Catecholamine and Serotonin Response to Cardiopulmonary Bypass

Replogle, Robert L.; Levy, Morris J.; Ra, Dewall; Rc, Lillehei

doi:10.1016/s0022-5223(19)32928-9

Cited by 115 publications

(5 citation statements)

References 23 publications

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“…This concept is strengthened by the fact that plasma catecholamines regularly increase fiveto fifteenfold when bypass is prolonged beyond one hour. 36 The patient undergoing a prolonged bypass exhibits a shocklike state characterized by cyanosis, coolness, and a narrowed pulse pressure, indicative of high peripheral resistance and low cardiac output. There may be blood volume deficits of a liter or more in the face of normal or elevated arterial and venous pressures.…”

Section: Treatment Of Shock In Manmentioning

confidence: 99%

The modern treatment of shock based on physiologic principles

Lillehei

Longerbeam

Bloch

et al. 1964

Clin Pharma and Therapeutics

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123

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The hemodynamic disturbances resulting from shock due to hemorrhage or endotoxins and the results of several methods of treatment are presented. The experimental data indicate that vasopressors intensify the visceral vasoconstriction, ischemia, and loss of capillary integrity characteristic of severe shock. The benefical effects of corticosteroids or phenoxybenzamine combined with volume replacement are indicated. The hemodynamics of shock appear to be similar in man and animals, although the visceral organ which suffers the greatest insult varies among the species. This concept of a basic hemodynamic mechanism of shock gains further support from the fact that the same therapy in dog and man produces similar results. In treating patients with actual or suspected bacterial shock, we prefer a regimen of hydrocortisone, plasma to replace volume loss, specific antibiotic therapy, and surgical intervention when necessary to eliminate the source of infection. Hydrocortisone is used in preference to phenoxybenzamine because it has a more subtle effect on vascular tone and is less likely to cause further hypotension. Plasma is preferred to low molecular dextr~n because of our concern over the combined effects of endotoxin shock and dextran on basic blood clotting mechanisms in man.A patient pursuit of facts, and cautious combination and comparison of them, is the drudgery to which man is subjected by his Maker, if he wishes to attain sure knowledge.In the past half century, there has been remarkable progress in our knowledge and ability to treat traumatic shock. No doubt,

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Section: Treatment Of Shock In Manmentioning

confidence: 99%

The modern treatment of shock based on physiologic principles

Lillehei

Longerbeam

Bloch

et al. 1964

Clin Pharma and Therapeutics

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123

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“…Replogle y Cols 18 refieren sin embargo un aumento notable de adrenalina y noradrelina al final de la circulación extracorpórea. Creemos que esto es debido a la utilización de débitos bajos durante la perfusión.…”

Section: Resultsunclassified

Analgésicos y respuesta neuroendocrina en cirugía cardíaca: II Respuesta médulo-suprarrenal

Osacar

Monserrat²,

Esparza³

et al. 2017

revista-de-medicina

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Se estudia, en 55 pacientes sometidos a cirugía a corazón abierto, los niveles plasmáticos de catecolaminas y excreción urinaria de adrenalina y norcdrendina. Según el analgésico administrado durante la intervención hemos dividido a los enfermos en tres grupos : Grupo A, pacientes anestesiados con Pentazocina ; el B con Morfina y el C con Fentanest.  Mediante la determinación de ambas catecolaminas hemos podido comvrobar un aumento de la actividad simpática en los tres grupos de pacientes. No obstante durante el período per-operatorio ésta fue menor con Fentanest y mayor con Pentazocina. La acción ¡malgésica más prolongada de la Morfina se manifiesta en el período postoperatorio por una menor eliminación de adrenalina. Posteriormente hemos estudiado la influencia que sobre el sistema simpático - medula - suprarrenal posee el Fentathienil, analgésico de reciente adquisición, pudiéndose evidenciar durante la perfusión extracorpórea una eliminación de catecolaminas inferior a la hallada en el grupo de Fentanest.

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“…1 Hypothermic CPB increased catecholamines, cortisol, and glucagon which stimulate glycosis, hepatic gluconeogenesis, and glucose production, decrease total body glucose uptake enhance renal absorption of filtered glucose, and decrease exogenous insulin activity. [12][13][14][15][16][17] High concentration of anti-insulin humoral factors also contribute to rise in blood glucose. 14 The degree and duration of hyperglycemia differ depending on the type of anesthesia, duration of CPB, degree of hemo dilution, and duration and depth of hypothermia.…”

Section: Discussionmentioning

confidence: 99%

Blood glucose monitoring in pediatric patients on cardio-pulmonary bypass

Sonkusale¹,

Zanwar

Kane

et al. 2016

Int J Contemp Pediatr

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In 1971 S. P. Allison, et al was first to study "Changes in insulin secretion during open heart surgery" since then various studies has been done to know glucose homeostasis during cardiac surgery in adult. 1 Recent emphasis is on good control of blood glucose intra operatively. 2 The effect of anesthesia and surgery are more pronounced during cardiac anesthesia because of more stress and exposure to extreme un-physiological conditions like Cardiopulmonary bypass (CPB). Children are more vulnerable to adverse effects of CPB on glucose homeostasis. Uncontrolled blood glucose ABSTRACT Background: Meticulous blood glucose control during cardio-pulmonary bypass has received a lot of attention recently. Children are more vulnerable to adverse effects of cardio-pulmonary bypass (CPB) on glucose homeostasis. Objectives of the study were to find out changes in blood glucose due to cardio-pulmonary bypass and the Insulin requirements intra-operatively. Methods: A single centre, prospective trial in 130 children undergoing cardiac surgery for congenital cyanotic/ acyanotic heart disease, requiring cardio-pulmonary bypass. We administered dextrose IV 0.5g/kg/hr in pre bypass period to avoid hypoglycemia. Blood glucose levels were measured at various point of time [baseline, after 10 min and then every half hourly during bypass, 30 minutes after bypass and next during the immediate post-operative using a Hemo-cue glucometer]. To control blood glucose on cardio-pulmonary bypass pump, we used inj. Insulin as per study protocol. The statistical analysis was done using paired and unpaired t test & chi square test. Results: We had examined 130 pediatric patients going on CPB for cardiac surgery. Blood glucose was monitored in patients who did not required inj. Insulin (Group II) on bypass for hyperglycemia (n=33) while 97 patients required insulin (Group I) on bypass because of hyperglycemia. 74% of patient required insulin on pump shows that cardiopulmonary bypass significantly affects glucose homeostasis in children; most of the children (43%) required insulin 30 min after starting cardio-pulmonary bypass. Conclusions: Blood glucose rise in children of congenital cardiac disease was significant after induction of anesthesia; on hypothermic CPB children of congenital cardiac disease may had rising blood glucose trend and the pre-operative blood glucose significantly affects the trend of blood glucose on CPB. The duration of CPB might not significantly affect insulin requirement of pediatric patients. CPB significantly affected glucose homeostasis in children. Hence it seems prudent to administer small amount of IV dextrose in prebypass period to avoid hypoglycemia but rate and dose of insulin should be adjusted as it may affect blood glucose level on CPB.

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Catecholamine and Serotonin Response to Cardiopulmonary Bypass

Cited by 115 publications

References 23 publications

The modern treatment of shock based on physiologic principles

The modern treatment of shock based on physiologic principles

Analgésicos y respuesta neuroendocrina en cirugía cardíaca: II Respuesta médulo-suprarrenal

Blood glucose monitoring in pediatric patients on cardio-pulmonary bypass

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