Effects of calcium channel antagonists on carotid sinus baroreflex control of arterial pressure and heart rate in anesthetized dogs

Verapamil buffering effect on the abrupt elevation in blood pressure, linkage with microcirculatory blood flow

1 We studied the effects of verapamil on sudden elevation in blood pressure, microcirculation and arterial baroreflex sensitivity (BRS). 2 Thirty experiments (10 controls and 20 with verapamil) were performed in rabbits sedated using pentobarbital infusion (5 mg kg(-1) h(-1)). 3 BRS, mean femoral artery blood pressure (MAP), heart rate (HR) and ear lobe skin microcirculatory blood flow, estimated using microphotoelectric plethysmography (MPPG), were simultaneously measured during 30 min of verapamil infusion (20 mug kg(-1) min(-1)). BRS was assessed from HR and MAP responses to intravenous phenylephrine (Ph) and by power spectral analysis using transfer function (TF) from MAP to the HR (BRS(Ph,TF)). 4 Verapamil significantly increased microcirculatory blood flow, and decreased BRS(Ph,TF) and phenylephrine-induced abrupt elevation in MAP (MAP(AE)). 5 A significant inverse correlation was found between verapamil-induced changes in MAP(AE), BRS and in microcirculatory blood flow, measured before phenylephrine blood pressure ramps (DeltaMAP(AE) with DeltaBRS(TF), r = -0.47, P < 0.036; DeltaMAP(AE) with DeltaMPPG, r = -0.49, P < 0.025). 6 These results suggest involvement of the arterial baroreflex and vascular blood pressure-buffering mechanisms, their enhancement by verapamil, and thus a potential benefit of verapamil in cardiovascular conditions where patients present with abrupt high elevations in blood pressure.

The effect of suction catheter insertion and tracheal stimulation in adults with severe brain injury

OBJECTIVE

To determine the effect of suction catheter insertion and tracheal stimulation on cerebrovascular and systemic vascular status in adults with severe traumatic brain injury.

DESIGN

Quasi-experimental, within-subject design.

SETTING

Two university-affiliated critical care units.

SUBJECTS

Thirty intubated and mechanically ventilated adults with severe brain injury. The participants' average age was 31 +/- 15 years.

OUTCOME MEASURES

Mean intracranial pressure (MICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and heart rate (HR) were measured.

INTERVENTION

Endotracheal suction catheter insertion with tracheal stimulation was performed.

RESULTS

Suction catheter insertion and tracheal stimulation, isolated from other components of the suctioning procedure, significantly increased MICP, MAP, and CPP. HR was not significantly increased. During the application of negative pressure for actual suctioning, MICP and HR significantly increased, whereas MAP and CPP did not significantly change compared with catheter insertion.

CONCLUSION

Tracheal stimulation during suction catheter insertion initiates both cerebrovascular and systemic vascular responses during the suctioning procedure. Study findings suggest that a potentially productive direction for intervention research is to identify ways to minimize airway stimulation during the suctioning procedure.

Pharmacodynamics and pharmacokinetics of clentiazem and diltiazem in closed-chest anesthetized dogs

In the present study we investigated the relationship between pharmacodynamic and pharmacokinetic properties of the benzothiazepine-like calcium antagonists, clentiazem and diltiazem. Experiments were carried out in closed-chest anesthetized dogs, instrumented for hemodynamic recording and blood sampling. Clentiazem and diltiazem bolus injections (400 micrograms/kg) were administered intravenously, and subgroups of animals were sacrificed at 15, 30, 60, or 120 minutes Clentiazem and diltiazem plasma and myocardial levels were determined by high performance liquid chromatography (HPLC). Clentiazem elicited a more marked reduction in mean arterial pressure (-17% for clentiazem vs. -12% for diltiazem), along with an attenuation of the expected positive reflex chronotropic response. Pharmacokinetic analysis revealed that clentiazem had a greater volume of distribution (33 +/- 16 l vs. 15 +/- 9 l for diltiazem), while the half-life of elimination (t1/2 beta) was similar (55 +/- 21 minutes vs. 59 +/- 23 minutes). The kinetic disposition profile of both drugs was analyzed through myocardial/plasma concentration ratios. In the distribution phase (0-15 minutes), this ratio was similar (26 +/- 2 for clentiazem vs. 18 +/- 5 diltiazem), suggesting that the myocardium was not a preferential site of distribution for either drugs. Data collected within the elimination phase indicate significant myocardial retention for clentiazem; at the end of the study period, the myocardial/plasma concentration ratio was twofold higher for clentiazem. The observed retention of clentiazem in the myocardium may be responsible for attenuation of the baroreflex. Clentiazem increased potency was confirmed by the fact that its hypotensive and cardioinhibitory effects were observed at lower plasma concentrations.

Differential age-dependent attenuation of reflex tachycardia by verapamil in rats

To determine if verapamil alters baroreflex function differently depending on age, reflex heart rate responses to intravenous infusions of phenylephrine or sodium nitroprusside were compared in conscious 5- and 14-month-old rats before and after daily oral administration of verapamil (100 mg/kg) for 6 days. The effects of verapamil on parasympathetic and sympathetic mediation of heart rate were also assessed by repeating baroreflex tests after treatment with either propranolol or atropine. All reflex heart rate responses were initially smaller in 14- than in 5-month-old rats. Regardless of age, magnitude of reflex bradycardia or the effects on it of either cholinergic or beta-adrenergic blockade, were unaffected by verapamil. By contrast, reflex tachycardia which was attenuated in both age groups, was decreased further by subsequent cholinergic or beta-adrenergic blockade in 5-month-old rats, but only by cholinergic blockade in 14-month-old rats. These findings suggest that while verapamil did not affect autonomic mediation of reflex bradycardia, it reduced that of reflex tachycardia differently depending on age. Whereas it attenuated both sympathetic and parasympathetic mediation of reflex tachycardia in 5-month-old rats, it attenuated only sympathetic mediation in 14-month-old rats.