Sohn Ju-Tae, Murray Paul A
Center for Anesthesiology Research, Division of naesthesiology and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Anesthesiology. 2003 Jan;98(1):104-13. doi: 10.1097/00000542-200301000-00019.
The authors recently demonstrated that etomidate and ketamine attenuated endothelium-dependent pulmonary vasorelaxation mediated by nitric oxide and Ca -activated K + channels. In the current study, they tested the hypothesis that these intravenous anesthetics inhibit pulmonary vasorelaxation mediated by adenosine triphosphate-sensitive potassium (K + ATP ) channel activation.
Endothelium intact and denuded pulmonary arterial rings were suspended in organ chambers for isometric tension recording. The effects of etomidate (5 x 10(-6) and 5 x 10(-5) m) and ketamine (5 x 10(-5) and 10(-4) m) on vasorelaxation responses to lemakalim (K + ATP channel activator), prostacyclin, and papaverine were assessed in phenylephrine-precontracted rings. The effect of cyclooxygenase inhibition with indomethacin was assessed in some protocols.
Etomidate (5 x 10(-6) m) only inhibited the vasorelaxant response to lemakalim in endothelium intact rings, whereas a higher concentration of etomidate (5 x 10(-5) m) inhibited relaxation in both intact and endothelium-denuded rings. Pretreatment with indomethacin abolished the endothelium-dependent attenuation of lemakalim-induced relaxation caused by etomidate. Ketamine (5 x 10(-5) and 10(-5) m) inhibited the relaxation response to lemakalim to the same extent in both endothelium-intact and -denuded rings, and this effect was not prevented by indomethacin pretreatment. Etomidate and ketamine had no effect on the relaxation responses to prostacyclin or papaverine.
These results indicate that etomidate, but not ketamine, attenuates the endothelium-dependent component of lemakalim-induced pulmonary vasorelaxation an inhibitory effect on the cyclooxygenase pathway. Both anesthetics inhibit K + ATP -mediated pulmonary vasorelaxation a direct effect on pulmonary vascular smooth muscle.
作者最近证明依托咪酯和氯胺酮可减弱由一氧化氮和钙激活钾通道介导的内皮依赖性肺血管舒张。在本研究中,他们检验了以下假设:这些静脉麻醉药会抑制由三磷酸腺苷敏感性钾(K⁺ATP)通道激活介导的肺血管舒张。
将完整内皮和去内皮的肺动脉环悬挂于器官浴槽中进行等长张力记录。在苯肾上腺素预收缩的血管环中,评估依托咪酯(5×10⁻⁶和5×10⁻⁵mol/L)和氯胺酮(5×10⁻⁵和10⁻⁴mol/L)对雷马卡林(K⁺ATP通道激活剂)、前列环素和罂粟碱引起的血管舒张反应的影响。在一些实验方案中评估了用吲哚美辛抑制环氧化酶的作用。
依托咪酯(5×10⁻⁶mol/L)仅抑制完整内皮血管环对雷马卡林的血管舒张反应,而较高浓度的依托咪酯(5×10⁻⁵mol/L)则抑制完整内皮和去内皮血管环的舒张。用吲哚美辛预处理可消除依托咪酯引起的雷马卡林诱导舒张的内皮依赖性减弱。氯胺酮(5×10⁻⁵和10⁻⁵mol/L)在完整内皮和去内皮血管环中对雷马卡林的舒张反应抑制程度相同,且吲哚美辛预处理不能阻止这种作用。依托咪酯和氯胺酮对前列环素或罂粟碱引起 的舒张反应无影响。
这些结果表明,依托咪酯而非氯胺酮减弱了雷马卡林诱导的肺血管舒张的内皮依赖性成分,这一作用与对环氧化酶途径的抑制有关。两种麻醉药均抑制K⁺ATP介导的肺血管舒张,这是对肺血管平滑肌的直接作用。