Haemodynamic Effects of Dihydroergotamine During Spinal Anaesthesia in Man

Abstract

Cardiac output was determined and arterial and pulmonary artery pressures were recorded during a control period, after spinal anaesthesia (Th I—III) and after administration of 1 mg dihydroergotomine (DHE) i. v. in 10 healthy males.After spinal anaesthesia, arterial and pulmonary artery pressures decreased, whereas heart rate and cardiac output remained unchanged. After administration of DHE, arterial pressure increased to control level, while pulmonary artery pressure increased significantly above that level. Cardiac output and heart rate remained mainly unchanged.Since stroke volume did not increase after DHE administration, the restitution of arterial pressure must be due to an effect on resistance vessels, although it has been shown that DHE has more pronounced effect on capacity than resistance vessels.However, the increase in pulmonary artery pressure might indicate that in this study also, the effect of DHE was more pronounced on capacity vessels, but in a situation with normal filling pressures this does not affect the cardiac output to a significant degree.ZUSAMMENFASSUNGCardiac Output, Arterien‐und Pulmonalarterien‐druck wurden während einer Kontrollperiode nach Spinalanaesthesie (Th I‐III) und nach Verabrei‐chung von 1 mg Dihydroergotamin (DHE) i. v. bei 10 gesunden Männern registriert.Nach Spinalanaesthesie waren Arterien‐und Pulmonalarteriendruck vermindert, während Herz‐frequenz und Cardiac Output unverändert blieben. Nach Verabreichung von DHE stieg der Arterien‐druck auf das Kontrollniveau an, während der Pulmonalarteriendruck dieses Niveau signifikant überstieg. Cardiac Output und Herzfrequenz blieben im wesentlichen unverändert.Da das Schlagvolumen nach Verabreichung von DHE nicht ansteigt, muß die Wiederherstellung des Arterienausgangsdruckes durch die »Resistancegefäße« bedingt sein, obwohl gezeigt wurde, daß DHE mehr Wirkung auf die Kapazität als auf die »Resistancegefäße« hat.Jedenfalls könnte die Erhöhung des Pulmonalar‐teriendruckes bei dieser Unte suchung darauf hinweisen, daß die Wirkung von DHE auf die Kapazitätsgefäße zwar stärker war, aber daß dies bei normalem Fülldruck den Cardiac Output nicht nennenswert beeinflußt.

Cardiovascular Effects of Dihydroergotamine during Epidural Anaesthesia in Dogs

“…Subsequently, its dihydrated derivative, DHE, has been investigated as a vasocon strictor agent in spinal [ 1 ] and epidural anaes thesia [4] as well as in high epidural anaesthe sia and mild acute hypovolaemia [15], Based on the observation that ergotamine caused stimulation of isolated canine veins in con centrations about 350 times lower than nor adrenaline but the maximal responses to er gotamine were only one third those to nor adrenaline. Miiller-Schweinitzer and Stunner [10] suggested the concept of a partial ago nistic action of ergot alkaloids on the vascular smooth muscle.…”

“…Dihydroergot amine (DHE) has been found to be useful as a vasoconstrictor in a variety of circulatory dis orders including spinal anaesthesia [1], epi dural anaesthesia [4. 15] and orthostatic hy potension [9. II], Furthermore, the drug is used for the treatment of migraine [6] and, because of the acceleration of venous blood flow, in combination with heparin for the prevention of postoperative venous throm bosis and pulmonary embolism [12], How ever, while it is generally agreed that DHE does not enhance myocardial contractility [5], the relative importance of a mobilization of blood by constriction of venous capaci tance vessels versus an increase in the tone of arteriolar resistance vessels to raise the blood pressure during epidural anaesthesia remains unclear.…”

Cardiovascular response to spinal anaesthesia in elderly men: effects of head‐up tilt and dihydroergotamine administration

“…In an earlier study in healthy young men (mean age 24, range 19-49), high spinal anaesthesia was found to cause a fall in arterial blood pressure because of reduced peripheral vascular resistance, while filling pressures were slightly reduced and stroke volume remained unchanged (Bergenwald et al, 1972). Yet dihydroergotamine (DHE), which is considered to have more pronounced effects on capacity than resistance vessels, restored the arterial pressure by increasing peripheral resistance in areas with sympathetic block.…”

Effects of Prenalterol and Volume Loading with Dextran on Haemodynamics and Oxygen Consumption in Dogs During High Epidural Block with Special Reference to the Splanchnic Region

“…These haemodynamic events may result in more or less profound hypotension (11). In order to restore the blood pressure, an effort can be made to improve the peripheral vasomotor tone, capacitance vessel function and cardiac performance by the use of vasoconstrictors such as dihydroergotamine (12,13,14), or sympathomimetic drugs such as ephedrine (15,16,17) or prenalterol (18,19). We have recently re-ported on the central and splanchnic circulatory effects of dihydroergotamine (14) and ephedrine (1 7) in the treatment of arterial hypotension caused by high epidural anaesthesia in the dog.…”