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CRITICAL CARE AND TRAUMA

S-nitroso-N-acetylpenicillamine (SNAP) During Hemorrhagic Shock Improves Mortality as a Result of Recovery From Vascular Hyporeactivity

Shigehito Sato, MD^*, Akira Suzuki, MD^*, Yoshiki Nakajima, MD^*, Tatsuaki Iwamoto, MD^*, Hiromichi Bito, MD^*, and Masayuki Miyabe, MD

*Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu; and Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan

Address correspondence and reprint requests to Shigehito Sato, MD, Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan. Address e-mail to ssato{at}hama-med.ac.jp

Nitric oxide donors are protective against hemorrhagic shock (HS). However, no detailed investigation has been performed. We investigated this mechanism using S-nitroso-N-acetylpenicillamine (SNAP). HS (mean arterial pressure: 40 mm Hg) was induced in 20 dogs. Sixty min after HS, the animals were treated with saline (Cont-Gr: n = 7) or SNAP; 5 µg · kg^-1 · 10 min^-1 fol- lowed by 5 µg · kg^-1 · h^-1 (SNAP-Gr: n = 7). After another 60 min, the shed blood was reinfused. Reactivities to noradrenalin (NA), changes in hemodynamics, the plasma catecholamines, and nitric oxide derivatives were determined. In Cont-Gr, 3 dogs died at 90, 98, and 102 min after HS. In Cont-Gr, % changes of systolic arterial blood pressure to 1 and 2.5 µg/kg of NA after the recovery from HS decreased from 23.7% ± 4.1% (before HS) to 6.5% ± 0.6% and from 50.1% ± 7.7% (before HS) to 14.5% ± 2.6%, respectively (P < 0.01). In SNAP-Gr, reactivity to NA was maintained. At 120 min after HS, mean arterial pressure and cardiac output in SNAP-Gr increased but not in Cont-Gr. Plasma catecholamine levels in SNAP-Gr were suppressed compared with those of Cont-Gr. In conclusion, a small dose of SNAP during HS decreased the mortality of the dogs. This might have been caused in part by residual vascular hyporeactivity.

Implications: The administration of a small dose of S-nitroso-N-acetylpenicillamine (a nitric oxide donor), a dose which did not exert a significant vasodilator effect, was administered during hemorrhagic shock in dogs. S-nitroso-N-acetylpenicillamine improved the vascular hyporeactivity to noradrenaline and decreased the mortality rate.

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				H. Igarashi, Y. Obata, Y. Nakajima, T. Katoh, K. Morita, and S. Sato Syringe pump displacement alters line internal pressure and flow: [Le deplacement verticalde la pompe a perfusion modifie la pression interne du catheter et le debit] Can J Anesth, August 1, 2005; 52(7): 685 - 691. [Abstract] [Full Text] [PDF]

				M. Miyabe, K. Yanagi, N. Ohshima, S. Sato, T. Fukuda, and H. Toyooka Sodium Nitroprusside Decreases Leukocyte Adhesion and Emigration After Hemorrhagic Shock Anesth. Analg., February 1, 2002; 94(2): 296 - 301. [Abstract] [Full Text] [PDF]

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