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Adie SK, Farina N, Abdul-Aziz AA, Lee R, Thomas MP, Konerman MC. Safety of dexmedetomidine in the cardiac intensive care unit. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 10:422-426. [PMID: 33620428 DOI: 10.1093/ehjacc/zuaa009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/17/2020] [Accepted: 07/31/2020] [Indexed: 01/14/2023]
Abstract
AIMS Dexmedetomidine is one of the sedative agents recommended by the Society of Critical Care Medicine as a preferred option over benzodiazepines in critically ill, mechanically ventilated patients. Little data exists describing sedation in the cardiac intensive care unit (CICU). The purpose of this study was to determine the prevalence of adverse events in CICU patients treated with dexmedetomidine. METHODS AND RESULTS This was a retrospective cohort analysis of patients >18 years old admitted to the University of Michigan CICU from June 2014 to October 2019 who received dexmedetomidine therapy. The primary outcome was the composite of adverse events including bradycardia, hypotension, increasing vasopressor/inotrope requirements, and asystole. Secondary outcomes included individual components of the primary outcome. Patients that experienced adverse events were compared to those that did not experience adverse events to identify risk factors for adverse events. A total of 197 patients were included. There were 116 adverse events in 106 patients. Hypotension was the most common adverse event, making up 60.3% of adverse events reported. Increased vasopressor requirement and bradycardia both occurred in 22 patients (18.9%). Asystole occurred in two patients. B-type natriuretic peptide (BNP) levels were significantly higher in those experiencing an adverse event (848 pg/mL vs. 431 pg/mL; P = 0.03). CONCLUSIONS Patients admitted to the CICU experienced a high rate of adverse events with dexmedetomidine use. Those experiencing adverse events were more likely to have a higher BNP. Future studies should explore the safety of alternative sedative agents to ascertain safe pharmacological options for patients admitted to the CICU.
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Affiliation(s)
- Sarah K Adie
- Department of Clinical Pharmacy, University of Michigan, Victor Vaughan Bldg, 1111 E Catherine St, Rm 305, Ann Arbor, MI 48109-2054, USA
| | - Nicholas Farina
- Department of Clinical Pharmacy, University of Michigan, Victor Vaughan Bldg, 1111 E Catherine St, Rm 305, Ann Arbor, MI 48109-2054, USA
| | - Ahmad A Abdul-Aziz
- Division of Cardiology, Department of Medicine, University of Michigan,1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ran Lee
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Michael P Thomas
- Division of Cardiology, Department of Medicine, University of Michigan,1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Matthew C Konerman
- Division of Cardiology, Department of Medicine, University of Michigan,1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Xia F, Jin Z, Lin T, Cai X, Pan L, Wang S, Cai Y, Chen H. Dexmedetomidine enhances tolerance to bupivacaine cardiotoxicity in the isolated rat hearts: alpha 2 adrenoceptors were not involved. BMC Pharmacol Toxicol 2019; 20:70. [PMID: 31753018 PMCID: PMC6873694 DOI: 10.1186/s40360-019-0371-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 11/08/2019] [Indexed: 12/05/2022] Open
Abstract
Background Dexmedetomidine was proved to mitigate bupivacaine-induced cardiotoxicity but mechanism of this ability is still unclear. This study was designed to investigate the direct effects of dexmedetomidine on cardiotoxicity induced by bupivacaine on Langendorff rat heart preparation and the role of alpha 2 adrenoceptors in this process was explored. Methods Hearts of rat were isolated, mounted on a Langendorff system. Five experimental groups were assessed after 10 min Krebs-Henseleit buffer (KHB) infusions as follow: (1) Group Con, only KHB was perfused; (2) Group Dex, KHB was perfused for 5 min, then dexmedetomidine (10 nmol/L) was added; (3) Group Bupi, KHB was perfused for 25 min, then bupivacaine (50 μmol/L) was added; (4) Group Bupi + Dex, KHB was perfused for 5 min, then the dexmedetomidine (10 nmol/L) was added for 20 min, at last a mixture of KHB + dexmedetomidine + bupivacaine were perfused; (5) Group Bupi + Dex + Yoh, a combination of KHB + yohimbine (alpha 2 adrenoceptor antagonists, 1 μmol/L) was perfusion for 5 min, then dexmedetomidine (10 nmol/L) was added for 20 min, at last a mixture of KHB + yohimbine + dexmedetomidine + bupivacaine was perfused. The experimental perfusion was maintained for 35 min in group Con and group Dex, and the experimental perfusion was sustained until asystole in the other three groups. Results Compared with group Bupi, dexmedetomidine significantly increased the time to first arrhythmia (P < 0.001) and time to asystole (P < 0.001) in group Bupi + Dex. In addition, dexmedetomidine also significantly increased the time to 25, 50 and 75% reductions in heart rate (P < 0.001) and the time to 25, 50 and 75% reductions in rate-pressure product (P < 0.001) in group Bupi + Dex. Dexmedetomidine increased the cardiac tissue bupivacaine content when asystole (Bupi + Dex vs. Bupi, 58.5 ± 6.3 vs. 46.8 ± 5.6 nmol/g, P = 0.003). The benefit of dexmedetomidine on bupivacaine-induced cardiotoxicity were not eliminated by yohimbine. Conclusions Dexmedetomidine could delay the occurrence of bupivacaine-induced arrhythmia and asystole in the isolated rat hearts, but the alpha 2 adrenoceptors were not involved in this process.
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Affiliation(s)
- Fangfang Xia
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Zhousheng Jin
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Tingting Lin
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Xixi Cai
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Linmin Pan
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Shi Wang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Yaoyao Cai
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China
| | - Hongfei Chen
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai village, Nanbaixiang town, Ouhai District, Wenzhou City, 325000, Zhejiang Province, China.
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Tapio H, Raekallio MR, Mykkänen A, Männikkö S, Scheinin M, Bennett RC, Vainio O. Effects of vatinoxan on cardiorespiratory function and gastrointestinal motility during constant-rate medetomidine infusion in standing horses. Equine Vet J 2019; 51:646-652. [PMID: 30793362 PMCID: PMC6767159 DOI: 10.1111/evj.13085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
Background Medetomidine suppresses cardiovascular function and reduces gastrointestinal motility in horses mainly through peripheral α2‐adrenoceptors. Vatinoxan, a peripheral α2‐antagonist, has been shown experimentally to alleviate the adverse effects of some α2‐agonists in horses. However, vatinoxan has not been investigated during constant‐rate infusion (CRI) of medetomidine in standing horses. Objectives To evaluate effects of vatinoxan on cardiovascular function, gastrointestinal motility and on sedation level during CRI of medetomidine. Study design Experimental, randomised, blinded, cross‐over study. Methods Six healthy horses were given medetomidine hydrochloride, 7 μg/kg i.v., without (MED) and with (MED+V) vatinoxan hydrochloride, 140 μg/kg i.v., followed by CRI of medetomidine at 3.5 μg/kg/h for 60 min. Cardiorespiratory variables were recorded and borborygmi and sedation levels were scored for 120 min. Plasma drug concentrations were measured. The data were analysed using repeated measures ANCOVA and paired t‐tests as appropriate. Results Initially heart rate (HR) was significantly lower and mean arterial blood pressure (MAP) significantly higher with MED compared with MED+V. For example at 10 min HR (mean ± s.d.) was 26 ± 2 and 31 ± 5 beats/minute (P = 0.04) and MAP 129 ± 15 and 103 ± 13 mmHg (P<0.001) respectively. At 10 min, cardiac index was lower (P = 0.02) and systemic vascular resistance higher (P = 0.001) with MED than with MED+V. Borborygmi were reduced after MED; this effect was attenuated by vatinoxan (P<0.001). All horses were sedated with medetomidine, but the mean sedation scores were reduced with MED+V until 20 min (6.8 ± 0.8 and 4.5 ± 1.5 with MED and MED+V, respectively, at 10 min, P = 0.001). Plasma concentration of dexmedetomidine was significantly lower in the presence of vatinoxan (P = 0.01). Main limitations Experimental study with healthy, unstimulated animals. Conclusions Vatinoxan administered i.v. with a loading dose of medetomidine improved cardiovascular function and gastrointestinal motility during medetomidine CRI in healthy horses. Sedation was slightly yet significantly reduced during the first 20 min.. The Summary is available in Portuguese – see Supporting Information
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Affiliation(s)
- H Tapio
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - M R Raekallio
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - A Mykkänen
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | | | - M Scheinin
- Institute of Biomedicine, University of Turku, Turku, Finland.,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - R C Bennett
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - O Vainio
- Faculty of Veterinary Medicine, Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
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Alekseev AE, Park S, Pimenov OY, Reyes S, Terzic A. Sarcolemmal α2-adrenoceptors in feedback control of myocardial response to sympathetic challenge. Pharmacol Ther 2019; 197:179-190. [PMID: 30703415 DOI: 10.1016/j.pharmthera.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
α2-adrenoceptor (α2-AR) isoforms, abundant in sympathetic synapses and noradrenergic neurons of the central nervous system, are integral in the presynaptic feed-back loop mechanism that moderates norepinephrine surges. We recently identified that postsynaptic α2-ARs, found in the myocellular sarcolemma, also contribute to a muscle-delimited feedback control capable of attenuating mobilization of intracellular Ca2+ and myocardial contractility. This previously unrecognized α2-AR-dependent rheostat is able to counteract competing adrenergic receptor actions in cardiac muscle. Specifically, in ventricular myocytes, nitric oxide (NO) and cGMP are the intracellular messengers of α2-AR signal transduction pathways that gauge the kinase-phosphatase balance and manage cellular Ca2+ handling preventing catecholamine-induced Ca2+ overload. Moreover, α2-AR signaling counterbalances phospholipase C - PKC-dependent mechanisms underscoring a broader cardioprotective potential under sympathoadrenergic and angiotensinergic challenge. Recruitment of such tissue-specific features of α2-AR under sustained sympathoadrenergic drive may, in principle, be harnessed to mitigate or prevent cardiac malfunction. However, cardiovascular disease may compromise peripheral α2-AR signaling limiting pharmacological targeting of these receptors. Prospective cardiac-specific gene or cell-based therapeutic approaches aimed at repairing or improving stress-protective α2-AR signaling may offer an alternative towards enhanced preservation of cardiac muscle structure and function.
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Affiliation(s)
- Alexey E Alekseev
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Stabile 5, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA; Institute of Theoretical and Experimental Biophysics, Russian Academy of Science, Institutskaya 3, Pushchino, Moscow Region 142290, Russia.
| | - Sungjo Park
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Stabile 5, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Oleg Yu Pimenov
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Science, Institutskaya 3, Pushchino, Moscow Region 142290, Russia
| | - Santiago Reyes
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Stabile 5, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Andre Terzic
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Stabile 5, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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Lervik A, Raszplewicz J, Ranheim B, Solbak S, Toverud SF, Haga HA. Dexmedetomidine or fentanyl? Cardiovascular stability and analgesia during propofol-ketamine total intravenous anaesthesia in experimental pigs. Vet Anaesth Analg 2018; 45:295-308. [DOI: 10.1016/j.vaa.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/13/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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Lépiz ML, Sayre R, Sawant O, Barr J, Pashmakova M, Washburn K, Washburn S. Maternal and fetal effects of dexmedetomidine infusion in pregnant ewes anesthetized with sevoflurane. Am J Vet Res 2017; 78:1255-1263. [DOI: 10.2460/ajvr.78.11.1255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lee K, Hwang HJ, Kim OS, Oh YJ. Assessment of dexmedetomidine effects on left ventricular function using pressure-volume loops in rats. J Anesth 2016; 31:18-24. [PMID: 27817156 DOI: 10.1007/s00540-016-2278-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/24/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE The role of dexmedetomidine on left ventricular function is ambiguous. We analyzed pressure-volume loops to investigate whether dexmedetomidine has a myocardial depressive effect. METHODS Thirty-two Sprague-Dawley rats were anesthetized and a pressure-volume loop catheter was advanced into the left ventricle. Rats were divided into four groups (n = 8 each). The control group received a 10-min infusion of 0.1 ml of normal saline, and the other three groups received 1.0 (Dex1.0 group) , 2.5 (Dex2.5 group), and 5.0 μg/kg (Dex5.0 group) dexmedetomidine in a similar fashion to the control group. Steady-state hemodynamic parameters were recorded. The inferior vena cava was occluded intermittently to assess preload-independent indices. RESULTS Compared with the control group, changes in the Dex1.0 group were insignificant. In the Dex2.5 group, only the systolic blood pressure was higher (vs control, P = 0.03), and other parameters were insignificant. The Dex5.0 group exhibited a lower heart rate, higher systolic blood pressure, higher arterial elastance (vs control, all P < 0.001), and unaltered cardiac output. The Dex5.0 group showed steeper slopes of end-systolic pressure increment and end-systolic pressure-volume relationship than the control, Dex1.0, and Dex2.5 groups (all P < 0.001). Slopes of end-diastolic pressure decrement and end-diastolic pressure-volume relationship did not differ among groups. CONCLUSION Dexmedetomidine had no direct myocardial depressant effect in the rat heart in doses that are similar to those encountered under clinical conditions. Dexmedetomidine did not significantly alter the ability of the heart to cope with bradycardia and greatly increased afterload. Their potentially negative impact on cardiac output was effectively attenuated by improved myocardial contractility and preserved diastolic function in healthy subjects.
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Affiliation(s)
- Kyuho Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Hye Jeong Hwang
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Ok Soo Kim
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Jun Oh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
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Schmeling WT, Farber NE. The Effects of α2-Adrenergic Agonists on the Cardiovascular System. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1177/108925329700100209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- William T. Schmeling
- Departments of Anesthesiology, Pharmacology & Toxicology, The Medical College of Wisconsin, Children's Hospital of Wisconsin, and The Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Neil E. Farber
- Departments of Anesthesiology, Pharmacology & Toxicology, The Medical College of Wisconsin, Children's Hospital of Wisconsin, and The Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Deutsch N, Finkel JC, Gold K, Cheng YI, Slack MC, Kanter J, Quezado ZMN. Dexmedetomidine for patients undergoing diagnostic cardiac procedures: a noninferiority study. Pediatr Cardiol 2013; 34:898-906. [PMID: 23124388 DOI: 10.1007/s00246-012-0568-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/11/2012] [Indexed: 12/01/2022]
Abstract
When anesthetizing children with congenital heart disease for diagnostic cardiac catheterization, anesthesiologists and cardiologists seek to use anesthetic regimens that yield minimal hemodynamic changes and allow for spontaneous ventilations. Recently, dexmedetomidine has been used as an anesthesia adjunct because of its sedative and analgesic properties and minimal ventilatory depressive effects. We tested the hypothesis that the combination of sevoflurane and dexmedetomidine is non-inferior to sevoflurane alone as it refers to hemodynamic measurements during diagnostic cardiac catheterization in children with a transplanted heart, one ventricle (Fontan procedure), or normal cardiac physiology. Patients were anesthetized with inhalation of sevoflurane in nitrous oxide/oxygen and, after baseline hemodynamic measurements, successive boluses of dexmedetomidine followed by continuous infusion were administered. In this study, non-inferiority was shown when differences at steady-state (dexmedetomidine + sevoflurane) compared to baseline (sevoflurane alone) and its associated 95% confidence interval fell completely within the range of plus or minus 20%. Forty-one (26 normal physiology, 9 cardiac transplantation, and 6 Fontan) patients were enrolled. Non-inferiority of sevoflurane + dexmedetomidine compared with sevoflurane alone was shown for heart rate, but not for arterial blood pressure in patients with normal and cardiac transplant physiology. In patients with normal cardiac physiology, non-inferiority was demonstrated for bispectral index. Therefore, while the lack of depressive respiratory effects and non-inferiority for heart rate are desirable, the lack of non-inferiority of dexmedetomidine + sevoflurane combination for arterial blood pressure do not justify the routine use of this combination compared with sevoflurane alone for children with congenital heart disease undergoing cardiac catheterization.
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Affiliation(s)
- Nina Deutsch
- Division of Anesthesiology and Pain Medicine, Children's National Medical Center, George Washington University, 111 Michigan Avenue, NW, Washington, DC 20010, USA.
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10
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Biermann K, Hungerbühler S, Mischke R, Kästner SBR. Sedative, cardiovascular, haematologic and biochemical effects of four different drug combinations administered intramuscularly in cats. Vet Anaesth Analg 2012; 39:137-50. [DOI: 10.1111/j.1467-2995.2011.00699.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jooste EH, Muhly WT, Ibinson JW, Suresh T, Damian D, Phadke A, Callahan P, Miller S, Feingold B, Lichtenstein SE, Cain JG, Chrysostomou C, Davis PJ. Acute hemodynamic changes after rapid intravenous bolus dosing of dexmedetomidine in pediatric heart transplant patients undergoing routine cardiac catheterization. Anesth Analg 2010; 111:1490-6. [PMID: 21059743 DOI: 10.1213/ane.0b013e3181f7e2ab] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Dexmedetomidine is a highly selective α(2)-adrenoceptor agonist with sedative, anxiolytic, and analgesic properties that has minimal effects on respiratory drive. Its sedative and hypotensive effects are mediated via central α(2A) and imidazoline type 1 receptors while activation of peripheral α(2B)-adrenoceptors result in an increase in arterial blood pressure and systemic vascular resistance. In this randomized, prospective, clinical study, we attempted to quantify the short-term hemodynamic effects resulting from a rapid i.v. bolus administration of dexmedetomidine in pediatric cardiac transplant patients. METHODS Twelve patients, aged 10 years or younger, weighing ≤40 kg, presenting for routine surveillance of right and left heart cardiac catheterization after cardiac transplantation were enrolled. After an inhaled or i.v. induction, the tracheas were intubated and anesthesia was maintained with 1 minimum alveolar concentration of isoflurane in room air, fentanyl (1 μg/kg), and rocuronium (1 mg/kg). At the completion of the planned cardiac catheterization, 100% oxygen was administered. After recording a set of baseline values that included heart rate (HR), systolic blood pressure, diastolic blood pressure, central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure, and thermodilution-based cardiac output, a rapid i.v. dexmedetomidine bolus of either 0.25 or 0.5 μg/kg was administered over 5 seconds. The hemodynamic measurements were repeated at 1 minute and 5 minutes. RESULTS There were 6 patients in each group. Investigation suggested that systolic blood pressure, diastolic blood pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure, and systemic vascular resistance all increased at 1 minute after rapid i.v. bolus for both doses and decreased significantly to near baseline for both doses by 5 minutes. The transient increase in pressures was more pronounced in the systemic system than in the pulmonary system. In the systemic system, there was a larger percent increase in the diastolic pressures than the systolic pressures. Cardiac output, central venous pressure, and pulmonary vascular resistance did not change significantly. HR decreased at 1 minute for both doses and was, within the 0.5 μg/kg group, the only hemodynamic variable still changed from baseline at the 5-minute time point. CONCLUSION Rapid i.v. bolus administration of dexmedetomidine in this small sample of children having undergone heart transplants was clinically well tolerated, although it resulted in a transient but significant increase in systemic and pulmonary pressure and a decrease in HR. In the systemic system, there is a larger percent increase in the diastolic pressures than the systolic pressures and, furthermore, these transient increases in pressures were more pronounced in the systemic system than in the pulmonary system.
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Affiliation(s)
- E H Jooste
- Department of Pediatric Anesthesia, Children's Hospital, Pittsburgh, PA 15201, USA.
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Zhang X, Schmidt U, Wain JC, Bigatello L. Bradycardia leading to asystole during dexmedetomidine infusion in an 18 year-old double-lung transplant recipient. J Clin Anesth 2010; 22:45-9. [DOI: 10.1016/j.jclinane.2009.06.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 06/11/2009] [Accepted: 06/24/2009] [Indexed: 12/01/2022]
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13
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Enouri SS, Kerr CL, McDonell WN, O'Sullivan ML, Neto FJT. Effects of a peripheral α2adrenergic-receptor antagonist on the hemodynamic changes induced by medetomidine administration in conscious dogs. Am J Vet Res 2008; 69:728-36. [DOI: 10.2460/ajvr.69.6.728] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Belda E, Laredo FG, Escobar M, Soler M, Lucas X, Agut A. Sedative and cardiorespiratory effects of three doses of romifidine in comparison with medetomidine in five cats. Vet Rec 2008; 162:82-7. [PMID: 18204032 DOI: 10.1136/vr.162.3.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study was designed to compare the effects of three doses of romifidine (200, 400 and 600 microg/kg) with medetomidine (80 microg/kg) administered intramuscularly to five cats. The quality of sedation and the cardiovascular and respiratory effects of each treatment were evaluated, and the onset and duration of the sedation, and the cats' recovery times, were measured. Cardiorespiratory variables were also analysed. The dose of 200 microg/kg romifidine was clinically superior to the other doses of romifidine, providing moderate sedation, with minor cardiorespiratory and other adverse effects. However none of the doses of romifidine induced as deep and reliable sedation as the dose of medetomidine.
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Affiliation(s)
- E Belda
- Departamento de Medicina y Cirugía Animal, Universidad de Murcia, Campus de Espinardo, 30100 Espinardo, Murcia, Spain
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Finkel JC, Johnson YJ, Quezado ZMN. The use of dexmedetomidine to facilitate acute discontinuation of opioids after cardiac transplantation in children. Crit Care Med 2005; 33:2110-2. [PMID: 16148487 DOI: 10.1097/01.ccm.0000178183.21883.23] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report the use of dexmedetomidine to facilitate rapid opioid and benzodiazepine withdrawal in children with transplanted hearts and to review the receptor physiology and pharmacodynamic impact of dexmedetomidine on the denervated heart. DESIGN Case series. SETTING Intensive care unit at a tertiary pediatric medical center. PATIENTS The series included a 6-month-old infant with pulmonary atresia who had a 3-month exposure to high-dose opioids and benzodiazepines and had undergone cardiac transplantation 4 wks before the use of dexmedetomidine and a 7-yr-old boy who had been sedated while undergoing extracorporeal membrane oxygenation for 3 wks before transplantation and started to receive dexmedetomidine 3 days after transplantation. INTERVENTION Administration of dexmedetomidine to facilitate the discontinuation of opioids and benzodiazepine. MAIN RESULT Successful rapid withdrawal from opioids and benzodiazepines while maintaining hemodynamic stability. CONCLUSION To our knowledge, this report describes the first use of dexmedetomidine to facilitate opioid withdrawal in children with a cardiac transplant. Dexmedetomidine allowed for the preservation of satisfactory hemodynamic parameters during acute withdrawal from opioids in children with denervated hearts.
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Affiliation(s)
- Julia C Finkel
- Department of Anesthesiology, Children's National Medical Center, George Washington University, Washington, DC, USA
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Murrell JC, Hellebrekers LJ. Medetomidine and dexmedetomidine: a review of cardiovascular effects and antinociceptive properties in the dog. Vet Anaesth Analg 2005; 32:117-27. [PMID: 15877658 DOI: 10.1111/j.1467-2995.2005.00233.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Alpha(2)-adrenoreceptor agonists (alpha(2)-agonists) are commonly used in small animal anaesthesia for their potent sedative and analgesic properties, although concerns about their cardiovascular effects have prevented their full adoption into veterinary practice. Research into alpha(2) adrenoreceptor agonists and their clinical use is extensive, therefore this review focuses on the use of dexmedetomidine and medetomidine in dogs. Emphasis is given to the cardiovascular effects and antinociceptive action of these agents.
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Affiliation(s)
- Joanna C Murrell
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, University of Utrecht, the Netherlands. j.c.murrell@
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Kuusela E, Vainio O, Kaistinen A, Kobylin S, Raekallio M. Sedative, analgesic, and cardiovascular effects of levomedetomidine alone and in combination with dexmedetomidine in dogs. Am J Vet Res 2001; 62:616-21. [PMID: 11327474 DOI: 10.2460/ajvr.2001.62.616] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether a high dose of levomedetomidine had any pharmacologic activity or would antagonize the sedative and analgesic effects of dexmedetomidine in dogs. ANIMALS 6 healthy Beagles. PROCEDURE Each dog received the following treatments on separate days: a low dose of levomedetomidine (10 microg/kg), IV, as a bolus, followed by continuous infusion at a dose of 25 microg/kg/h; a high dose of levomedetomidine (80 microg/kg), IV, as a bolus, followed by continuous infusion at a dose of 200 microg/kg/h; and a dose of isotonic saline (0.9% NaCl) solution, IV, as a bolus, followed by continuous infusion (control). For all 3 treatments, the infusion was continued for 120 minutes. After 60 minutes, a single dose of dexmedetomidine (10 microg/kg) was administered IV. Sedation and analgesia were scored subjectively, and heart rate, blood pressure, respiratory rate, arterial blood gas partial pressures, and rectal temperatures were monitored. RESULTS Administration of levomedetomidine did not cause any behavioral changes. However, administration of the higher dose of levomedetomidine enhanced the bradycardia and reduced the sedative and analgesic effects associated with administration of dexmedetomidine. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that administration of dexmedetomidine alone may have some cardiovascular benefits over administration of medetomidine, which contains both dexmedetomidine and levomedetomidine. Further studies are needed to confirm the clinical importance of the effects of levomedetomidine in dogs.
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Affiliation(s)
- E Kuusela
- Department of Clinical Sciences, University of Helsinki, Finland
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Blake DW, Ludbrook J, Van Leeuwen AF. Dexmedetomidine and haemodynamic responses to acute central hypovolaemia in conscious rabbits. Clin Exp Pharmacol Physiol 2000; 27:801-9. [PMID: 11022973 DOI: 10.1046/j.1440-1681.2000.03345.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. Effects of the alpha2-adrenoceptor agonist dexmedetomidine on vasoconstrictor and heart rate (HR) responses to acute central hypovolaemia were studied in eight chronically instrumented rabbits. We compared intravenous (i.v.) and fourth ventricular (V4) dexmedetomidine (0.1-10 microg/kg) and the reversal of effects by the alpha2-adrenoceptor antagonist idazoxan and the opioid agonist alfentanil. 2. Gradual inflation of an inferior vena cava (IVC) cuff reduced cardiac index (CI) by 8%/min, with progressive vasoconstriction and increased HR. In control rabbits, at approximately 40% baseline CI, there was sudden decompensation with failure of vasoconstriction and a fall in mean arterial pressure (MAP). 3. Dexmedetomidine (i.v. and V4) reduced resting MAP and HR and caused an earlier decompensation during central hypovolaemia. Intravenous dexmedetomidine (3 and 10 microg/kg) also reduced the slope of the initial vasoconstrictor response and the maximum HR. 4. The effects of dexmedetomidine were reversed by the antagonist idazoxan, which prevented the decompensation phase. Intravenous alfentanil was also effective in restoring the vasoconstrictor response and delaying decompensation with hypovolaemia after dexmedetomidine. Combining dexmedetomidine with an opioid, such as alfentanil, may provide the benefit of reduced sympathetic tone without increased risk of cardiovascular collapse.
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Affiliation(s)
- D W Blake
- Department of Pharmacology, University of Melbourne Parkville, Victoria, Australia.
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Mantz J. Alpha2-adrenoceptor agonists: analgesia, sedation, anxiolysis, haemodynamics, respiratory function and weaning. Best Pract Res Clin Anaesthesiol 2000. [DOI: 10.1053/bean.2000.0094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Roekaerts PM, Lawrence CJ, Prinzen FW, de Lange S. Alleviation of the peripheral hemodynamic effects of dexmedetomidine by the calcium channel blocker isradipine. Acta Anaesthesiol Scand 1997; 41:364-70. [PMID: 9113181 DOI: 10.1111/j.1399-6576.1997.tb04700.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alpha 2-adrenergic agonists have peripheral vasoconstrictive effects and central sympatholytic and sedative effects. Whereas the latter are the basis of their use in anesthesia, the former could limit their clinical application. METHODS To study whether a vasodilator could alleviate the systemic and coronary vasoconstrictor effects of dexmedetomidine without influencing the central sympatholytic effects, the calcium channel blocker isradipine was infused after a high dose of dexmedetomidine in anesthetized dogs. RESULTS Dexmedetomidine 10 micrograms.kg-1 decreased plasma concentrations of norepinephrine and epinephrine by more than 90%, heart rate by 39%, cardiac output by 64%, dp/dtmax by 29% and increased mean arterial pressure by 55% and the left ventricular end-diastolic pressure (LVEDP) 4-fold as compared to baseline. In addition, coronary blood flow decreased by 52% and coronary venous oxygen saturation by 51%. Isradipine could completely antagonize all the coronary and systemic hemodynamic changes induced by dexmedetomidine, but only partially he increase in LVEDP. Isradipine caused no changes in plasma catecholamine levels. CONCLUSION Isradipine could alleviate the peripheral hemodynamic actions of dexmedetomidine while having no effect on its central sympatholytic properties.
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Affiliation(s)
- P M Roekaerts
- Department of Anesthesiology, University Hospital of Maarstricht, The Nederlands
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Cullen LK. Medetomidine sedation in dogs and cats: a review of its pharmacology, antagonism and dose. THE BRITISH VETERINARY JOURNAL 1996; 152:519-35. [PMID: 8885463 DOI: 10.1016/s0007-1935(96)80005-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Medetomidine is a relatively new sedative analgesic in dogs and cats but some precautions are required when using it. It is a potent alpha 2-adrenoceptor agonist and stimulates receptors centrally to produce dose-dependent sedation and analgesia and receptors centrally and peripherally to cause marked bradycardia and decrease the cardiac output. While hypotension occurs frequently, higher doses of the sedative can raise the blood pressure due to an affect on peripheral receptors. Slowing of the respiratory rate is a frequent effect of medetomidine with some dogs showing signs of cyanosis. Other actions that follow medetomidine use are slowing of gastrointestinal motility, hypothermia, changes to endocrine function and, occasionally, vomiting and muscle twitching. The clinical use of medetomidine in dogs and cats is discussed. Recommended dose rates are presented along with precautions that should be taken when it is used alone for sedation, as an anaesthetic premedicant or in combination with ketamine, propofol or opioids. Hypoxaemia occurs frequently in dogs given medetomidine and propofol. The actions of medetomidine can be rapidly reversed with the specific alpha 2-adrenoceptor antagonist, atipamezole, which is an advantage because undesirable and sedative actions of medetomidine can be terminated.
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Affiliation(s)
- L K Cullen
- School of Veterinary Studies, Murdoch University, Australia
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Jalonen J, Halkola L, Kuttila K, Perttilä J, Rajalin A, Savunen T, Scheinin M, Valtonen M. Effects of dexmedetomidine on coronary hemodynamics and myocardial oxygen balance. J Cardiothorac Vasc Anesth 1995; 9:519-24. [PMID: 8547552 DOI: 10.1016/s1053-0770(05)80134-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE alpha 2-adrenergic agonists decrease central sympathetic outflow and maintain normal transmural myocardial blood flow distribution, but intravenous bolus doses of these agents can also induce excessive coronary vasoconstriction and myocardial ischemia. The hypothesis of the present study was that a rapid intravenous bolus of dexmedetomidine, a specific alpha 2-adrenergic agonist, will cause coronary vasoconstriction and accompanying myocardial ischemia in young pigs. DESIGN Prospective, controlled study on experimental animals. SETTING Animal laboratory of a university cardiorespiratory research center. PARTICIPANTS Twelve domestic 8-week-old open-chest pigs, anesthetized with high-dose fentanyl. Another six pigs served as controls. INTERVENTIONS Sequential intravenous dexmedetomidine boluses of 3, 10, and 30 mg/kg were administered, and responses were measured during peak changes (2 minutes after injection) and during recovery after each dose. MEASUREMENTS AND MAIN RESULTS Left anterior descending coronary artery blood flow, calculated regional coronary vascular resistance, myocardial extraction of oxygen and lactate, plasma catecholamine levels, and conventional central hemodynamic parameters were measured. The two higher doses of dexmedetomidine induced 21% and 29% immediate increases in left anterior descending coronary artery blood flow. At the same time mean systemic blood pressure and pulmonary capillary wedge pressure increased, and calculated regional coronary vascular resistance increased. Myocardial extraction of oxygen and lactate remained unchanged. CONCLUSIONS Large intravenous doses of dexmedetomidine caused moderate regional coronary vasoconstriction without metabolic signs of myocardial ischemia in young domestic pigs at the same time as a marked vasoconstrictive response in the systemic circulation.
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Affiliation(s)
- J Jalonen
- Department of Anesthesiology, University of Turku, Finland
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Abstract
The effects of medetomidine on load-dependent and relatively load-independent indices of left ventricular contractility and hemodynamics were studied in 8 chloralose-anesthetized, autonomic-blocked dogs. Left ventricular contractility was assessed by the maximum rate of increase in pressure (dP/dtmax), the slope of the end-systolic pressure volume relationship (Ees), preload recruitable stroke work (PRSW), and dP/dtmax-end-diastolic volume relation (SdPV). Dogs received 5 or 10 micrograms/kg of medetomidine IV. The dP/dtmax decreased significantly 30 minutes after both doses of medetomidine. The Ees did not change. Both SdPV and PRSW increased 5 minutes after both doses of medetomidine. Mean arterial pressure, left-ventricular end-diastolic and end-systolic pressures, peripheral vascular resistance and effective arterial elastance increased 5 minutes after both doses of medetomidine. Stroke volume, cardiac output, and stroke work decreased 5 minutes after medetomidine administration. End-diastolic volume did not change. End-systolic volume increased but the difference was not significant. Our study suggests that medetomidine increases inotropy and vascular resistance in autonomic-blocked dogs and that both ventricular and vascular responses to pharmacological manipulation must be considered for a complete assessment of the inotropic effects of a drug.
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Affiliation(s)
- H S de Morais
- Departamento de Clínicas Veterinárias, Universidade Estadual de Londrina, Paraná, Brazil
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Flacke WE, Flacke JW, Bloor BC, McIntee DF, Sagan M. Effects of dexmedetomidine on systemic and coronary hemodynamics in the anesthetized dog. J Cardiothorac Vasc Anesth 1993; 7:41-9. [PMID: 8094301 DOI: 10.1016/1053-0770(93)90117-4] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In addition to central effects, which are the basis of their use in anesthesiology, alpha 2-adrenergic agonists have direct peripheral cardiovascular effects. Dexmedetomidine (DM) has been found to depress cardiac function in dogs, even after autonomic denervation. The present experiments evaluated the effects of DM on coronary flow, myocardial oxygen extraction, and cardiac function in intact, open chest dogs under enflurane anesthesia. Heart rate (HR), mean arterial pressure (MAP), left ventricular end-diastolic pressure (LVEDP), the first derivative of systolic left ventricular pressure (dP/dtmax), and flow in the left anterior descending coronary artery (CBF) were measured and continuously recorded. Cardiac output (CO), plasma catecholamines (CA), hemoglobin and oxygen saturation in arterial, mixed venous, and coronary sinus blood were measured at intervals. Cardiac index (CI), systemic vascular resistance index (SVRI), regional coronary vascular resistance (CVR), and oxygen concentration differences across the systemic [C(a-v)O2], and coronary [C(a-cs)O2] circulations were calculated. DM doses of 0.25, 0.5, 1.0, 2.0, and 4.0 micrograms/kg were given IV at 20-minute intervals. Measurements and samples were taken at peak drug effects and just prior to the next dose. The alpha 2-antagonist atipamezole, 0.5 mg/kg, was given after the last dose of DM. DM caused immediate dose-dependent increases in SVRI, CVR, LVEDP, C(a-v)O2, and C(a-cs)O2, and decreases in HR, and CI, with recovery between doses. DP/dtmax declined after the first two doses and stabilized thereafter, as plasma CA fell to minimal levels. Atipamezole completely reversed all changes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W E Flacke
- Department of Anesthesiology, University of California, Los Angeles 90024-1778
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