RESUMEN
Previous studies have suggested a critical role for the vagi during the hypertonic resuscitation of hemorrhagic shocked dogs. Vagal blockade prevented the full hemodynamic and metabolic recovery and increased mortality. This interpretation, however, was challenged on the grounds that the blockade also abolished critical compensatory mechanisms and therefore the animals would die regardless of treatment. To test this hypothesis, 29 dogs were bled (46.0 +/- 6.2 ml/kg, enough to reduce the mean arterial pressure to 40 mmHg) and held hypotensive for 45 min. After 40 min, vagal activity was blocked in a reversible manner (0 masculine C/15 min) and animals were resuscitated with 7.5% NaCl (4 ml/kg), 0.9% NaCl (32 ml/kg), or the total volume of shed blood. In the vagal blocked isotonic saline group, 9 of 9 dogs, and in the vagal blocked replaced blood group, 11 of 11 dogs survived, with full hemodynamic and metabolic recovery. However, in the hypertonic vagal blocked group, 8 of 9 dogs died within 96 h. Survival of shocked dogs which received hypertonic saline solution was dependent on vagal integrity, while animals which received isotonic solution or blood did not need this neural component. Therefore, we conclude that hypertonic resuscitation is dependent on a neural component and not only on the transient plasma volume expansion or direct effects of hyperosmolarity on vascular reactivity or changes in myocardial contraction observed immediately after the beginning of infusion.
Asunto(s)
Soluciones Isotónicas/administración & dosificación , Resucitación/métodos , Solución Salina Hipertónica/administración & dosificación , Choque Hemorrágico/terapia , Nervio Vago/fisiología , Animales , Protocolos Clínicos , Perros , Masculino , Bloqueo Nervioso , Volumen Plasmático/efectos de los fármacos , Nervio Vago/efectos de los fármacosRESUMEN
Previous studies have suggested a critical role for the vagi during the hypertonic resuscitation of hemorrhagic shocked dogs. Vagal blockade prevented the full hemodynamic and metabolic recovery and increased mortality. This interpretation, however, was challenged on the grounds that the blockade also abolished critical compensatory mechanisms and therefore the animals would die regardless of treatment. To test this hypothesis, 29 dogs were bled (46.0 ± 6.2 ml/kg, enough to reduce the mean arterial pressure to 40 mmHg) and held hypotensive for 45 min. After 40 min, vagal activity was blocked in a reversible manner (0ºC/15 min) and animals were resuscitated with 7.5 percent NaCl (4 ml/kg), 0.9 percent NaCl (32 ml/kg), or the total volume of shed blood. In the vagal blocked isotonic saline group, 9 of 9 dogs, and in the vagal blocked replaced blood group, 11 of 11 dogs survived, with full hemodynamic and metabolic recovery. However, in the hypertonic vagal blocked group, 8 of 9 dogs died within 96 h. Survival of shocked dogs which received hypertonic saline solution was dependent on vagal integrity, while animals which received isotonic solution or blood did not need this neural component. Therefore, we conclude that hypertonic resuscitation is dependent on a neural component and not only on the transient plasma volume expansion or direct effects of hyperosmolarity on vascular reactivity or changes in myocardial contraction observed immediately after the beginning of infusion.
Asunto(s)
Animales , Masculino , Perros , Soluciones Isotónicas , Resucitación , Solución Salina Hipertónica , Choque Hemorrágico , Nervio Vago , Protocolos Clínicos , Bloqueo Nervioso , Volumen Plasmático , Nervio VagoRESUMEN
Previous cerebral ischemia studies have reported the limitations of restricted periods of postischemic hypothermia in producing long-term neuroprotection. The present experiment attempts to determine whether delayed treatment with the free radical scavenger N-tert-butyl-a-phenylnitrone (PBN) is protective at 2 months following transient global forebrain ischemia, and whether additive effects can be observed when PBN is administered in combination with moderate hypothermia. For this aim rats were subjected to 10 min of two-vessel forebrain ischemia followed by (a) 3 h of postischemic normothermia (37 degrees C); (b) 3 h of postischemic hypothermia (30 degrees C); (c) normothermic procedures combined with delayed injections of PBN (100 mg/kg) on days 3, 5 and 7 post-insult; (d) postischemic hypothermia combined with delayed PBN treatment; or (e) sham procedures. Outcome measures included cognitive behavioral testing and quantitative histopathological analysis at 2 months. Postischemic PBN injections induced a systemic hypothermia (1.5 degrees C-2.0 degrees C) that lasted for 2-2.5 h. Water maze testing revealed significant performance deficits relative to shams in the normothermic ischemic group, with the postischemic hypothermia and PBN groups showing intermediate values. A significant attenuation of cognitive deficits was observed in the animal group receiving the combination postischemic hypothermia and delayed PBN treatment. Quantitative CA1 hippocampal cell counts indicated that each of the ischemia groups exhibited significantly fewer viable CA1 neurons compared to sham controls. However, in rats receiving either delayed PBN treatment or 3 h of postischemic hypothermia, significant sparing of CA1 neurons relative to the normothermic ischemia group was observed. These data indicate that hypothermia combined with PBN treatment provides long-term cognitive improvement compared to nontreatment groups. PBN-induced mild hypothermia could contribute to the neuroprotective effects of this pharmacological strategy.
Asunto(s)
Conducta Animal/fisiología , Hipotermia Inducida , Ataque Isquémico Transitorio/tratamiento farmacológico , Ataque Isquémico Transitorio/patología , Óxidos de Nitrógeno/farmacología , Animales , Conducta Animal/efectos de los fármacos , Temperatura Corporal , Óxidos N-Cíclicos , Depuradores de Radicales Libres/farmacología , Masculino , Aprendizaje por Laberinto/efectos de los fármacos , Aprendizaje por Laberinto/fisiología , Memoria/efectos de los fármacos , Memoria/fisiología , Fármacos Neuroprotectores/farmacología , Prosencéfalo/irrigación sanguínea , Prosencéfalo/patología , Prosencéfalo/fisiología , Ratas , Ratas Wistar , Percepción Espacial/efectos de los fármacos , Percepción Espacial/fisiología , Factores de TiempoRESUMEN
We investigated whether moderate, transient whole-body hyperthermia (approximately 39.6 degrees C), if imposed 1 day following a brief episode of forebrain ischemia, would affect the neuropathologic outcome. Forty-two Wistar rats were subjected to either a 5- or 7-minute period of bilateral common carotid artery occlusion plus hypotension (50 mm Hg), or to the equivalent sham procedure. Twenty-four hours later, rats of one subgroup were placed into a hyperthermic chamber containing high-intensity lamps designed to elevate rectal temperature to 39 to 40 degrees C for 3 hours. Normothermic subgroups received the same procedures, but the heating lamps were turned off. Eight days after brain ischemia or the sham procedure, brains were perfusion-fixed, and numbers of ischemic-appearing CA1 pyramidal neurons were counted. In rats with 7-minute forebrain ischemia, delayed hyperthermia increased mean numbers of ischemic neurons by 2.6- to 2.7-fold in all subsectors of area CA1 (p < 0.05, ANOVA). Delayed hyperthermia in 5-minute ischemic rats also tended to increase mean numbers of ischemic neurons (by 11-fold in lateral, 6-fold in middle, and 5-fold in medial CA1 subsectors), but these differences were not statistically significant. We conclude that moderate, transient hyperthermia, even if occurring 1 day after a 7-minute global ischemic insult, exacerbates the extent of ischemic neuronal injury.
Asunto(s)
Hipocampo/patología , Hipertermia Inducida/efectos adversos , Ataque Isquémico Transitorio/patología , Neuronas/patología , Análisis de Varianza , Animales , Astrocitos/patología , Temperatura Corporal/fisiología , Núcleo Celular/patología , Citoplasma/patología , Humanos , Macrófagos/patología , Masculino , Células Piramidales/patología , Ratas , Ratas Wistar , Factores de TiempoRESUMEN
PURPOSE: To study the early hemodynamic effects of the rapid infusion of 7.5g/dl NaCl/ 6g/dl dextran-70 solution in dogs submitted to hemorrhagic shock. METHODS: Mongrel dogs were anesthetized with pentobarbital and a electromagnetic flowmeter probe was placed around the ascending aorta or the portal vein. By external bleeding the arterial pressure was lowered to 40mmHg and held for 30min. The animals received a 4ml/kg infusion of the hypertonic solution in 90s. Arterial blood pressure and flow were registered continuously during 3min and the derived hemodynamic variables were calculated at regular time intervals. RESULTS: The total plasma protein concentration decreased and the cardiac output showed a continuous elevation during the infusion. The arterial blood pressure showed two oscillations and then decreased during a short period of time. This moment was coincident with the initial increase of the portal flow and preceded the elevation of the systemic vascular resistance and the arterial pressure. CONCLUSION: The rapid infusion of hypertonic NaCl/dextran solution to dogs in hemorrhagic shock determines immediate and intense hemodynamic effects. During the infusion period there is volemic expansion and the cardiac output increases rapidly. The arterial pressure shows oscillations and decreases as a consequence of visceral arterial dilation before starting its final elevation that occurs as the vascular resistance increases.
Asunto(s)
Presión Sanguínea/fisiología , Gasto Cardíaco/fisiología , Dextranos/administración & dosificación , Solución Salina Hipertónica/administración & dosificación , Choque Hemorrágico/fisiopatología , Resistencia Vascular/fisiología , Animales , Perros , Inyecciones Intraventriculares , Masculino , Choque Hemorrágico/tratamiento farmacológicoRESUMEN
Single injections of 4 ml/kg hypertonic NaCl (7.5%) resuscitate dogs from severe blood loss (40-45 ml/kg). Mechanisms involve osmolarity-dependent volume expansion, increased myocardial contractility, and vasodilation. The role of central angiotensinergic pathways in the hemorrhage-hypertonic resuscitation interaction was investigated through experiments performed on male pentobarbital sodium-anesthetized dogs bled to, and held at, 40 mmHg for 30 min. Dogs were treated with 4 ml/kg of 7.5% NaCl or 32 of 0.9% NaCl iv preceded by intracerebroventricular (ICV) injections of 150 micrograms saralasin, 20 micrograms arginine vasopressin inhibitor (AVPI), or 10 micrograms morphine. ICV saralasin and morphine inhibited the full recovery response to hypertonic NaCl, whereas AVPI had no such effect. Saralasin did not inhibit the recovery from hemorrhagic shock produced by large volume isotonic saline reexpansion. These data demonstrate an interaction between the central angiotensin system and small volume hypertonic resuscitation from severe hemorrhagic shock but not between this central system and large volume isotonic reexpansion of circulatory volume. In contrast, the central vasopressinergic system does not appear to be similarly involved.