Central inhibition of opioid receptor subtypes and its effect on haemorrhagic hypotension in conscious sheep

Aim: To investigate the contribution of cerebral μ‐, κ‐ and δ‐opioid receptors in causing the hypotension, bradycardia and renal hypoperfusion evoked by haemorrhage. Methods: Adult conscious ewes were bled continuously from a jugular vein until mean arterial blood pressure (MAP) was reduced to below 50 mmHg. Starting 30 min before and continuing until 60 min after haemorrhage either artificial cerebrospinal fluid (control), d ‐Phe‐Cys‐Tyr‐d ‐Trp‐Orn‐Thr‐Pen‐Thr‐NH₂ (CTOPμ‐receptor antagonist), ICI 174,864 (δ‐receptor antagonist) or nor‐binaltorphimine dihydrochloride (nor‐BNI, κ‐receptor antagonist) were infused intracerebroventricularly. In a randomized crossover fashion the effect of antagonizing one central opioid receptor subtype was compared to control experiments in the same animal (n = 6 in all groups). Results: Compared to corresponding controls, nor‐BNI and ICI 174,864 significantly increased the haemorrhage volume needed to reduce MAP to below 50 mmHg (+4.7 mL kg^?1, SD 1.8 and +3.1 mL kg^?1, SD 3.0 respectively). In the nor‐BNI group this was accompanied by a significantly augmented tachycardia before MAP fell. Both nor‐BNI and ICI 174,864 also postponed haemorrhagic bradycardia and prolonged adequate blood flow to the kidney. The infusions did not affect the circulation per se or the recovery after haemorrhage. The μ‐opioid receptor blockade had no effect on baseline circulation or the response to haemorrhage. Conclusion: Activation of κ‐ and δ‐opioid receptors adjacent to the ventricular compartment contributes to initiating haemorrhagic hypotension and bradycardia in conscious sheep. However, other parts of the brain and different receptors are likely to play a role as well.     

内源性舒张因子在失血性休克中的变化

目的探讨内源性舒张因子一氧化氮（NO）与一氧化碳（CO）在失血性休克中的变化。方法按照Wigger’s改良法制作家猪失血性休克模型，失血性休克（H）组经股动脉快速放血使MAP降至40mmHg，然后复苏。对照（C）组处理同H组，但未失血。各组分别在休克前、休克末、复苏末、复苏后30、60、120、240min分别记录平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、肺动脉压（PAP）、肺动脉楔压（PCWP）、气道压（Peak）的变化，采血测定pH值、BE值、CO、NO及乳酸盐（Lae）水平。结果H组休克后MAP、PAP和CVP降低而HR升高，Peak、PCWP无显著变化。血浆NO水平在休克后逐渐升高，复苏后120min显著高于休克前和c组水平，此后一直维持较高水平，240rain时达到高峰。休克后CO水平逐渐增加，复苏后120min显著高于休克前，并高于c组，此后逐渐下降；Lac在失血后显著升高，休克末达峰值，显著高于休克前和c组，以后逐渐下降。pH值、BE值在休克后逐渐下降，与c组相比有显著差异。结论失血性休克后NO、CO水平增加，可能作为两种内源性保护因子起作用。     

不同液体限制性复苏对活动性出血休克大鼠白细胞介素-6和肿瘤坏死因子-α的影响

目的 探讨不同液体限制性复苏对活动性出血休克大鼠血白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的影响。方法 将健康SD大鼠随机分成对照组、乳酸钠林格液复苏组(晶体组)、羟乙基淀粉复苏组(胶体组)和晶胶液复苏组(晶胶组),各实验复苏组分别制作活动性出血休克模型,于休克前、休克后平均动脉压(MAP)为40 mmHg(1 mmHg=0.133kPa)维持30 min后(0时相)、MAP为60 mmHg维持30 min后(1时相)、MAP为80 mmHg维持60 min后(2时相)以及复苏成功24 h后(3时相)分别取外周血,对照组只在实验前和3时相取血,各组均采用ELISA法测定血浆IL-6和TNF-α含量。结果 各组大鼠休克前及休克开始复苏前(0时相)血浆中IL-6和TNF-α含量比较差异无统计学意义(P值均>0.05)。在复苏过程中,晶体组血IL-6和TNF-α的含量均呈现先升高再下降的趋势,3时相血IL-6和TNF-α含量较对照组升高,差异均有统计学意义(P值均<0.05);胶体组和晶胶组在复苏过程中IL-6和TNF-α的含量均呈现持续下降的趋势,3时相血IL-6和TNF-α的含量均较对照组减低,差异均有统计学意义(P值均<0.05);1时相、2时相和3时相晶胶组血IL-6和TNF-α的含量均较胶体组减低,差异均有统计学意义(P值均<0.05)。结论 晶胶液比晶体液、胶体液能更好地抑制活动性出血休克大鼠的促炎介质释放,可能是一种相对较好的复苏液体。     

Earliest Bedside Assessment of Hemodynamic Parameters and Cardiac Biomarkers: Their Role as Predictors of Adverse Outcome in Patients with Septic Shock

Background: Early assessment and aggressive hemodynamic treatment have been shown to increase the survival of patients in septic shock. Current and past sepsis guidelines recommend a resuscitation protocol including central venous pressure (CVP), mean arterial blood pressure (MAP), urine output and central venous oxygen saturation (ScvO₂) for resuscitation within the first six hours. Currently, the established severity score systems like APACHE II score, SOFA score or SAPS II score predict the outcome of critically ill patients on the bases of variables obtained only after the first 24 hours. The present study aims to evaluate the risk of short-term mortality for patients with septic shock by the earliest possible assessment of hemodynamic parameters and cardiac biomarkers as well as their role for the prediction of the adverse outcome.Methods: 52 consecutive patients treated for septic shock in the intensive care unit of one centre (Marien Hospital Herne, Ruhr University Bochum, Germany) were prospectively enrolled in this study. Hemodynamic parameters (MAP, CVP, ScvO₂, left ventricular ejection fraction, Hematocrit) and cardiac biomarkers (Troponin I) at the ICU admission were evaluated in regard to their influence on mortality. The primary endpoint was all-cause mortality within 28 days after the admission.Results: A total of 52 patients (31 male, 21 female) with a mean age of 71.4±8.5 years and a mean APACHE II score of 37.0±7.6 were enrolled in the study. 28 patients reached the primary endpoint (mortality 54%). Patients presenting with hypotension (MAP <65 mmHg) at ICU admission had significantly higher rates of 28-day mortality as compared with the group of patients without hypotension (28-day mortality rate 74 % vs. 32 %, p<0.01). Furthermore, the patients in the hypotension present group had significantly higher lactate concentration (p=0.002), higher serum creatinin (p=0.04), higher NTproBNP (p=0.03) and after the first 24 hours higher APACHE II scores (p=0.04). A MAP <65 mmHg was the only hemodynamic parameter significantly predicting the primary endpoint (OR: 4.1, CI: 1.1 - 14.8, p=0.008), whereas the remaining hemodynamic variables CVP, ScvO₂, Hematocrit, Troponin I and left ventricular ejection fraction (LVEF) seemed to have no influence on survival. Besides, non-survivors had a significantly higher age (74.1±9.0 vs. 68.4±6.9, p=0.01). If hypotension coincided with an age ≥72 years, the 28-day mortality rate escalated to 88%.Conclusions: In our study, we identified a risk group with an exceedingly high mortality rate: the patients with an age ≥72 years and presenting with hypotension (MAP <65 mmHg). These data can be easily obtained at the time of the very first patient contact. As a result, an aggressive and a more effective treatment can be initiated within the first minutes of the primary care, possibly reducing organ failure and short-term mortality in this risk group.     

Sympathetic influence on cardiovascular responses to sustained head-up tilt in humans

Sympathetic β-adrenergic influences on cardiovascular responses to 50d? head-up tilt were evaluated with metoprolol (β₁-blockade; 0.29 mg kg^-1) and propranolol (β₁ and β-₂-blockade; 0.28 mg kg^-1) in eight males. A normotensive-tachycardic phase was followed by a hypotensive-bradycardic episode associated with presyncopal symptoms after 23pL3 min (control, mean pLSE). Head-up tilt made thoracic electrical impedance (3.0pL10Ω), mean arterial pressure (MAP, 86pL4-93pL4 mmHg), heart rate (HR, 63pL3-99pL10 beats min^-1) and total peripheral resistance (TPR, 15pL1-28pL4 mmHg min L^-1) increase, while central venous oxygen saturation (74pL2-58pL4%), cardiac output (5.7pL0.1–3.1pL0.3 L min^-1), stroke volume (95pL6-41pL5 mL) and pulse pressure (55pL4-49pL4 mmHg) decreased (P < 0.05). Central venous pressure decreased during head-up tilt (7pL2-0pL1 mmHg), but it remained stable during the sustained tilt. At the appearance of preswyncopal symptoms MAP (49pL3 mmHg), HR (66pL4 beats min^-1) and TPR (15pL3 mmHg min L^-1) decreased (P < 0.05). Neither metoprolol or propranolo changed tilt tolerance or cardiovascular variables, except for HR that remained at 57pL2 (metoprolol) and 55pL3 beats min^-1 (propranolol), and MAP that remained at 87pL5 mmHg during the first phase with metoprolol. In conclusion, sympathetic activation was crucial for the heart rate elevation during normotensive head-up tilt, but not for tilt tolerance or for the associated hypotension and bradycardia.     

Cerebrovascular responses to haemorrhagic hypotension in anaesthetized cats. Effects of α-adrenoceptor antagonists

Haemorrhagic hypotension induces the phenomenon of cerebrovascular autoregulation and, concomitantly, involves an activation of the sympathetic nervous system. As brain vessels in cats have an atypical adrenoceptor distribution we studied the effects of an a-adrenoceptor antagonist on the autoregulatory response to haemorrhage. Cortical blood flow was studied by the H₂ technique in chloralose-anaesthetized cats subjected to a period of graded haemorrhage over 3 h. Three groups of cats were studied: control, i.e. those receiving saline (n= 10); yohimbine-treated (200/μg^-kg^-1 h^-1, n= 7); and prazosin-treated (50μg-kg^-1 h^-1, n= 6). In the control group, cortical blood flow remained relatively constant when mean arterial pressure was decreased from 102±1 mmHg (mean ± SE) to approximately 50.1 mmHg; thereafter, blood flow decreased with decreasing perfusion pressure. In the arterial pressure range 64-55 mmHg, cortical blood flow was significantly higher in the yohimbine group (109±12 ml-100 g^-1 min^-1) compared to the control group (69 ±6 ml-100 g^-1 min^-1) and remained higher in the yohimbine-treated cats at more extreme levels of hypotension. Blood flow did not fall significantly in the yohimbine-treated cats until mean arterial pressures of 31 ± 1 mmHg were attained. In the prazosin-treated cats, flow began to decrease at arterial pressures even greater than those observed in the control group. Thus, there is a sympathetic vasoconstriction of brain arteries that is primarily mediated by α₂-adrenoceptors in the feline cerebrovascular bed.     

Enhanced beta-adrenergic response in rat papillary muscle by inhibition of inducible nitric oxide synthase after myocardial infarction

Aim: Myocardial infarction (MI) induces a progressive ventricular remodelling leading to a contractility depression. During the acute phase of MI inducible nitric oxide synthase (iNOS) expression and nitric oxide (NO) production increases in the heart. The aim of this study was to investigate the role of iNOS in the left ventricular contractility at 3 days after MI. Methods: Wistar rats were divided into: sham operated (SHAM, n = 23), infarction (INF, n = 18); sham operated plus the iNOS inhibitor, S‐methylisothiourea (SMT) 5 mg kg^?1 day^?1, i.p. treatment (SHAM‐SMT, n = 26) and infarction plus SMT (INF‐SMT, n = 22). Concentration–response curves for isoprenaline, Ca²⁺ and frequency–force curve were studied in isolated papillary muscle from left ventricle. Results: After 3 days infarct area was similar between groups. SMT treatment reduced the time to peak tension during frequency–force curve in the infarct group (SHAM = 63 ± 3; SHAM‐SMT = 71 ± 3; INF = 90 ± 4; INF‐SMT = 79 ± 4 ms, P < 0.05) and increased the maximal response to isoprenaline (SHAM = 0.93 ± 0.11; SHAM‐SMT = 1.13 ± 0.1; INF =0.84 ± 0.16; INF‐SMT = 1.49 ± 0.15 g mm^?2, P < 0.05). The response to Ca²⁺ was equally reduced in the INF and INF‐SMT groups. SMT treatment did not change the reduced post‐rest potentiation performed by INF group, but attenuated the plasma nitrite and nitrate (NOx) levels in the INF group without any haemodynamic effect. Conclusion: These finding suggest that at 3 days after MI the iNOS modulates the isolated papillary muscle response to isoprenaline and its inhibition improves the β‐adrenergic inotropic responses.     

The hemodynamic effects of insulin following overdosage with levobupivacaine or racemic bupivacaine in dogs

Although levobupivacaine (LBUP) is less cardiotoxic than racemic bupivacaine (RBUP), the resuscitation from the LBUP-induced cardiovascular collapse (CVC) has not been easy as expected. Following the recent reports that proposed the resuscitative action of insulin for the RBUP-induced CVC, a controlled trial was performed to assess the feasibility of insulin for the LBUP-induced CVC. Fourteen dogs were randomly allocated into two groups: the RBUP and LBUP groups. Each group received continuous intravenous infusions of RBUP or LBUP until the mean arterial pressure (MAP) reached 40 mmHg. Then, an intravenous bolus of insulin (2 U/kg) was administered. Both groups were successfully resuscitated. At CVC, a decrease of cardiac output and an increase of systemic vascular resistance were observed but to a lesser degree in the LBUP group (p<0.05). After insulin injection, the MAP further declined to under 40 mmHg for several minutes, which was more protracted in the LBUP group (p<0.05). The CVCs induced by LBUP or RBUP in anesthetized dogs could be successfully resuscitated by insulin. Compared with RBUP, however, the less degree of vasoconstriction by LBUP and the innate vasodilatory property of insulin yielded a delayed increment of MAP during the immediate resuscitation period in the LBUP-induced CVC.     

Cardiovascular and endocrine responses to haemorrhage in the pig

Heart rate (HR), mean arterial pressure (MAP), indices of sympathetic and parasympathetic activity (plasma concentrations of adrenaline, noradrenaline and pancreatic polypeptide, PP), vasopressin (VP) and aldosterone (ALDO) were measured in six pigs during continuous bleeding resulting in hypovolaemic shock, from which five survived. Three stages of haemorrhage could be defined. Stage I. Resting MAP was 85 ± 6 mmHg and increased to 96 ± 5 mmHg with a blood loss of 275 (range 250–300) (10 (9–12)% of the estimated blood volume) concomitant with an increase in HR from 105 ± 5 to 113 ± 6 beats min^-1 (P < 0.05). Stage II. After a blood loss of 375 (300–500) ml (15 (13–16)%) MAP fell to 62 ± 9 mmHg and HR to 95 ± 5 beats min^-1 (P < 0.05). Stage III. A blood loss of 1113 (825–1450) ml (44 (30–52)%) resulted in a MAP of 50 ± 4 mmHg and an increase in HR to 206 ± 3 beats min^-1 (P < 0.05). Adrenaline increased from 0.3 ± 0.1 to 0.8 ± 0.3 (stage II) and 3.6 ± 1.1 nmol l^-1 (stage III) (P < 0.05); noradrenaline from 0.4 ± 0.1 to 1.5 ± 0.4 (stage II) and 5.9 ± 1.7 nmol l^-1 (stage III) (P < 0.05); PP from 6.2 ± 1.6 to 13.3 ± 2.3 (stage II) and 20.9 ± 7.8 pmol l^-1 (stage III) (P < 0.05). VP changed only marginally, but ALDO increased from 496 ± 54 to 623 ± 76 pmol l^-1 (stage III) (P < 0.05). The results suggest that a high HR and intense sympathetic activity is seen during severe haemorrhage in the pig while vagal slowing of the heart and moderate hypotension are prominent when bleeding amounts to approximately 15% of the estimated blood volume.     

Diabetes affects blood pressure and heart rate responses during acute hypothermia

Many diabetics are cold-intolerant and experience dramatic changes in normal systemic function during hypothermia. Little is known of the cardiovascular adjustments in diabetics exposed to an acute cold stress. In an effort to identify the alterations in mean arterial blood pressure (MAP) and heart rate (HR) in the diabetic during environmental cooling (10 ± 2 °C), we compared the in vivo MAP and HR responses of urethane-anaesthetized (1.5 g kg^?1), streptozotocin-diabetic (STZ, 65 mg kg^?1, n = 12) and control (CON, n = 10) rats during acute hypothermia. MAP was measured directly via an indwelling carotid artery cannula and HR was calculated from the peak systolic pressure waves. Overall, the STZ rats were more cold-intolerant than CON as evidenced by the greater rate of decline in colonic temperature (T_c) from 36 to 28 °C (STZ, 0.16 °C min^?1 vs. CON, 0.06 °C min^?1; P < 0.05). Prior to cooling, HR was significantly lower (P < 0.05) in STZ (282 ± 9 beats min^?1) than in CON rats (399 ± 24 beats min^?1); however, during the acute hypothermic period, HR displayed a similar rate of decline in both groups. With respect to MAP, both groups demonstrated similar pre-experimental pressor responses (CON, 81.7 ± 5.4 vs. STZ, 83.2 ± 5.1 mmHg, P > 0.05). During progressive hypothermia, MAP gradually increased (P < 0.05) in the CON group from baseline (T_c = 36 °C) and reached peak values (118.4 ± 2.5 mmHg) at T_c = 30 °C, while the STZ group failed to exhibit any cold pressor response. At the conclusion of the experiment (T_c = 28 °C), the STZ group pressor response to hypothermia was not different from baseline (T_c = 36 °C, 83.2 ± 5.1 vs. T_c = 28 °C, 77.4 ± 3.4 mmHg; P > 0.05). The absence of any pressor response in the diabetic group during progressive hypothermia reflects the poor overall vasoconstrictive capacity to cooling and could partially explain the rapid decline of core temperature in this group.     

Vascular effects of endothelin-1 in the cat; modification by indomethacin and l-NAME

Intravenous infusion of endothelin-1 (ET-1) in the cat, 60 pmol × kg body wt^-1x min^-1for 5 min, induced an increase in mean arterial blood pressure (MAP) of 41.3 ± 4.8 mmHg (n= 6; P < 0.001). Blood flow, as determined with radioactive microspheres, was reduced in many tissues. Reductions by 70–80% were observed in the choroid plexus, pineal and pituitary glands. Total cerebral blood flow was reduced by 18–23%. Pre-treatment with indomethacin or a combination of indomethacin and l -NAME caused vasoconstriction in many tissues and modified the responses to ET-1 in a variable way, suggesting that normally, ET-1 tends to release arachidonic acid metabolites and nitric oxide with great variations between different tissues. Intracerebroventricular infusion (i.c.v.) of ET-1, 10 pmol × kg body wt^-1x min^-1, caused an increase in MAP of 79 ± 11 mmHg (n= 6; P < 0.001). Regional blood flow in the medulla oblongata, medulla spinalis, choroid plexus, pineal and pituitary glands was reduced by 60–80%. Heart rate, cardiac output and coronary blood flow were significantly increased after 30 min i.c.v. infusion, indicating an activation of the heart, most probably as part of a central ischaemic response. Our results indicate that in many tissues the vasoconstrictive effect of ET-1 is influenced by indomethacin- and l -NAME-sensitive vasodilator mechanisms that are activated by the peptide. In the CNS, there may be marked effects on regional blood flow after i.c.v. infusion.     

Cardiovascular and adrenal sensitivity to angiotensin II in essential hypertension

Summary Regulation of aldosterone secretion by sodium chloride is impaired in a group of essential hypertensives: high-salt diet fails to suppress aldosterone in these patients despite low renin values. The mechanism of this impaired regulation of aldosterone has not been clarified so far. We tested the sensitivity of aldosterone secretion and blood pressure to A II in 20 normotensive controls (aged 20–60, MAP 92±3 mm Hg), in ten normotensives with one or two parents with hypertension, and in 21 patients with essential hypertension (aged 17–65, MAP 119±4 mm Hg). After a period of 6 days on high-salt intake (300–320 mEq Na⁺/day), A II (0.1, 0.5, 1.0 and 2.0 ng/kg/min) was infused, each concentration for 30 min. According to aldosterone excretion during sodium loading, patients were divided into group A with complete suppression (n=12, aldosterone excretion 3.6±0.4 µg/day) and in group B with insufficient suppression (n=9, aldosterone excretion 15.5±2.3 µg/day). Despite similarly low plasma renins, rise of serum aldosterone levels during A II infusion was significantly higher in group B patients than in group A patients and normotensive controls. Rise in mean arterial blood pressure, however, brought about by graded A II infusion was similar in both groups of hypertensives and in normotensive controls. The results demonstrate an increased adrenal sensitivity to A II in a subgroup of essential hypertensives only. A similar adrenal hypersensitivity to A II found by others in patients with hyperaldosteronism due to adrenal hyperplasia supports the hypothesis that the same mechanism underlies both disorders.Abbreviations MAP mean arterial blood pressure - A II Angiotensin II Dedicated to Prof. Dr. W. Kaufmann on the occasion of his 60^th birthday     

Role of adrenals on development of pressure-induced myocardial hypertrophy

The effect of coarctation of the abdominal aorta (AC) and of sham operation (SO) on the development of myocardial hypertrophy was studied in three groups of male rats, i.e., a group without treatment prior to AC or SO (untreated), a group with bilateral adrenalectomy (ADX) 5-7 days before AC or SO, and a group in which the adrenal medulla was removed (MDX) 5-7 days before AC or SO. MDX resulted in functional elimination of the adrenal medulla without apparent effect on cortical function. The animals were killed 7-10 days after AC or SO. AC produced carotid blood pressure (CBP) increases of 33, 31, and 25 mmHg in the untreated, ADX, and MDX groups, respectively. Ventricular weight (HW), ventricular RNA concentration, and RNA-to-DNA ratio increased significantly after AC only in the untreated and MDX groups. In the ADX group, hypertension was followed by an increase in HW that could be detected only after normalization for body weight. It is concluded that absence of the adrenal gland significantly reduces the development of pressure-induced myocardial hypertrophy. Apparently, this is due to the absence of the adrenal cortex and not absence of the adrenal medulla.     

Hemodilution with liposome-encapsulated low-oxygen-affinity hemoglobin does not attenuate hypothermic cerebral ischemia in rats

Hypothermia decreases cerebral metabolism and increases hemoglobin oxygen affinity. A hypothesis that the reversal of increased oxygen affinity would further attenuate hypothermic cerebral ischemia was tested by evaluating the effects of liposome-encapsulated hemoglobin (LipoHb) with low oxygen affinity (P₅₀ = 40–50 mmHg) on hypothermic incomplete cerebral ischemia. Wistar rats were randomly assigned to one of the following two groups: (A) exchange transfusion with LipoHb solution (Hb = 6 g/dl) (LipoHb, n = 5), (B) no exchange transfusion (control, n = 5). After surface cooling to 22°C, forebrain ischemia was induced for 15 min by bilateral carotid artery occlusion combined with a decrease in the mean arterial pressure (MAP) to 40 mmHg. ³¹P-magnetic resonance spectroscopy was performed during ischemia and 45 min of reperfusion. After reperfusion, MAP was significantly higher in the control group than in the LipoHb group (P < 0.01), although there were no significant differences during ischemia. Intracellular pH and phosphocreatine (PCr) levels decreased during ischemia and returned to the preischemic level in both groups following reperfusion. The LipoHb group had a significantly larger decrease and smaller recovery in PCr than the control group (P < 0.0001). Althouth β-adenosine triphosphate decreased during ischemia in the LipoHb group, it increased in the control group (P < 0.0001). Inorganic phosphate (Pi) increased during ischemia and decreased to the normal value after reperfusion. The LipoHb group experienced a significantly larger production of Pi than the control group (P = 0.02). Hemodilution with high-P₅₀ LipoHb does not reduce ischemic energy depletion induced by hypothermic incomplete forebrain ischemia in rats.     

Influence of neurohumoral blockade on heart rate and blood pressure responses to haemorrhage in isoflurane anaesthetized rats

Four groups of Sprague-Dawley rats were anaesthetized with isoflurane (ISO) (1.7% end-tidal concentration) in 40% oxygen, and mechanically ventilated. The animals were bled 15 mL kg-1 b.w. from the femoral vein over 10 min, followed by an observation period of 30 min. Ten minutes before haemorrhage each group of animals was pre-treated with intravenous injection/infusion of either: isotonic saline (Group B; CON; n=7), vasopressin V1-receptor antagonist [d(CH2)5Tyr(Me)AVP; 10 microg kg-1] (Group C; AVP-a; n=7), the non-selective angiotensin II receptor antagonist saralasin (10 microg kg-1 min-1) (Group D; SAR; n=7) or hexamethonium (10 mg kg-1) (Group E; HEX; n=7). A separate group of conscious animals were pre-treated with isotonic NaCl and subjected to the same haemorrhage protocol (Group A; AW; n=7). Mean arterial pressure (MAP), heart rate (HR) and blood gases were observed during the experiments. Only pre-treatment with SAR and HEX reduced MAP significantly. The pre-haemorrhage HR was only affected by HEX, which caused a reduction by 17%. The HR was significantly lower at the end of haemorrhage compared with pre-haemorrhage levels in all groups except that group treated with HEX. In that group the HR changed in the opposite direction. The ability to maintain MAP during haemorrhage, and the post-haemorrhage period, was significantly impaired in the groups treated with AVP-a, SAR or HEX compared with the group receiving NaCl. It is concluded that autonomic nervous activity is of major importance for the maintenance of MAP during isoflurane anaesthesia, whereas circulating angiotensin II and vasopressin levels contribute to a much smaller degree in this regard. General anaesthesia in combination with different degrees of neurohumoral blockade impairs the haemodynamic responses to blood loss, seen in conscious individuals. The impairment involves both the early and late phases during haemorrhage, as well as the post-bleeding recovery period. All three neurohumoral systems (autonomic nervous activity, angiotensin II and vasopressin) are of importance for regulating MAP during and after haemorrhage, although the autonomic nervous outflow appears to contribute to a larger extent.     

Role of the orexinergic system in acute haemorrhage in the rat

Orexins (OXs) stimulate sympathetic nerve activity to increase arterial pressure (AP) and heart rate (HR). We have previously reported that the OX(1)-receptor antagonist SB-334867 reversed the sympathomimetic actions of orexin A (OXA). In the present study we have investigated the role(s) of the orexinergic system in sympathetic activation during haemorrhage in rats. Sixteen Wistar rats, anaesthetised with pentobarbital, were assigned to 2 groups: saline i.p. (group S) and SB-334867 30 mg/kg i.p. (group SB) n=8 each. Haemorrhagic shock was established by acute withdrawal of 10 ml/kg of blood via an arterial catheter three times with a 30 min interval between each withdrawal. Haemodynamics were assessed 30 min after 10, 20, and 30 ml/kg of blood withdrawal. In addition, plasma orexin A and catecholamine concentrations in the shed blood were determined. In both groups, mean AP (MAP) and HR decreased significantly. Plasma catecholamine concentrations significantly increased following blood withdrawal. The reduction in MAP/HR and elevation of catecholamine levels were dependent on the total amount of shed blood. There were no differences between the groups. Plasma OXA concentrations increased to a greater extent in group SB than group S in response to haemorrhage. There was a significant correlation between plasma catecholamines and %change in MAP (epinephrine: r=0.553, p=0.0001, norepinephrine: r=0.374, p=0.0087) and HR (epinephrine: r=0.403, p=0.005, norepinephrine: r=0.436, p=0.002). There was no correlation with plasma orexin A levels. These data suggest that despite a weak activation the orexinergic system is unlikely to make a major contribution to the response to haemorrhage.     

Involvement of arginine vasopressin in endogenous central histamine-induced reversal of critical haemorrhagic hypotension in rats

Objective and design:Histamine is a potent stimulator of arginine vasopressin (AVP) release and therefore, the role of AVP was studied in the reversal of critical haemorrhagic hypotension induced by endogenous central histamine after inhibition of histamine N-methyltransferase (HNMT) activity in rats. Material:In 48 ethylurethane-anaesthetised male Wistar rats cardiovascular parameters and plasma hormone concentrations were measured. Treatment:Haemorrhage-shocked rats with mean arterial pressure (MAP) 20–25 mmHg were injected intracerebroventricularly (icv) with HNMT inhibitor metoprine (20 g) after pre-treatment with V_1a, V_1b and V₂ receptor antagonists – [-mercapto-,cyclopentamethylenepropionyl¹, O-me-Tyr²,Arg⁸]AVP (10 g/kg; iv), SSR149415 (10 mg/kg; ip) and [adamantaneacetyl¹,O-Et-D-Tyr²,Val⁴, aminobutyryl⁶,Arg^8,9]AVP (10 g/kg; iv), respectively, or saline. Methods:MAP, heart rate (HR) and regional haemodynamics were monitored within 2 h after treatment or to death if it occurred earlier. Plasma hormone concentrations were measured using enzyme immunoassays. ANOVA followed by Neuman-Keules test, and Fishers exact test were used to compare the results. Results:Metoprine produced a long-lasting increase in MAP, HR, renal, hindquarters and mesenteric blood flows, and a 100% survival at 2 h (P < 0.05 vs. the control group). The action was associated with increased plasma AVP concentration (587.5 ± 98.9 vs. 387.3 ± 125.2 pg/ml; P < 0.05) in comparison to the control group as measured at 20 min after treatment. V_1a, but not V_1b and V₂, receptor antagonist inhibited metoprine-induced haemodynamic effects, with no influence on survival at 2 h. SSR149415 did not influence ACTH and adrenaline plasma concentrations in the metoprine-treated group. Conclusion:AVP, acting via V_1a receptors, is involved in endogenous central histamine-induced reversal of critical haemorrhagic hypotension in rats.Received 9 October 2003; returned for revision 2 December 2003; accepted by A. Falus 23 December 2003     

Coronary reactive hyperaemia and arterial pressure in anaesthetized goats

To study the effects of arterial pressure on coronary reactive hyperaemia, left circumflex coronary artery flow was measured, and reactive hyperaemia was determined after 5, 10 or 20 s of occlusion of this artery in anaesthetized goats during normotension, hypertension and hypotension. During hypertension induced by aortic constriction (mean arterial pressure, MAP = 140 +/- 6 mmHg) coronary vascular resistance (CVR), reactive hyperaemia (ratio of peak in hyperaemic flow to control flow and ratio of repayment to debt) and the decrease in CVR during the peak in hyperaemic flow were comparable to those during normotension. During hypertension induced by noradrenaline (MAP = 144 +/- 6 mmHg) CVR was 16% lower (P < 0.05), reactive hyperaemia was reduced by 14-25% (P < 0.05) and the decrease in CVR during the peak in hyperaemic flow was lower than the values of these parameters during normotension. During hypotension induced by constriction of the caudal vena cava (MAP = 40 +/- 4 mmHg) CVR was 22% lower (P < 0.05), reactive hyperaemia was reduced by 25-65% (P < 0.05) and the decrease in CVR during the peak in hyperaemic flow was less compared to the values of these parameters during normotension. During hypotension induced by isoprenaline (MAP = 45 +/- 4 mmHg) CVR was 59% lower, reactive hyperaemia was reduced by 55-100% (P < 0.01) and the decrease in CVR during the peak in hyperaemic flow was less compared to the values of these parameters during normotension. Arterial pressure is a main determinant of coronary reactive hyperaemia after brief periods of ischaemia, and the relationship between arterial pressure and reactive hyperaemia may depend in part on changes in CVR after variations in arterial pressure. These changes in CVR may be related to the action on coronary vessels of myocardial factors and vascular myogenic mechanisms.     

l-Arginine-induced hypotension in the rat: evidence that NO synthesis is not involved

l -Arginine is the biological precursor for nitric oxide (NO). NO is formed continuously in endothelial cells and maintains a certain degree of vasodilator tone under physiological conditions. Although the formation of NO is not primarily controlled by precursor availability, the extent to which extra supplementation with l -arginine may affect endothelial NO formation, and hence, vasodilator tone and systemic blood pressure, is not entirely clear. To address this issue, we infused l -arginine i.v. in anaesthetized normotensive rats pretreated with N^G-nitro-l -arginine methyl ester (l -NAME, 50 or 200 mg^-1) and in untreated controls, under continued recording of mean arterial pressure (MAP). In control animals l -arginine (25 or 100 mg kg^-1 min^-1) had no effect on systemic MAP (111 ± 3 mm Hg), while l -arginine (200 mg kg^-1 min^-1) lowered MAP (to 70 ± 6mmHg). D-Arginine (200 mg kg^-1 min^-1) also induced hypotension; during infusion of D-arginine MAP fell from 106 ± 4 to 64 ± 4 mm Hg. Pretreatment with l -NAME (50 and 200mgkg^-1) elevated MAP to 140 ± 2 and 147 ± 3 mm Hg, respectively, but failed to affect the hypotensive response to l -arginine; during infusion of l -arginine (200 mg kg^-1 min^-1) in rats pretreated with l -NAME (50 and 200 mg kg^-1) MAP fell to 86 ± 9 and 104 ± 6 mm Hg, respectively. Plasma levels of the NO metabolite, nitrate, were 18 ± 4 and 17 ± 3μmol l^-1, respectively, before and after infusion of l -arginine (200 mg kg^-1 min^-1). Trapping of NO to haemoglobin (HbNO) could not be detected, either before or after infusion of l -arginine (200 mg kg^-1 min^-1). We conclude that a high dose of l -arginine may act hypotensive in normotensive rats. This effect does, however, not seem to be based on an augmented formation of NO.     

Portacaval shunting attenuates portal hypertension and systemic hypotension in rat anaphylactic shock

Anaphylactic shock in rats is characterized by antigen-induced hepatic venoconstriction and the resultant portal hypertension. We determined the role of portal hypertension in anaphylactic hypotension by using the side-to-side portacaval shunt- and sham-operated rats sensitized with ovalbumin (1 mg). We measured the mean arterial blood pressure (MAP), portal venous pressure (PVP), and central venous pressure (CVP) under pentobarbital anesthesia and spontaneous breathing. Anaphylactic hypotension was induced by an intravenous injection of ovalbumin (0.6 mg). In sham rats, the antigen caused not only an increase in PVP from 11.3 cmH₂O to the peak of 27.9 cmH₂O but also a decrease in MAP from 103 mmHg to the lowest value of 41 mmHg. CVP also decreased significantly after the antigen. In the portacaval shunt rats, in response to the antigen, PVP increased slightly, but significantly, to the peak of 17.5 cmH₂O, CVP did not decrease, and MAP decreased to a lesser degree with the lowest value being 60 mmHg. These results suggest that the portacaval shunt attenuated anaphylactic portal hypertension and venous return decrease, partially preventing anaphylactic hypotension. In conclusion, portal hypertension is involved in rat anaphylactic hypotension presumably via splanchnic congestion resulting in decreased venous return and thus systemic arterial hypotension.