Ganglionic Blockade and Its Protective Action in Hemorrhage

In patients with myocardial infarction, from 5 to 17 per cent will develop shock which has a mortality rate of from 80 to 90 per cent when untreated.' In these patients, there is a reduced stroke volume accompanied by tachycardia and peripheral vasoconstriction.2 It has been postulated by some that it is the failure of adequate vasoconstriction to compensate for the degree of fall in cardiac output that is the essential problem in shock accompanying myocardial infaretion.3 , 4 However, it was also once thought that the drop in blood pressure after infarction was beneficial.But, Corday and his associates 5 in 1949 showed that, in dogs, there was a loss of contractility and a ballooning of the myocardium in the area of myocardial infarction when hypotension was present. These factors caused a marked diminution in cardiac output. As soon as the blood pressure in the dogs was raised, the ballooning disappeared and the cardiac output increased. These same workers also showed that hypotension in cardiogenic shock caused a marked diminution in coronary blood flow which was overcome when the systemic blood pressure was raised. Nonetheless, the physiologists, such as Aviado have long contended that vasoconstriction per se is not desirable. Thus, it soon becomes evident that the factors involved in shock are not as well understood as we would like, nor is there any unanimity, therefore, on the type of therapy needed. However, it is self-evident that immediate and rapid therapy is necessary to increase cardiac output and coronary blood flow, and thereby to alleviate myocardial hypoxia with diminished myocardial carbohydrate metabolism and reduced cardiac function, while, at the same time to maintain flow to the brain, kidneys and other vital organs.To accomplish these ends, a number of methods have been used including plasma volume expanders, intra-arterial blood or plasma transfusions, extracorporeal circulation' and pressor amines. The last method is the one most readily available for use in every day practice and so, at this time, is of most importance from a practical point of view.

show abstract

“…22 In further studies,23 , 24 they used Arfonad, both in animals and in humans, to treat hemorrhagic shock with good results.…”

Section: Resultsmentioning

confidence: 99%

The Treatment of Shock Accompanying Myocardial Infarction

Bernstein¹,

Rothfeld²,

Robins³

et al. 1963

Angiology

View full text Add to dashboard Cite

show abstract

“…Although primarily designed to limit bleeding during operations (Rollason, 1953) it soon became apparent that these agents afforded some protection against the development of shock during elective surgery. Attention immediately became focussed on the possibility that vasomotor overactivity was probably the essential cause of peripheral circulatory failure and several important papers supporting this concept have now been published (Martin, 1955;Boba and Converse, 1957;Paton, 1957). The ganglionic blockers hexamethonium and trimetaphan act mainly on the parasympathetic synapses and on the synapses of the paravertebral and collateral sympathetic ganglia and do not appear to exert any significant effect on the synapses within the suprarenal medulla (Hall, 1957;Kumick, 1956;Freyburger, 1950: Freyburger et al, 1948).…”

Section: Ganglion Blocking Drugsmentioning

confidence: 99%

“…During the past few years an accumulation of •evidence has indicated that the development of the so-called irreversible stage of shock may well be due to excessive prolongation of the vaso-constrictive reaction which, after a time, becomes self-perpetuating (Paton, 1957;Boba and Converse, 1957;Zweifach and Thomas, 1957;Martin, 1955). In the earlier stages of shock the constrictor actions of circulating adrenaline and noradrenaline are intensified by a vasoexcitor material (V.E.M.)…”

mentioning

confidence: 99%

The Role of Halothane in the Prevention of Surgical Shock

Johnstone¹

1958

British Journal of Anaesthesia

View full text Add to dashboard Cite

“…Chmcally, adrenergic or ganglionic blocking agents have been advocated for protection against shock and, m addibon to blood volume replacement, for the treatment of existang shodk (3,7,17) The reports of such treatments appear to be noteworthy and one has the impressmn that adrenergic blocking agents in combination with blood volume replacement would give better results than the present treatment of shock with transfusions and supportive measures The value of many of the pubhcations, particularly those from Europe, is discounted because they are written in a flowery language with specially invented terminology, and because the argumentabon is frequently based on very theoretical grounds.The basic concept for tins new approach appears to be this. A dimimshed blood volume leads to a decrease in venous rebn-n and a reduced cardiac out-put The resulting fall in blood pressure is counteIacted by peripheral vasoconstriction, which is induced and possibly maintained by the activity of the sympathetic nervous system including the adrenal medula.…”

mentioning

confidence: 99%

“…Attempts have Been made to use these findings as the basis for a new approach to the prevention and treatment of clinical shock (3,17). The results of such a treatment are diiiicult to judge since no reliable signs exist to determine objectively the severity of a state of shock.…”

mentioning

confidence: 99%

Adrenergic blocking agents in shock

Spoerel

1958

Can. Anaes. Soc. J.

View full text Add to dashboard Cite

IN RECENT YEARS a number of agents have been developed which block the sympathetm nervous system These agents can be dwided into two groups according to their site of action, ganghonic blocking agents block the transmission of impulses at the ganghonm synapses, adrenergic blocking agents act on the sympathetic end organs and reduce or reverse the pressor effect of adrenahn The latter group includes agents hke dlbenamine, dlbenzyhne, regitme, priscoline, hydergine, and chlorpromazme (Largactil) Especially for chlorpromazme and more recently for hydergine, claims hay6 been made that these agents would prevent shock caused by haemorrhage and severe trauma or would at least delay the onset of an irreversible state of shock Laborit's (15) concept of artificml hibernation, m which Largactd plays the principle role, has received wide publicitT, parbcuIarly in regard to its apphcation in shock. Chmcally, adrenergic or ganglionic blocking agents have been advocated for protection against shock and, m addibon to blood volume replacement, for the treatment of existang shodk (3,7,17) The reports of such treatments appear to be noteworthy and one has the impressmn that adrenergic blocking agents in combination with blood volume replacement would give better results than the present treatment of shock with transfusions and supportive measures The value of many of the pubhcations, particularly those from Europe, is discounted because they are written in a flowery language with specially invented terminology, and because the argumentabon is frequently based on very theoretical grounds.The basic concept for tins new approach appears to be this. A dimimshed blood volume leads to a decrease in venous rebn-n and a reduced cardiac out-put The resulting fall in blood pressure is counteIacted by peripheral vasoconstriction, which is induced and possibly maintained by the activity of the sympathetic nervous system including the adrenal medula. This vasoconstrmtion in reducing the blood flow produces bssue hypoxia, which leads to an increased capillary permeability. Leakage from the capillaries reduces the blood volume fitrther and thus a vicious cycle is set into operation (Fig. 1 ).The important concept in this "shockwheel" is that compensatory mechanisms contribute to the progress of shock. Erlanger .and Gasser (6) in 1919 expressed the view that the increased adrenergic acbvity in shock was an important factor in the deterioration of the organism. It was later on demonstrated that a continuous infusion of adrenahn could produce shock (8), and a marked rise of the blood level of adrenalm was observed following haemorrhage in dogs (23) 1Presented at the combined meeting of Section of Anaesthema, ()ntaxao Medacal Associalaon, and the Ontario Dlvlmon of the Canadaan Anaesthetasts' Socmty, October 5, 1957, m Hamilton, Ont. 2Departuaent

show abstract

Ganglionic Blockade and Its Protective Action in Hemorrhage

Cited by 17 publications

References 0 publications

The Treatment of Shock Accompanying Myocardial Infarction

The Treatment of Shock Accompanying Myocardial Infarction

The Role of Halothane in the Prevention of Surgical Shock

Adrenergic blocking agents in shock

Contact Info

Product

Resources

About