Pharmacologic attenuation of the hyperdynamic response to supraceliac aortic clamping Marlin Wayne Causey, MD, Seth Miller, MD, Niten Singh, MD, Matthew.

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Pharmacologic attenuation of the hyperdynamic response to supraceliac aortic clamping Marlin Wayne Causey, MD, Seth Miller, MD, Niten Singh, MD, Matthew Martin, MD Journal of Vascular Surgery Volume 61, Issue 1, Pages 224-230 (January 2015) DOI: 10.1016/j.jvs.2013.08.033 Copyright © 2015 Terms and Conditions

Fig 1 Temporal relationships of hemodynamic measurements are shown during the 50-minute supraceliac aortic cross-clamp. Demonstrated in the (A) heart rate (HR) and (B) mean arterial blood pressure hemodynamic curves is the attenuation of the normal physiologic response with 4 mg/kg hydrogen sulfide (H2S; HS) administration. C, Cardiac output followed the normal physiologic curve and demonstrated greatest attenuation beyond 30 minutes. D, Right heart and (E) pulmonary artery (PA) systolic (top) and diastolic (bottom) pressures were unchanged. Journal of Vascular Surgery 2015 61, 224-230DOI: (10.1016/j.jvs.2013.08.033) Copyright © 2015 Terms and Conditions

Fig 2 Resuscitation requirements are shown after 35% blood volume hemorrhage, 50-minute supraceliac aortic cross-clamp, and 6-hour resuscitation. Volumes of intravenous fluids and vasopressors are aggregate totals that were administered as continuous infusions. The error bars indicate the standard deviation. Journal of Vascular Surgery 2015 61, 224-230DOI: (10.1016/j.jvs.2013.08.033) Copyright © 2015 Terms and Conditions

Fig 3 Histopathology of ischemia-reperfusion injury in swine liver. A, In normal control liver (sham animal), scattered sinusoidal lymphocytes (arrowheads) are seen, but otherwise the liver is unremarkable. B, Liver from a pig that underwent cross-clamp and hemorrhage, but received no pharmacotherapy (hemorrhagic shock animal), shows extensive centrilobular zone 3 necrosis (area within dotted line) and only a thin rim of normal zone 1 hepatocytes remain (area between solid arrowheads). C, Liver from a pig that was administered hydrogen sulfide (H2S; HS) at cross-clamp shows focal necrosis (black arrowheads), inflammation, and diffuse hepatic sinusoidal dilatation (white arrowheads). Scale bar = 100 microns. Journal of Vascular Surgery 2015 61, 224-230DOI: (10.1016/j.jvs.2013.08.033) Copyright © 2015 Terms and Conditions