Anesthetic actions on cardiovascular control mechanisms in the central nervous system

An Experimental-Computational Study of Catheter Induced Alterations in Pulse Wave Velocity in Anesthetized Mice

Computational methods for solving problems of fluid dynamics and fluid-solid-interactions have advanced to the point that they enable reliable estimates of many hemodynamic quantities, including those important for studying vascular mechanobiology or designing medical devices. In this paper, we use a customized version of the open source code SimVascular to develop a computational model of central artery hemodynamics in anesthetized mice that is informed with experimental data on regional geometries, blood flows and pressures, and biaxial wall properties. After validating a baseline model against available data, we then use the model to investigate the effects of commercially available catheters on the very parameters that they are designed to measure, namely, murine blood pressure and (pressure) pulse wave velocity (PWV). We found that a combination of two small profile catheters designed to measure pressure simultaneously in the ascending aorta and femoral artery increased the PWV due to an overall increase in pressure within the arterial system. Conversely, a larger profile dual-sensor pressure catheter inserted through a carotid artery into the descending thoracic aorta decreased the PWV due to an overall decrease in pressure. In both cases, similar reductions in cardiac output were observed due to increased peripheral vascular resistance. As might be expected, therefore, invasive transducers can alter the very quantities that are designed to measure, yet advanced computational models offer a unique method to evaluate or augment such measurements.

Effects of General Anesthetics on Regulation of the Peripheral Vasculature

The heart is a passively filling pump in a circulatory system that is connected in series with distensible blood vessels. Therefore, systemic blood pressure and tissue perfusion depend upon adequate peripheral vascular tone as well as myocardial function. Likewise, pharmacologic agents that alter circulatory stability can affect one or both of these components. The generalized depressor effects of general anesthetics have been well known clinically for over 50 years. Moreover, there are many similarities in basic cellular regulatory mechanisms among the different tissue types, and general anesthetics are well known to distribute freely among the perfusion-rich tissues (eg, central nervous system, cardiovascular system, and renal system). Therefore, it is likely that the hemodynamic depression resulting from the systemic administration of anesthetics results from actions on regulatory mechanisms of the peripheral vasculature as well as on the heart. The peripheral vasculature is regulated by extrinsic neural, endothelial, and humoral mechanisms, which interact with each other as well as with intrinsic membrane and intracellular systems within the vascular smooth muscle cell. Different general anesthetics have been found to act on specific mechanisms at each of these levels. However, the large number and complexity of these known mechanisms, as well as the many anesthetic agents, has made it extremely difficult to determine which are significant in terms of the meaningful mechanisms that are responsible for anesthetic action, major side effects, or both. Current knowledge about the effects of general anesthetics on both the extrinsic intrinsic regulatory mechanisms of peripheral vascular control is reviewed.

Pretreatment with dexmedetomidine: altered indices of anesthetic depth for halothane in the neuraxis of cats

The sedative and anesthetic-sparing ability of the alpha2-adrenergic agonist dexmedetomidine is well documented. In this study, we identified the effects of halothane, with and without dexmedetomidine, on hemodynamic and electroencephalographic (EEG) variables and quantified the concentration of halothane resulting in various anesthetic depth indices mediated through the central nervous system (CNS) in chronically instrumented cats. Halothane was given alone or after dexmedetomidine (15 microg/kg p.o.). In both groups, four indices of anesthetic depth--minimum alveolar anesthetic concentration (MAC; no movement to noxious stimuli), MAC(BAR) (no autonomic response to noxious stimuli), MAC(BS) (EEG burst suppression), and MAC(ISOELECTRIC) (EEG isoelectricity)--were determined. Halothane decreased arterial blood pressure, heart rate, and higher frequency components of the EEG before the onset of burst suppression and isoelectricity. Dexmedetomidine pretreatment augmented the actions of halothane on arterial pressure, heart rate, and the EEG. Dexmedetomidine reduced the halothane concentrations resulting in MAC (from 1.22% +/- 0.06% to 0.89% +/- 0.08%) and MAC(BAR) (from 1.81% +/- 0.05% to 1.1% +/- 0.10%), but not those resulting in MAC(BS) (3.01% +/- 0.17% vs 3.14% +/- 0.10%) or MAC(ISOELECTRIC) (4.39% +/- 0.26% vs 4.65% +/- 0.12%). These results suggest that dexmedetomidine does not alter various CNS-mediated indices of anesthetic action to equivalent degrees and that there are dissimilar degrees of an anesthetic-sparing action at different levels of the neuraxis.

IMPLICATIONS

The anesthetic adjuvant dexmedetomidine seems to differentially alter central nervous system-mediated indices of anesthetic action. Lower brainstem or spinal determinants of anesthetic depth (movement and hemodynamic responses) are more attenuated than those of higher brain functions, such as the electroencephalogram.