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CARDIOVASCULAR ANESTHESIA

-Opioid Receptor Antagonism Improves Recovery from Myocardial Stunning in Chronically Instrumented Dogs

Maike A. Grosse Hartlage, MD^*, Marc M. Theisen, MD^*, Nelson P. Monteiro de Oliveira^*, Hugo Van Aken, MD, FRCA, FRANZCA^*, Manfred Fobker, MD, and Thomas P. Weber, MD^*

From the *Department of Anaesthesiology and Intensive Care; and Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Münster, Münster, Germany.

Address correspondence and reprint requests to Maike A. Grosse Hartlage, MD, Universitätsklinikum Münster, Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Albert-Schweitzer-Straße 33, 48149 Münster, Germany. Address e-mail to grosse.hartlage{at}anit.uni-muenster.de.

We tested the hypothesis that the selective -opioid receptor antagonist nor-binaltorphimine (nor-BNI) improves recovery from myocardial stunning. Ten dogs were chronically instrumented for measurement of heart rate, left atrial, aortic and left ventricular pressure (LVP), and the maximum rate of LVP increase (LV dP/dt_max) and decrease (LV dP/dt_max), coronary blood flow velocity and myocardial wall-thickening fraction. Regional myocardial blood flow was determined with fluorescent microspheres. Catecholamine plasma levels were measured by high-performance liquid chromatography, and ß-endorphin and dynorphin plasma levels by radioimmunoassay. An occluder around the left anterior descending artery (LAD) allowed induction of a reversible LAD-ischemia. Animals underwent two experiments in a randomized crossover fashion on separate days: (a) 10 min LAD-occlusion (control experiment), (b) second ischemic episode 24 h after nor-BNI (2.5 mg/kg IV) (intervention). Dogs receiving nor-BNI showed an increase in wall-thickening fraction, LV dP/dt_max and LV dP/dt_min before ischemia and during the whole reperfusion (P < 0.05 versus control experiment). After nor-BNI pretreatment, dynorphin levels increased after induction of ischemia to a peak level of 15.1 ± 3.6 pg/mL (P < 0.05 versus control experiment). The increase in plasma ß-endorphin during ischemia and early reperfusion was attenuated after nor-BNI. Compared with the control experiment, nor-BNI left global hemodynamics, regional myocardial blood flow, and catecholamine levels unchanged. In conclusion, nor-BNI improves recovery from myocardial stunning after regional myocardial ischemia in chronically instrumented dogs.