
- Equine Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hanover, Germany.
- Department of Clinical Studies-NBC, School of Veterinary Medicine, University of Pennsylvania, 382 West Street Road, Kennett Square, PA, 19348, USA.
| | - Liza Wittenberg-Voges
- Equine Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hanover, Germany
| | - Florian Geburek
- Equine Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hanover, Germany
| | - Charlotte Hopster-Iversen
- Equine Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hanover, Germany
| | - Sabine B R Kästner
- Equine Clinic, University of Veterinary Medicine Hanover, Foundation, Bünteweg 9, D-30559, Hanover, Germany
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Ter Horst EN, Krijnen PAJ, Flecknell P, Meyer KW, Kramer K, van der Laan AM, Piek JJ, Niessen HWM. Sufentanil-medetomidine anaesthesia compared with fentanyl/fluanisone-midazolam is associated with fewer ventricular arrhythmias and death during experimental myocardial infarction in rats and limits infarct size following reperfusion. Lab Anim 2017; 52:271-279. [PMID: 28776458 PMCID: PMC5967036 DOI: 10.1177/0023677217724485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
To improve infarct healing following myocardial infarction in humans, therapeutic interventions can be applied during the inflammatory response. Animal models are widely used to study this process. However, induction of MI in rodents is associated with high mortality due to ventricular fibrillation (VF) during coronary artery ligation. The anaesthetic agent used during the procedure appears to influence the frequency of this complication. In this retrospective study, the effect on ventricular arrhythmia incidence during ligation and infarct size following in vivo reperfusion of two anaesthetic regimens, sufentanil–medetomidine (SM) and fentanyl/fluanisone–midazolam (FFM) was evaluated in rats. Anaesthetics were administered subcutaneously using fentanyl/fluanisone (0.5 mL/kg) with midazolam (5 mg/kg) (FFM group, n = 48) or sufentanil (0.05 mg/kg) with medetomidine (0.15 mg/kg) (SM group, n = 47). The coronary artery was ligated for 40 min to induce MI. Heart rate and ventricular arrhythmias were recorded during ligation, and infarct size was measured via histochemistry after three days of reperfusion. In the SM group, heart rate and VF incidence were lower throughout the experiment compared with the FFM group (6% versus 30%) (P < 0.01). Fatal VF did not occur in the SM group whereas this occurred in 25% of the animals in the FFM group. Additionally, after three days of reperfusion, the infarcted area following SM anaesthesia was less than half as large as that following FFM anaesthesia (8.5 ± 6.4% versus 20.7 ± 5.6%) (P < 0.01). Therefore, to minimize the possibility of complications related to VF and acute death arising during ligation, SM anaesthesia is recommended for experimental MI in rats.
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Affiliation(s)
- Ellis N Ter Horst
- 1 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.,2 Netherlands Heart Institute, Utrecht, The Netherlands.,3 Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands.,4 Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Paul A J Krijnen
- 3 Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands.,4 Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Paul Flecknell
- 5 Comparative Biology Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Klaas W Meyer
- 6 Amsterdam Animal Research Centre, VU University, Amsterdam, The Netherlands
| | - Klaas Kramer
- 6 Amsterdam Animal Research Centre, VU University, Amsterdam, The Netherlands
| | - Anja M van der Laan
- 1 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jan J Piek
- 1 Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Hans W M Niessen
- 3 Institute for Cardiovascular Research (ICaR-VU), VU University Medical Centre, Amsterdam, The Netherlands.,4 Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.,7 Department of Cardiac Surgery, VU University, Amsterdam, The Netherlands
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Hodgson E. Perioperative cardiac care - not just systolic. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2014.10844565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- E Hodgson
- Anaesthesia, Inkosi Albert Luthuli Central Hospital
- Department of Anaesthesia, Nelson R Mandela School of Medicine, Durban
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Ibacache M, Sanchez G, Pedrozo Z, Galvez F, Humeres C, Echevarria G, Duaso J, Hassi M, Garcia L, Díaz-Araya G, Lavandero S. Dexmedetomidine preconditioning activates pro-survival kinases and attenuates regional ischemia/reperfusion injury in rat heart. Biochim Biophys Acta Mol Basis Dis 2011; 1822:537-45. [PMID: 22230708 DOI: 10.1016/j.bbadis.2011.12.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 11/15/2011] [Accepted: 12/22/2011] [Indexed: 11/29/2022]
Abstract
Pharmacological preconditioning limits myocardial infarct size after ischemia/reperfusion. Dexmedetomidine is an α(2)-adrenergic receptor agonist used in anesthesia that may have cardioprotective properties against ischemia/reperfusion injury. We investigate whether dexmedetomidine administration activates cardiac survival kinases and induces cardioprotection against regional ischemia/reperfusion injury. In in vivo and ex vivo models, rat hearts were subjected to 30 min of regional ischemia followed by 120 min of reperfusion with dexmedetomidine before ischemia. The α(2)-adrenergic receptor antagonist yohimbine was also given before ischemia, alone or with dexmedetomidine. Erk1/2, Akt and eNOS phosphorylations were determined before ischemia/reperfusion. Cardioprotection after regional ischemia/reperfusion was assessed from infarct size measurement and ventricular function recovery. Localization of α(2)-adrenergic receptors in cardiac tissue was also assessed. Dexmedetomidine preconditioning increased levels of phosphorylated Erk1/2, Akt and eNOS forms before ischemia/reperfusion; being significantly reversed by yohimbine in both models. Dexmedetomidine preconditioning (in vivo model) and peri-insult protection (ex vivo model) significantly reduced myocardial infarction size, improved functional recovery and yohimbine abolished dexmedetomidine-induced cardioprotection in both models. The phosphatidylinositol 3-kinase inhibitor LY-294002 reversed myocardial infarction size reduction induced by dexmedetomidine preconditioning. The three isotypes of α(2)-adrenergic receptors were detected in the whole cardiac tissue whereas only the subtypes 2A and 2C were observed in isolated rat adult cardiomyocytes. These results show that dexmedetomidine preconditioning and dexmedetomidine peri-insult administration produce cardioprotection against regional ischemia/reperfusion injury, which is mediated by the activation of pro-survival kinases after cardiac α(2)-adrenergic receptor stimulation.
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Affiliation(s)
- Mauricio Ibacache
- Division de Anestesiologia, Facultad Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Affiliation(s)
- Giora Landesberg
- Department of Anesthesiology and C.C.M., Hebrew University, Hadassah Medical Center, Jerusalem, Israel 91120
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New practice guidelines for perioperative beta blockade from the United States and Europe: incremental progress or a necessary evil? Can J Anaesth 2010; 57:301-12. [DOI: 10.1007/s12630-010-9273-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
PURPOSE OF REVIEW Perioperative cardiac complications remain a major area of concern as our surgical population increases in volume, age and frequency of comorbidity. A variety of strategies can be used to optimize patients and potentially reduce the incidence of these serious complications. RECENT FINDINGS Recent literature suggests a trend towards less invasive testing for detection and quantification of coronary artery disease and greater interest in pharmacologic 'cardioprotection' using beta-blockers, statins and other agents targeting heart rate control and other mechanisms (e.g. reducing inflammatory responses). The recent Perioperative Ischemic Evaluation study has substantially altered this approach at least towards widespread application to lower/intermediate risk cohorts. Considerable attention has been focused on ensuring optimal standardized perioperative management of patients with a recent percutaneous coronary intervention, particularly those with an intracoronary stent. Widespread surveillance of postoperative troponin release and increasing recognition of the prognostic potential of elevated preoperative brain natriuretic peptides point towards changing strategies for long-term risk stratification. SUMMARY The complexity of a particular patient's physiologic responses to a wide variety of surgical procedures, which are undergoing constant technological refinement generally associated with lesser degrees of invasivity and stress make calculation of patients' perioperative risk very challenging. At the present time, adequate information is available for the clinician to screen patients with high-risk preoperative predictors, delay elective surgery for patients with recent intracoronary stents and continue chronic beta-blockade in appropriate patients. New large-scale database and subanalyses of major trials (e.g. Perioperative Ischemic Evaluation and Coronary Artery Revascularization Prophylaxis) should provide additional information to minimize perioperative cardiac risk.
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