Deleterious effects of shock in internal mammary artery anastomoses

Details

Serval ID
serval:BIB_9854616F8D45
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Deleterious effects of shock in internal mammary artery anastomoses
Journal
Annals of Thoracic Surgery
Author(s)
von Segesser  L. K., Lehmann  K., Turina  M.
ISSN
0003-4975
Publication state
Published
Issued date
04/1989
Peer-reviewed
Oui
Volume
47
Number
4
Pages
575-579
Notes
Journal Article --- Old month value: Apr
Abstract
Internal mammary arteries (IMAs) are increasingly used for coronary artery revascularization. However, spastic reactions after IMA-coronary artery anastomoses have been reported. Internal mammary artery flow and the effects of sudden hypovolemia, gradual hypovolemia, papaverine hydrochloride, nitrates, and epinephrine were evaluated in a canine model (n = 10) (body weight, 19 +/- 5 kg) without interference from coronary artery resistance by dissecting the IMA as a pedicle, calibrating the flowmeter during free IMA flow, and anastomosing the IMA to the right atrium. Sudden hypovolemia (withdrawal of 20% of circulating blood volume over 90 seconds) caused significant modifications (p less than 0.01) of the following hemodynamic variables: heart rate (+12%), right atrial pressure (-17%), pulmonary artery pressure (-20%), wedge pressure (-30%), aortic pressure (-49%), cardiac output (-33%), distal IMA pressure (-54%), and IMA flow (-85%). During hypovolemia, IMA flow could not be increased with topical application of papaverine, but baseline values were achieved after retransfusion of the withdrawn blood volume. Gradual hypovolemia and application of large doses of nitrates showed less dramatic effects, and injection of an epinephrine bolus under normovolemic conditions increased aortic pressure and IMA flow. Under sever hypovolemia, however, administration of an epinephrine bolus provoked only a minimal increase in aortic pressure and a contrasting decrease in IMA flow. We conclude that sudden, severe hypovolemia can lead to disproportionate IMA flow reduction and that pharmacological interventions are delicate under these circumstances.
Keywords
Animals Coronary Circulation/drug effects Dogs Epinephrine/pharmacology Hemodynamics/drug effects Humans *Internal Mammary-Coronary Artery Anastomosis Nitrates/pharmacology Papaverine/pharmacology Postoperative Complications/*etiology Pulsatile Flow/drug effects Shock/*complications
Pubmed
Web of science
Create date
14/02/2008 14:18
Last modification date
20/08/2019 15:00
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