Effects of the intravenously administered anaesthetics ketamine, propofol, and thiamylal on the cortical renal blood flow in rats

A cardiovascular model for renal perfusion during cardiopulmonary bypass surgery

Acute kidney injury (AKI) is a major complication following cardiac surgery requiring cardiopulmonary bypass (CPB). It is likely that poor renal perfusion contributes to the occurrence of AKI, via renal hypoxia, so it is imperative to maintain optimal renal perfusion during CPB. We have developed a straightforward cardiovascular perfusion model with parameter values calibrated against experimental and/or clinical data from several independent studies of CPB in humans and animals. Following model development and calibration, we performed a one-at-a-time parametric study to investigate the response of renal perfusion to several variables during CPB, namely pump flow (denoted CO for 'cardiac output'), renal vascular resistance, and non-renal vascular resistance. From the parametric study, we have found that all three parameters had a similarly strong influence on renal perfusion. We simulated three potential strategies for maintaining optimum renal perfusion during CPB and tested their effectiveness. The strategies were: (1) increasing the pump flow; (2) administrating noradrenaline (vasopressor); and (3) administrating fenoldopam (renal vasodilator). Simulations have revealed that administration of fenoldopam is likely to be the most effective of the three strategies. Other findings from our simulations are that increasing pump flow is less effective when central venous pressure is elevated. Further, renal autoregulation is likely inoperative during CPB, as evidenced by an unchanging renal vascular resistance with increasing CO and blood pressure. The cardiac-renal perfusion model developed in this study can be linked with other kidney models to simulate the changes in renal oxygenation during CPB.

Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery

Background

Acute kidney injury is a common complication after cardiac surgery with cardiopulmonary bypass. The authors evaluated the effects of normothermic cardiopulmonary bypass on renal blood flow, glomerular filtration rate, renal oxygen consumption, and renal oxygen supply/demand relationship, i.e., renal oxygenation (primary outcome) in patients undergoing cardiac surgery.

Methods

Eighteen patients with a normal preoperative serum creatinine undergoing cardiac surgery procedures with normothermic cardiopulmonary bypass (2.5 l · min−1 · m−2) were included after informed consent. Systemic and renal hemodynamic variables were measured by pulmonary artery and renal vein catheters before, during, and after cardiopulmonary bypass. Arterial and renal vein blood samples were taken for measurements of renal oxygen delivery and consumption. Renal oxygenation was estimated from the renal oxygen extraction. Urinary N-acetyl-β-d-glucosaminidase was measured before, during, and after cardiopulmonary bypass.

Results

Cardiopulmonary bypass induced a renal vasoconstriction and redistribution of blood flow away from the kidneys, which in combination with hemodilution decreased renal oxygen delivery by 20%, while glomerular filtration rate and renal oxygen consumption were unchanged. Thus, renal oxygen extraction increased by 39 to 45%, indicating a renal oxygen supply/demand mismatch during cardiopulmonary bypass. After weaning from cardiopulmonary bypass, renal oxygenation was further impaired due to hemodilution and an increase in renal oxygen consumption, accompanied by a seven-fold increase in the urinary N-acetyl-β-d-glucosaminidase/creatinine ratio.

Conclusions

Cardiopulmonary bypass impairs renal oxygenation due to renal vasoconstriction and hemodilution during and after cardiopulmonary bypass, accompanied by increased release of a tubular injury marker.

Vasorelaxant mechanisms of ketamine in rabbit renal artery

Background

Ketamine is a non-barbiturate anesthetic agent which has various effects on the cardiovascular system. Among them, ketamine is known for its hypotensive properties. The hypotension is thought to be mediated by a direct effect on vascular smooth muscles. This study is designed to examine the effects of ketamine on KCl- and histamine-induced contraction in isolated rabbit renal arteries.

Methods

Endothelium-intact or -denuded smooth muscle rings were prepared and mounted in myographs for isometric tension measurements. The inhibitory effect of ketamine were investigated in smooth muscle rings precontracted with either 50 mM KCl- or 10 µM histamine.

Results

Ketamine (0.1-100 µg/ml) produced similar concentration-dependent inhibition of contractile responses induced by either 50 mM KCl or 10 µM histamine. The respective IC₅₀ values measured for ketamine following precontractions by 50 mM KCl and 10 µM histamine were 28.9 µg/ml (105.5 µM) and 26.7 µg/ml (97.5 µM). The inhibitory effect of 30 µg/ml ketamine were similarly observed after removal of endothelium or pretreatment with N^G-Nitroarginine Methyl Ester (0.1 mM). The inhibitory effect of 30 µg/ml ketamine on histamine-evoked contraction was reduced by either tetraethylammonium (10 mM) or iberiotoxin, a large conductance Ca²⁺-activated K⁺ channel blocker. However, depletion of intracellular Ca²⁺ stores by ryanodine (10 µM) or thapsigargin (10 µM) showed no significant effect on 30 µg/ml ketamine-induced relaxation. Pre-incubation with 30 µg/ml ketamine significantly inhibited CaCl₂-induced contraction at almost all ranges of concentration.

Conclusions

Ketamine-induced relaxation of rabbit renal arteries is mediated by both the activation of large conductance Ca²⁺-activated K⁺ channel and the inhibition of Ca²⁺ influx.

Increased hypoxia and reduced renal tubular response to furosemide detected by BOLD magnetic resonance imaging in swine renovascular hypertension

Oxygen consumption beyond the proximal tubule is mainly determined by active solute reabsorption, especially in the thick ascending limb of the Loop of Henle. Furosemide-induced suppression of oxygen consumption (FSOC) involves inhibition of sodium transport in this segment, which is normally accompanied by a marked decrease in the intrarenal deoxyhemoglobin detectable by blood oxygen level-dependent (BOLD)-magnetic resonance imaging (MRI). This study tested the hypothesis that the magnitude of BOLD-MRI signal change after furosemide is related to impaired renal function in renovascular hypertension. In 16 pigs with unilateral renal artery stenosis, renal hemodynamics, function, and tubular function (FSOC and fluid concentration capacity) were evaluated in both kidneys using MR and multidetector computerized tomography (MDCT) imaging. Animals with adequate FSOC (23.6 +/- 2.2%, P > 0.05 vs. baseline) exhibited a mean arterial pressure (MAP) of 113 +/- 7 mmHg, and relatively preserved glomerular filtration rate (GFR) of 60 +/- 4.5 ml/min, comparable to their contralateral kidney (66 +/- 4 ml/min, P > 0.05). In contrast, animals with low FSOC (3.1 +/- 2.1%, P = NS vs. baseline) had MAP of 124 +/- 9 mmHg and GFR (22 +/- 6 ml/min) significantly lower than the contralateral kidneys (66 +/- 4 ml/min, P < 0.05). The group with preserved GFR and FSOC showed an increase in intratubular fluid concentration as assessed by MDCT that was greater than that observed in the low GFR group, suggesting better preservation of tubular function in the former group. These results suggest that changes in BOLD-MRI after furosemide can differentiate between underperfused kidneys with preserved tubular function and those with tubular dysfunction. This approach may allow more detailed physiologic evaluation of poststenotic kidneys in renovascular hypertension than previously possible.

Assessment of renal hemodynamics and function in pigs with 64-section multidetector CT: comparison with electron-beam CT

PURPOSE

To prospectively evaluate the feasibility of obtaining reliable measurements of renal hemodynamics and function by using 64-section multidetector CT.

MATERIALS AND METHODS

This study was approved by the Institutional Animal Care and Use Committee. Eight pigs (two with induced unilateral renal artery stenosis) were studied with both electron-beam CT and 64-section multidetector CT at 1-week intervals in randomized order. Both kidneys were scanned repeatedly, without table movement, for about 3 minutes after intravenous (IV) administration of a bolus of contrast medium and again during vasodilator challenge (acetylcholine). Images were reconstructed on each CT console but were analyzed on the same independent workstation. Attenuation changes in the kidneys were plotted as function of time, and time-attenuation curves (TACs) were subsequently analyzed to determine regional perfusion and volume, glomerular filtration rate (GFR), and renal blood flow (RBF). Statistical analysis utilized Student t test, analysis of variance (ANOVA), linear regression, and Bland-Altman analysis.

RESULTS

TACs obtained with multidetector CT were qualitatively similar to those obtained with electron-beam CT, as were the quantitative values of renal perfusion and function. RBF correlated significantly between the two techniques (RBF(MD) = 0.96 . RBF(EB) mL/min; R = 0.77, P < .01). GFR(MD) was also similar to GFR(EB) (77.6 +/- 8.3 vs 79.8 +/- 8.8 mL/min, p > .05). Bland-Altman plots showed good agreement between the two techniques. Both techniques similarly detected the differences between stenotic and contralateral kidneys.

CONCLUSION

The clinical multidetector CT scanner provides reliable measurements of single-kidney hemodynamics and function, which are similar to those obtained with previously validated electron-beam CT.

Nitric oxide induced by ketamine/xylazine anesthesia maintains hepatic blood flow during hypothermia

Among the anesthetics influencing the nitric oxide (NO) pathway, ketamine is widely reported in the literature. We researched the variations in blood physiological parameters following ketamine/xylazine- or pentobarbital-induced anesthesia, with particular emphasis on plasmatic NO levels and oxidative stress-related factors. The effects of ketamine on hepatic blood flow during deep hypothermia were also examined. Adult male Sprague-Dawley rats were anesthetized intraperitoneally with ketamine/xylazine or with sodium pentobarbital. Animals underwent serial blood extraction to analyze acid-base balance and lactate levels in blood, as well as NO, MDA, SH groups, and AST levels in plasma samples. We demonstrated that ketamine leads to increased plasmatic NO levels, induces metabolic acidosis, and causes oxidative damage, though without reaching hepatic toxicity. When experimental hypothermia was induced, ketamine affected hepatic blood flow. Based on these results, we suggest that studies on physiological processes involving NO should exercise caution if anesthesia is induced by ketamine.

Impaired resting perfusion in viable myocardium distal to chronic coronary stenosis in rats

Chronic coronary artery stenosis results in patchy necrosis in the dependent myocardium and impairs global and regional left ventricular (LV) function in rats in vivo. The aim of the present study was to compare regional myocardial blood flow (RMBF) and function (F) in poststenotic myocardium by using magnetic resonance imaging (MRI) and to compare MRI blood flow changes to histological alterations to assess whether RMBF in the viable poststenotic tissue remains normal. MRI was performed in 11 anesthetized Wistar rats with 2-wk stenosis of the left coronary artery. Postmortem, the extent of fibrotic tissue was quantified. Poststenotic RMBF was significantly reduced to 2.21 ± 0.30 ml·g−1·min−1 compared with RMBF in the remote myocardium (4.05 ± 0.50 ml·g−1·min−1). A significant relationship between the poststenotic RMBF (%remote area) and the poststenotic F (%remote myocardium) was calculated ( r = 0.61, P < 0.05). Assuming perfusion in scar tissue to be 32 ± 5% of perfusion of remote myocardium, as measured in five additional rats, and that in remote myocardium to be 114 ± 25% of that in normal myocardium, as assessed in five sham rats, the calculated perfusion in partially fibrotic tissue samples (35.7 ± 5.2% of analyzed area) was 2.88 ± 0.18 ml·g−1·min−1, whereas measured MRI perfusion was only 1.86 ± 0.24 ml·g−1·min−1 ( P < 0.05). These results indicate that resting perfusion in viable poststenotic myocardium is moderately reduced. Alterations in global and regional LV function are therefore secondary to both patchy fibrosis and reduced resting perfusion.

High rectal temperature indicates an increased risk of unexpected recovery in anaesthetized badgers

OBJECTIVE

To identify factors associated with sudden early recovery (SER) from anaesthesia in badgers (Meles meles).

STUDY DESIGN

Experimental trial.

ANIMALS

Ninety-three adult wild badgers.

METHODS

Animals were randomly assigned to receive one of four anaesthetics based on medetomidine (M) ketamine (K) and butorphanol (B) combined in different ratios: (i) MKB 20:40:80 microg kg(-1); (ii) MKB 20:40:60 microg kg(-1); (iii) MKB 20:60:40 microg kg(-1); and (iv) ketamine alone 0.2 mg kg(-1). For each animal, induction time was measured and physiological variables (heart rate, respiratory rate and rectal temperature) were recorded at 5-minute intervals during anaesthesia. Cases of SER were recorded and binary logistic regression applied to identify predictive factors.

RESULTS

Fourteen animals (15%) exhibited SER. Rectal temperature was the only variable that was a significant predictor of SER. Animals showing SER had significantly higher rectal temperatures which, in contrast to other cases, did not fall during the first 10 minutes of anaesthesia, which was when most SERs occurred.

CONCLUSION AND CLINICAL RELEVANCE

We recommend that (i) rectal temperature is closely monitored during wild badger anaesthesia and (ii) that animals with higher than expected temperatures are treated with additional caution.