The adverse effects of indigo carmine

A case of diencephalic dysregulation is reported during urological endoscopy following the intravenous administration of indigo carmine. It should be kept in mind that according to the literature, indigo carmine has severe side-effects on the cardiovascular system caused by vasoconstriction. Ergotamine-like effects of indigo carmine due to direct vasoconstriction with spasm of the cerebral arteries are discussed.     

The effect of intravenous indigo carmine on near-infrared cerebral oximetry

The effects of IV-administered dyes on pulse oximetry have been well described. However, the effects on near-infrared cerebral oximetry have not been well documented. We report a series of four patients undergoing radical prostatectomy who were monitored with cerebral oximetry during surgery. After the administration of indigo carmine, intraoperative desaturations were observed for an extended period. Because clinical use of near-infrared cerebral oximetry is increasing, anesthesiologists should be aware of this issue.     

Acute hemodynamic effects of lumbar sympathectomy

Lumbar sympathectomy increases total limb blood flow after aortofemoral bypass in a high percentage of cases. This was true in eleven of fourteen extremities (78.6 per cent) in our series even though no specific selection criteria for entry into the study, other than the need for aortofemoral bypass, were used: that is, patients were entered into the study irrespective of preoperative ankle/arm pressure indexes or results of hyperemia testing. Overall, flow rates after sympathectomy was added to aortofemoral bypass were 1.55 times greater than after aortofemoral bypass alone. This degree of augmentation of flow may be important, particularly in cases of limited outflow.     

Acute hemodynamic effects of pericardial closure in man

The acute hemodynamic effects of pericardial closure were studied in 30 patients with normal left ventricular function, who were undergoing coronary artery bypass surgery. Closure of the pericardium resulted in decreases in arterial blood pressure (P less than 0.01), cardiac index (P less than 0.001), mean right atrial (P less than 0.001), mean pulmonary artery (P less than 0.001) and pulmonary capillary wedge pressure (P less than 0.001). The observed hemodynamic changes are probably caused by a change in the ventricular pressure-volume relationships.     

Pulse dye densitometry using indigo carmine is useful for cardiac output measurement, but not for circulating blood volume measurement

BACKGROUND AND OBJECTIVE: We evaluated the validity of a newly developed pulse dye densitometer for indigo carmine for measuring cardiac output and circulating blood volume. METHODS: Measurements of cardiac output and circulating blood volume were performed with the indigo carmine densitometer during normovolaemia, hypovolaemia and hypervolaemia in nine mongrel dogs under general anaesthesia. The validity was evaluated by comparison of the values of cardiac output and circulating blood volume obtained by the thermodilution technique and the 51Cr-labelled red blood cell method, respectively. We also examined indigo carmine removal by continuous veno-venous haemofiltration after indigo carmine injection. RESULTS: There was good agreement between dye densitometer- and thermodilution-derived cardiac output (r = 0.885, P < 0.001). The bias and limits of agreement of these values were 0.09 and+/-1.07 L min(-1) (2 SD, n 22), respectively. The dye-densitometer-derived circulating blood volume was greater than that of the 51Cr-labelled red blood cell method, and both values showed weak agreement (r = 0.587, P < 0.027). The sieving coefficient of indigo carmine through continuous veno-venous haemofiltration was 0.34+/-0.06. CONCLUSIONS: These data indicate that indigo carmine densitometry is a reliable method for cardiac output determination, but it overestimates circulating blood volume, probably due to the transition of indigo carmine into the extravascular space in the systemic circulation.     

Cerebral hemodynamic effects of fluid resuscitation in the presence of an experimental intracranial mass

We addressed the impact on intracranial pressure (ICP) of posthemorrhage fluid resuscitation with a protocol in which additional fluid was infused to maintain a stable cardiac output after an initial bolus of fluid was infused. Anesthetized, mechanically ventilated mongrel dogs (n = 27) underwent a 30-minute interval of hemorrhagic shock (mean arterial pressure = 55 mm Hg) during which inflation of a subdural balloon maintained ICP at 15 mm Hg. After shock, animals were resuscitated with one of four randomly assigned fluids: (1) slightly hypotonic crystalloid (Na+, 125 mEq.L-1; designated Na-125); (2) hypertonic crystalloid (Na+, 250 mEq.L-1; designated Na-250); (3) slightly hypotonic crystalloid plus 10% pentastarch (Na-125P); or (4) hypertonic crystalloid plus 10% pentastarch (Na-250P). Supplemental fluid was administered as needed to maintain cardiac output comparable to baseline values. ICP increased progressively in all fluid groups during resuscitation. Cerebral blood flow, measured by the cerebral venous outflow method, increased immediately after resuscitation and then declined steadily over time in all groups. Fluids containing pentastarch maintained hemodynamic stability with minimal supplementation throughout most of the postresuscitation period, compared with crystalloid alone, which required substantial additional volume. If decreased intracranial compliance and hemorrhage are combined, ongoing resuscitation is associated with significantly increased ICP and significantly decreased cerebral blood flow, independent of the tonicity and oncotic pressure of the infused fluid.     

Renal and hemodynamic effects of dopamine in infants following cardiac surgery

The renal and hemodynamic effects of dopamine were measured during the immediate postoperative period in six infants following repair of congenital cardiac defects. Dopamine was infused at rates of 5, 10, and 15 micrograms/kg/min. Cardiac index (CI) increased significantly at a dopamine infusion rate of 15 micrograms/kg/min. The glomerular filtration rate (GFR) and urine output increased at dopamine infusion rates of 5 and 10 micrograms/kg/min and returned to baseline at 15 micrograms/kg/min. No significant changes occurred in right atrial pressure (RAP), left atrial pressure (LAP), systemic artery pressure, systemic vascular resistance (SVR), or pulmonary vascular resistance (PVR). Heart rate (HR) increased slightly at a dopamine infusion rate of 15 micrograms/kg/min. Pulmonary artery pressure (PAP) increased significantly in only one patient. These data demonstrate that infants require high doses of dopamine to produce the hemodynamic effects seen in adults and that these higher doses may be used without adverse renal effects.     

Acute renal hemodynamic effects of dimanganese decacarbonyl and cobalt protoporphyrin

BACKGROUND: Heme oxygenase (HO) products have a protective role in acute renal failure (ARF) that may be hemodynamically mediated because the HO-derived carbon monoxide (CO) is an important control system of arteriolar tone. The vascular effects of HO may be caused directly through changes in CO synthesis, and indirectly by alterations in nitric oxide (NO) release. The present study evaluated in vivo the renal effects of a heme oxygenase inhibitor, Co(III)Protoporphyrin (CoPP) alone or in combination with the CO donor dimanganese decacarbonyl (Mn2(CO)10). METHODS: All drugs were administered into the renal artery of anesthetized rats. Changes in renal cortical nitric oxide concentration were measured in vivo electrochemically. RESULTS: The intrarenal administration of the CO donor Mn2(CO)10 increased blood carboxyhemoglobin levels (+74%), renal blood flow (+54%), glomerular filtration (+38%), and urinary cGMP excretion (+128%). On the other hand, the inhibition of renal HO with CoPP progressively induced an ARF characterized by a drop in renal blood flow (-77%), glomerular filtration (-93%), and urinary cGMP excretion (-93%). These deleterious effects of HO inhibition on renal function were nearly abolished by supplementing CO with the coadministration of Mn2(CO)10+ CoPP, indicating that they may be caused by inhibition of CO synthesis and the resulting hemodynamic changes. In addition, CoPP lowered the renal cortical NO concentration (-21%) and also decreased the urinary excretion of nitrates/nitrites, while Mn2(CO)10 increased renal NO levels (+20%) and raised the excretion of nitrates/nitrites, suggesting that changes in NO release may contribute to the renal effects of the HO-CO system. CONCLUSION: These results indicate that heme oxygenase-derived CO plays a cardinal role in the control of renal hemodynamics and glomerular filtration.     

Strategies in the patient with compromised respiratory function

Respiratory diseases are commonly divided into restrictive or obstructive lung diseases. For anaesthesiological considerations restrictive lung diseases appear as a static condition with minimal short-term development. Overall, restrictive lung diseases don't lead to acute exacerbations due to the choice of anaesthetic techniques or the choice of anaesthesia-specific agents. Compared to restrictive lung diseases, obstructive lung diseases such as asthma or chronic obstructive lung diseases have a high prevalence and are one of the four most frequent causes of death. Obstructive lung diseases can be significantly influenced by the choice of anaesthetic technique and anaesthetic agent. Basically, the severity of the chronic obstructive pulmonary disease (COPD) and the degree of bronchial hyperreactivity will determine the perioperative anaesthetic risk. This risk has to be assessed by a thorough preoperative evaluation and will provide the rationale on which to decide the adequate anaesthetic technique. In particular, airway instrumentation can cause severe reflex bronchoconstriction. The use of regional anaesthesia alone or in combination with general anaesthesia can help to avoid airway irritation and even leads to reduced postoperative complications. Prophylactic anti-obstructive treatment, volatile anaesthetics, propofol, opioids, and an adequate choice of muscle relaxants minimize the anaesthetic risk when general anaesthesia is required. If intraoperative bronchospasm occurs, despite all precautions, deepening of anaesthesia, repeated administration of β₂-adrenergic agents and parasympatholytics, and a single systemic dose of corticosteroids are the main treatment options.     

Xenon produces minimal haemodynamic effects in rabbits with chronically compromised left ventricular function

Background. Xenon has only minimal haemodynamic side-effectson normal myocardium and might be a preferable anaesthetic agentfor patients with heart failure. We studied the haemodynamicchanges caused by 70% xenon in rabbits with chronically compromisedleft ventricular (LV) function. Methods. Anaesthetized rabbits were thoracotomized and a majorcoronary artery was ligated to induce ischaemic heart disease.Nine weeks later, rabbits were again anaesthetized (ketamine/propofol),and haemodynamics were measured during inhalation of 70% xenonusing echocardiography [LV end-diastolic dimension (LVedD),fractional shortening (FS), velocity of circumferential fibreshortening (VcF), ejection fraction (EF)] in closed-chest animals.Subsequently, rabbits were thoracotomized and instrumented formeasurement of LV pressure (tip manometer), LV dP/dt_max andcardiac output (ultrasonic flow probe). Haemodynamics were recordedagain during inhalation of 70% xenon. Results. All rabbits had compromised LV function 9 weeks aftercoronary artery ligation. Mean LVedD increased from 12.9 (SD0.9) mm to 17.1 (0.4) mm; EF decreased from 73 (9) to 64 (8)%;FS decreased from 36 (7) to 29 (5)%; VcF decreased from 28.9(6.8) to 17.6 (4.7) mm s^–1; all P<0.05. Inhalationof 70% xenon had no effect on haemodynamics in closed-chestrabbits, as measured by echocardiography. After invasive instrumentation,small decreases in LV pressure from 78 (20) to 72 (19) mm Hg,LV dP/dt_max from 3081 (592) to 2633 (503) mm Hg s^–1 andcardiac output from 239 (69) to 225 (71) ml min^–1 wereobserved during xenon inhalation (all P<0.05). Conclusion. These data show that xenon has only minimal negativeinotropic effects in rabbits with LV dysfunction after coronaryartery ligation. Br J Anaesth 2002; 88: 264–9