endothelin-1 and Blood-Loss--Surgical

To test the compensatory role of endothelin-1 when acute blood loss is superimposed on anaesthesia, by characterizing the effect of systemic endothelin receptor subtype A (ET(A)) blockade on the haemodynamic and hormonal responses to haemorrhage in dogs anaesthetized with xenon/remifentanil (X/R) or isoflurane/remifentanil (I/R).. Prospective experimental randomized controlled study.. Six female Beagle dogs, 13.4 +/- 1.3 kg.. Animals were anaesthetized with remifentanil 0.5 microg kg(-1) minute(-1) plus either 0.8% isoflurane (I/R) or 63% xenon (X/R), with and without (Control) the systemic intravenous endothelin receptor subtype A antagonist atrasentan (four groups, n = 6 each). After 60 minutes of baseline anaesthesia, the dogs were bled (20 mL kg(-1)) over 5 minutes and hypovolemia was maintained for 1 hour. Continuous haemodynamic monitoring was performed via femoral and pulmonary artery catheters; vasoactive hormones were measured before and after haemorrhage.. In Controls, systemic vascular resistance (SVR), vasopressin and catecholamine plasma concentrations were higher with X/R than with I/R anaesthesia at pre-haemorrhage baseline. The peak increase after haemorrhage was higher during X/R than during I/R anaesthesia (SVR 7420 +/- 867 versus 5423 +/- 547 dyne seconds cm(-5); vasopressin 104 +/- 23 versus 44 +/- 6 pg mL(-1); epinephrine 2956 +/- 310 versus 177 +/- 99 pg mL(-1); norepinephrine 862 +/- 117 versus 195 +/- 33 pg mL(-1), p < 0.05). Haemorrhage reduced central venous pressure from 3 +/- 1 to 1 +/- 1 cm H(2)O (I/R, ns) and from 8 +/- 1 to 5 +/- 1 cm H(2)O (X/R, p < 0.05), but did not reduce mean arterial pressure, nor cardiac output. Atrasentan did not alter the haemodynamic and hormonal response to haemorrhage during either anaesthetic protocol.. Selective ET(A) receptor blockade with atrasentan did not impair the haemodynamic and hormonal compensation of acute haemorrhage during X/R or I/R anaesthesia in dogs.

Topics: Anesthesia; Anesthesia, Inhalation; Anesthesia, Intravenous; Anesthetics, Inhalation; Anesthetics, Intravenous; Animals; Atrasentan; Blood Loss, Surgical; Catecholamines; Dog Diseases; Dogs; Endothelin A Receptor Antagonists; Endothelin-1; Epinephrine; Female; Hemodynamics; Hemorrhage; Isoflurane; Norepinephrine; Piperidines; Pyrrolidines; Remifentanil; Time Factors; Vascular Resistance; Vasopressins; Xenon

The liver and portal circulation contribute to production and clearance of endothelin-1 (ET-1). This study was undertaken to investigate what variables relate to the dynamics of ET-1 in hepatic resection and its clinical implication.. On 20 patients with (n = 8) or without (n = 12) chronic liver disease who underwent hepatic resection, peripheral arterial and portal venous ET-1 were serially measured to determine a correlation with pre-, intra-, and postoperative variables.. The preoperative factors with which the portal ET-1 showed a positive correlation were the indocyanine green retention rate at 15 min (ICG R15) and portal venous pressure. The ET-1 clearance, as calculated from the difference between the portal and the peripheral ET-1 concentrations, was also correlated with the ICG R15. The peripheral ET-1 elevated significantly in the patients with increasing intraoperative blood loss or hepatic inflow occlusion. An increase in the portal ET-1 was correlated with an elevation of portal venous pressure after hepatectomy. Postoperative increase in serum bilirubin was closely correlated with the peripheral ET-1 at closure.. The peripheral and portal ET-1 are correlated with not only preoperative hepatic reserve and portal venous pressure but also invasiveness of hepatectomy and postoperative course.

Topics: Blood Loss, Surgical; Endothelin-1; Female; Hepatectomy; Humans; Intraoperative Period; Liver; Liver Function Tests; Male; Middle Aged; Portal Pressure; Portal Vein; Postoperative Period; Time Factors