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Anesth Analg 1986; 65:612-616
© 1986 International Anesthesia Research Society
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Augmentation of Venous Return by Adrenergic Agonists during Spinal Anesthesia

John F. Butterworth, IV, MD, William Piccione, Jr, MD, Luis D. Berrizbeitia, MD, Garland Dance, BA, Richard J. Shemin, MD, and Lawrence H. Cohn, MD

Received from the Departments of Anesthesia and Surgery, Harvard Medical School, and the Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts.

Abstract

To test the effectiveness of adrenergic agonists in correcting the vascular sequelae of spinal anesthesia, we used venous reservoir volume (RV) and mean arterial pressure (MAP) as indices of the changes in venous capacitance and arterial resistance produced by adrenergic agonists in dogs anesthetized with pentobarbital and undergoing cardiopulmo-nary bypass (CPB). A CPB-based technique was chosen both to prevent drug and reflex effects on the heart from influencing the results and to provide a convenient means by which to monitor venous capacitance. Total spinal anesthesia significantly decreased both RV and MAP relative to steady-state CPB values. Return of these hemodynamic alterations to baseline was attempted using pure {alpha}-and ß-adrenergic agonists, and a mixed adrenergic agonist (phenyl-ephrine, isoproterenol, and ephedrine, respectively). Isoproterenol increased RV, but further decreased MAP. Phenyl-ephrine increased MAP but not RV. Ephedrine increased both MAP and RV. We conclude that a mixed adrenergic agonist such as ephedrine more ideally corrects the noncardiac circulatory sequelae of spinal anesthesia than does either a pure {alpha}-or ß-adrenergic agonist.

Key Words: ANESTHETIC TECHNIQUES, SPINAL • SYMPATHETIC NERVOUS SYSTEM, PHARMACOLOGY—vasopressors




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1986 by the International Anesthesia Research Society.