Systemic hypertension induced by aortic cross-clamping: Detrimental effects of direct smooth muscle relaxation compared with ganglionic blockade  Mohammed.

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Presentation transcript:

Systemic hypertension induced by aortic cross-clamping: Detrimental effects of direct smooth muscle relaxation compared with ganglionic blockade  Mohammed M. Moursi, MD, Matthew A. Facktor, BMA, Gerald B. Zelenock, MD, Louis G. D'Alecy, DMD, PhD  Journal of Vascular Surgery  Volume 19, Issue 4, Pages 707-716 (April 1994) DOI: 10.1016/S0741-5214(94)70045-1 Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Time course and sampling protocol. Large box represents 90-minute infrarenal aortic cross-clamp time. Rx box represents 30 minutes intraoperative drug (nitroprusside or trimethaphan camsylate) therapy. Hemodynamic variables were recorded continuously. Arrows correspond to sampling times (−10, 30, 60, 90, 120 minutes; end of each period) when data and blood were taken for analysis. Journal of Vascular Surgery 1994 19, 707-716DOI: (10.1016/S0741-5214(94)70045-1) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Time course of suprarenal MAP (A) and CO (B) before, during, and after application of infrarenal aortic cross-clamp. Trimethaphan camsylate treatment was more effective antihypertensive medication than nitroprusside. Ninety-minute cross-clamp time and 30 minutes of intraoperative drug therapy are indicated as solid horizontal bars. Both groups (n = 10) are pooled for preclamp and period A periods and are represented by circle. Lower panel (B) shows dramatic and significant CO increase in NP group. TC group experienced no significant CO changes. Sample sizes are indicated parenthetically. Journal of Vascular Surgery 1994 19, 707-716DOI: (10.1016/S0741-5214(94)70045-1) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Time course of suprarenal MAP (A) and CO (B) before, during, and after application of infrarenal aortic cross-clamp. Trimethaphan camsylate treatment was more effective antihypertensive medication than nitroprusside. Ninety-minute cross-clamp time and 30 minutes of intraoperative drug therapy are indicated as solid horizontal bars. Both groups (n = 10) are pooled for preclamp and period A periods and are represented by circle. Lower panel (B) shows dramatic and significant CO increase in NP group. TC group experienced no significant CO changes. Sample sizes are indicated parenthetically. Journal of Vascular Surgery 1994 19, 707-716DOI: (10.1016/S0741-5214(94)70045-1) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Time course of HR (A) and SV (B) in both TC and NP groups. Both groups exhibited increase in HR during drug administration. When drug infusion stopped, HR decreased in NP group but remained elevated in TC group. Lower panel (B) shows SV decrease in TC group after drug administration and relative constancy of SV in NP group. Sample sizes are indicated parenthetically. Journal of Vascular Surgery 1994 19, 707-716DOI: (10.1016/S0741-5214(94)70045-1) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Time course of HR (A) and SV (B) in both TC and NP groups. Both groups exhibited increase in HR during drug administration. When drug infusion stopped, HR decreased in NP group but remained elevated in TC group. Lower panel (B) shows SV decrease in TC group after drug administration and relative constancy of SV in NP group. Sample sizes are indicated parenthetically. Journal of Vascular Surgery 1994 19, 707-716DOI: (10.1016/S0741-5214(94)70045-1) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Time course of TPR (A) and CMW (B) in both TC and NP groups. After initial increase after clamp application, TPR is significantly reduced in NP group but unchanged in TC group. In lower panel (B) CMW increases with clamp application. NP group had significantly increased CMW whereas TC group had reduced values to baseline levels. Sample sizes are indicated parenthetically. Journal of Vascular Surgery 1994 19, 707-716DOI: (10.1016/S0741-5214(94)70045-1) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Time course of TPR (A) and CMW (B) in both TC and NP groups. After initial increase after clamp application, TPR is significantly reduced in NP group but unchanged in TC group. In lower panel (B) CMW increases with clamp application. NP group had significantly increased CMW whereas TC group had reduced values to baseline levels. Sample sizes are indicated parenthetically. Journal of Vascular Surgery 1994 19, 707-716DOI: (10.1016/S0741-5214(94)70045-1) Copyright © 1994 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions