Document Detail


Systemic and regional hemodynamic effects of high-dose epinephrine infusion in hypoxic piglets resuscitated with 100% oxygen.
MedLine Citation:
PMID:  17577139     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Shock and poor regional perfusion are common in asphyxiated neonates. We compared the systemic and regional hemodynamic effects of high-dose epinephrine (E) with those of dopamine combined with low-dose epinephrine (DE) infusions in a neonatal model of hypoxia-reoxygenation. Neonatal piglets (1-3 days, 1.5-2.5 kg) were acutely instrumented to continuously monitor systemic arterial pressure (SAP), pulmonary artery pressure, cardiac index (CI), and blood flows at the left common carotid, superior mesenteric, and renal arteries. Either epinephrine (1 microg.kg(-1).min(-1)) or dopamine (10 microg.kg(-1).min(-1)) and epinephrine (0.2 microg.kg(-1).min(-1)) were given for 2 h in hypoxic piglets resuscitated with 100% oxygen (n = 8 per group) in a randomized blinded fashion. Control piglets received hypoxia and reoxygenation but no catecholamine infusion (n = 7). Alveolar hypoxia (PaO2, 33-37 mmHg) caused reduced CI (89-92 vs. 171-186 mL.kg(-1).min(-1) of baseline, P < 0.05), hypotension (SAP, 28-32 mmHg) with pH 7.05 to 7.10, and decreased regional flows. Upon reoxygenation, CI and SAP improved but gradually deteriorated to 131 to 136 mL.kg(-1).min(-1) and 41 to 49 mmHg at 2 h of reoxygenation, respectively. E and DE administration similarly improved CI (167 +/- 60 and 166 +/- 55 vs. 121 +/- 35 mL.kg(-1).min(-1) of controls) and SAP (53 +/- 7 and 56 +/- 10 vs. 39 +/- 8 mmHg of controls), respectively, and the pulmonary vascular resistance (vs. controls, all P < 0.05). Heart rate and pulmonary artery pressure were not different between groups. Systemic oxygen delivery and consumption were increased in E- and DE-treated groups with no difference in extraction ratio between groups. There were no differences in regional blood flows and oxygen delivery between groups. After hyperlactatemia with hypoxia, plasma lactate levels decreased with no difference between groups. Epinephrine given as the sole agent is as effective as dopamine and low-dose epinephrine combined in treating shock and hypotension that follow the resuscitation of hypoxic neonatal piglets, with no reduction in regional perfusion.
Authors:
Po-Yin Cheung; Sameh Abozaid; Zakariya Al-Salam; Scott Johnson; Yingqian Li; David Bigam
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Shock (Augusta, Ga.)     Volume:  28     ISSN:  1073-2322     ISO Abbreviation:  Shock     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-12     Completed Date:  2008-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421564     Medline TA:  Shock     Country:  United States    
Other Details:
Languages:  eng     Pagination:  491-7     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. poyin@ualberta.ca
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MeSH Terms
Descriptor/Qualifier:
Animals
Animals, Newborn
Anoxia / drug therapy*,  physiopathology
Blood Flow Velocity / drug effects
Blood Pressure / drug effects
Catecholamines / administration & dosage,  pharmacology
Dopamine / administration & dosage,  pharmacology
Dose-Response Relationship, Drug
Epinephrine / administration & dosage,  pharmacology*
Heart Rate / drug effects
Hyperbaric Oxygenation / methods*
Oxygen / administration & dosage,  metabolism,  therapeutic use*
Random Allocation
Stroke Volume / drug effects
Swine
Vasoconstrictor Agents / administration & dosage,  pharmacology
Chemical
Reg. No./Substance:
0/Catecholamines; 0/Vasoconstrictor Agents; 51-43-4/Epinephrine; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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