Interactive ventilatory effects of two respiratory stimulants, caffeine and doxapram, in newborn lambs

Caffeine and doxapram are two respiratory stimulants used in the treatment of apnea in newborns. When used concurrently, these drugs may produce interactive effects on the control of breathing in the newborn. The ventilatory effects of these drugs, given alone or together, were measured during 150 min of drug infusion in two groups of awake lambs 2-5 days old. The first group (n = 5) received a caffeine loading dose of 10 mg/kg followed by a maintenance dose of 0.1 mg/kg/h and incremental doses of doxapram: 0.25, 0.5, 1.25 and 2.5 mg/kg/30 min. The second group (n = 5) received a doxapram loading dose of 5.5 mg/kg followed by a maintenance dose of 1 mg/kg/h and incremental doses of caffeine: 2.5, 5.0, 7.5 and 10.0 mg/kg/30 min. In the first group, ventilation increased after the caffeine loading dose from 566 +/- 55 to 680 +/- 74 ml/kg/min (plasma caffeine = 14.7 +/- 1.6 mg/l) and progressively increased with the addition of incremental doses of doxapram up to 1,000 +/- 108 ml/kg/min at 2.5 mg/kg of doxapram (p less than 0.001 compared to baseline and caffeine loading dose). In contrast, in the second group, the doxapram loading dose markedly increased ventilation from 582 +/- 50 to 936 +/- 75 (p less than 0.002 and p less than 0.04 compared to caffeine loading dose) at plasma doxapram of 5.3 +/- 0.8 mg/l, but incremental doses of caffeine had no effects. We conclude that doxapram exerts a brisk and powerful respiratory stimulant effect and produces an additional dose-dependent ventilatory response when added to caffeine.

Effect of sleep on regional blood flow distribution in piglets

The regional distribution of blood flow to the brain and to other major organs was studied during wakefulness and sleep in growing piglets. A young group was studied at 6.8 +/- 1.3 d of age and an older group at 33.5 +/- 5.5 d. Two d before the experiments, we instrumented the animals for measurement of blood flow by the microsphere technique. We determined sleep state using EEG and behavioral criteria. Although we did not find significant differences in blood gas tensions and cardiac output with changes in behavioral states, we did note a number of important changes in brain and muscle blood flow with sleep. 1) Although total brain blood flow changed little between wakefulness and sleep at both ages, regional differences existed. Indeed, at both ages, during rapid eye movement sleep (active sleep), blood flow to the thalamus-hypothalamus and brainstem was significantly higher than during wakefulness (p less than 0.025); in older piglets, blood flow to these two regions was significantly lower in quiet sleep than in wakefulness (p less than 0.05). 2) Blood flow to most skeletal muscle groups, and particularly to the diaphragm, was lower during sleep than during wakefulness. 3) Age did not have a significant effect on the regional distribution of blood flow during sleep. We conclude that behavioral states influence the regional distribution of blood flow in early life, but not in an age-dependent fashion. We speculate that, because no difference was observed in other hemodynamic variables, the regional changes in organ blood flow with sleep most probably reflect the differences in local metabolic needs.

Effect of enkephalins on cardiac output and regional blood flow in conscious dogs

Page H1656: C. L. Rosen, A. Cote, and G. G. Haddad. “Effect of enkephalins on cardiac output and regional blood flow in conscious dogs.” Figures 5 and 6 should appear as follows.

(See PDF)

Effect of enkephalins on cardiac output and regional blood flow in conscious dogs

Page H1656: C. L. Rosen, A. Cote, and G. G. Haddad. “Effect of enkephalins on cardiac output and regional blood flow in conscious dogs.” Figures 5 and 6 should appear as follows.

(See PDF)

Effect of enkephalins on cardiac output and regional blood flow in conscious dogs

To investigate the effects of enkephalins on cardiac output and regional blood flow, we administered D-Ala-D-Leu-enkephalin (DADLE) intracisternally (ic) to 14 chronically instrumented unanesthetized dogs. Measurements were made at base line, 20, 45, and 75 min after DADLE (25 or 125 micrograms/kg) and 15 min after naloxone (5 micrograms/kg ic). After 125 micrograms/kg DADLE, all animals developed hypoventilation, bradycardia, and decreased O2 consumption without hypotension. Cardiac output decreased (-34%), but brain blood flow increased (+110%). Blood flow decreased to the diaphragm (-38%), heart (-21%), skeletal muscle (-40%), skin (-67%), pancreas (-79%), and gastrointestinal tract (-26%). After 25 micrograms/kg DADLE, there were no consistent changes in cardiac output or regional blood flow. Four additional animals (without DADLE) were exposed to altered inspired gases to reproduce the blood gas changes after DADLE. These animals developed hyperventilation without bradycardia and increased brain (+114%) and diaphragm (+649%) blood flow. We conclude that centrally administered enkephalins produce 1) a parallel decrease in ventilation, heart rate, O2 consumption, and cardiac output and 2) a major blood flow redistribution, primarily dictated by the effects of opioids on ventilation, heart rate, and metabolism.