Bomzon A, Monies-Chass I, Kamenetz L, Blendis L
Rappaport Institute for Medical Research, Haifa, Israel.
Hepatology. 1990 Apr;11(4):551-6. doi: 10.1002/hep.1840110405.
Cardiovascular homeostasis is comprised under general anesthesia and in jaundice. Because surgery is often performed on jaundiced patients, it is not altogether surprising that the incidence of perioperative complications is higher in such patients than in nonjaundiced ones. In this study we assessed the potential synergistic effects of anesthesia and jaundice on cardiovascular responsiveness of chronic bile-duct-ligated dogs. Responsiveness to norepinephrine, angiotensin II and isoproterenol was determined before and after chronic bile-duct ligation or sham-operation while the dogs were conscious or under halothane, fentanyl or pentobarbital-sodium anesthesia. These data have shown that halothane- and barbiturate-induced anesthesia do not alter mean arterial blood pressure in unoperated dogs when compared with conscious dogs before laparotomy. Furthermore, these two agents did not modify the pressor, dilator and positive inotropic responses to intravenous infusions of norepinephrine, angiotensin II and isoproterenol. Fentanol, however, reduced mean arterial blood pressure and heart rate without influencing responsiveness to the three vasoactive agents. Blunted responsiveness in the chronic bile-duct-ligated dogs to the three vasoactive agents was observed without any marked changes in mean arterial blood pressure or heart rate. The same blunted responses observed in the conscious, chronic bile-duct-ligated dogs were also seen in the anesthetized, chronic bile-duct-ligated dogs. Halothane caused a marked hypotensive effect in the chronic bile-duct-ligated dogs that was not seen in the sham-operated dogs. Conscious and anesthetized sham-operated dogs responded in the same manner as the conscious and anesthetized dogs before ligation. (ABSTRACT TRUNCATED AT 250 WORDS)
全身麻醉和黄疸状态下会出现心血管稳态。由于手术常常在黄疸患者身上进行,这类患者围手术期并发症的发生率高于非黄疸患者也就不足为奇了。在本研究中,我们评估了麻醉和黄疸对慢性胆管结扎犬心血管反应性的潜在协同作用。在慢性胆管结扎或假手术前后,当犬处于清醒状态或接受氟烷、芬太尼或戊巴比妥钠麻醉时,测定其对去甲肾上腺素、血管紧张素II和异丙肾上腺素的反应性。这些数据表明,与剖腹术前清醒的犬相比,氟烷和巴比妥类药物诱导的麻醉不会改变未手术犬的平均动脉血压。此外,这两种药物不会改变对静脉输注去甲肾上腺素、血管紧张素II和异丙肾上腺素的升压、扩张血管及正性肌力反应。然而,芬太尼降低了平均动脉血压和心率,但不影响对这三种血管活性药物的反应性。在慢性胆管结扎犬中观察到对这三种血管活性药物的反应性减弱,而平均动脉血压或心率没有任何明显变化。在清醒的慢性胆管结扎犬中观察到的同样减弱的反应,在麻醉的慢性胆管结扎犬中也可见。氟烷在慢性胆管结扎犬中引起显著的降压作用,而在假手术犬中未观察到。清醒和麻醉的假手术犬的反应方式与结扎前清醒和麻醉的犬相同。(摘要截短至250字)