Spontaneous oscillation of the systemic arterial pressure during cardiopulmonary bypass in man. The effects of some drugs used during the operation

Abstract

Despite the fact that the blood flow maintained during cardiopulmonary bypass is rather steady in the extracorporeal pump output, the arterial pressure under high-dose fentanyl anaesthesia quite often shows sinusoidal oscillations. In the present study the duration of an oscillatory cycle was on average 17.6 +/- 3.6 s, its amplitude 7.3 +/- 1.6 mm Hg and mean systemic arterial pressure 75 +/- 12 mm Hg. The oscillation is affected by the drugs used under bypass conditions. In our series of clinical observations the blood pressure oscillation disappeared under the influence of chlorpromazine, phentolamine, droperidol, and enflurane, and it disappeared or at least was distinctly attenuated under fentanyl, thiopental, diazepam, sodium nitroprusside, nitroglycerin, acebutolol, and potassium chloride. Pancuronium, atropine and furosemide appeared to be practically ineffective. In spite of the fact that the drugs used affected several sites of the sympathetic efferent chain, the disappearance and attenuation of the oscillation were associated with a simultaneous decrease of blood pressure. Hence, it is suggested that the occurrence of the oscillations requires some level of peripheral vascular tone.

Spontaneous oscillation of systemic arterial pressure during cardiopulmonary bypass in the dog

“…The threshold value of blood pressure for the oscillation to occur seems to be 50 mm Hg (2,8). Droperidol erased the oscillation for a short period as also observed in man (20). Continuation of the oscillation after the perfusion phase as observed in our canine series has been described also after open heart surgery (6).…”

“…The systemic arterial blood pressure oscillations in the dog during the cardiopulmonary bypass highly resemble those observed in open heart patients (17,20). The occurrence of the oscillation in human operations is stochastic (17), although rather common under high-dose fentanyl anesthesia (19).…”

Wavelet analysis of laser Doppler flux time series of tumor and inflammatory associated neoangiogenesis. Differences in rhythmical behavior

“…These frequencies were in a range of about 0.13 SD 0.03 corresponding to SL2 of the present study. Prior studies have identified the emergence of these oscillations in systemic arterial pressure in the absence of natural heartbeat in experimental animals [35] and humans [32], referred to as vasomotor waves or idioperipheral pulsations.…”

Less peri- and postoperative inotropic support in open-heart patients with vasomotor waves during cardiopulmonary bypass?

“…The smaller amount of women among oscillating patients, although significant, may be a chance due to the significantly greater proportion of men having coronary operations in our area. In the prior materials of our clinics the proportion of women among patients with VMW has been 12-21% (17,18). The random occurrence of VMW has been a puzzle both in animal experiments (10) as well as in human studies (15,17).…”

“…Spontaneous regular slow oscillation of the systemic arterial pressure during cardiopulmonary bypass (CPB) is a recognized phenomenon in man (3,15,(17)(18)(19). These vasomotor waves (VMW) (Mayer waves, third order waves) have also been observed in conscious man (2,14), and they have been the object of numerous many-faeeted studies in experimental animals (7).…”