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LETTERS TO THE EDITOR

Pharmacologic Therapy of Pulmonary Vasoconstriction in Acute Pulmonary Embolism

University of Sao Paulo, Faculty of Medicine of Ribeirao Preto, Department of Pharmacology, Ribeirao Preto, SP, Brazil

To the Editor:

Drs. Stratmann and Gregory (1) have written a very interesting review on neurohumoral factors that contribute to the increases in pulmonary artery pressures seen in acute pulmonary embolism (APE). As the authors appropriately mention in their review, the relevance of pulmonary artery vasoconstriction in APE has only recently been valued. The authors have based their analysis of such an important clinical problem on results from animal experiments. In addition, the information the authors have elegantly compiled in their review, we would like to add important information regarding the pathophysiology and pharmacologic management of gas embolism, a complication that may take place during many medical and surgical procedures (2). We have shown that nitric oxide inhalation attenuates the increase in pulmonary vascular resistance and improves cardiac output during air embolism (3,4). Similar effects were observed with the use of endothelin receptor antagonists (5,6). Interestingly, both pharmacologic approaches blunted the release of thromboxane A2 (4–6). While both gas embolism and thromboembolism may share many pathophysiologic features, pulmonary vasoconstriction may play a more important role in gas embolism, a condition often encountered by anesthesiologists.

Footnotes

Dr. Stratmann does not wish to respond.

References

1. Stratmann G, Gregory G A. Neurogenic and humoral vasoconstriction in acute pulmonary thromboembolism. Anesth Analg 2003; 97: 341–54.[Free Full Text]
2. Tanus-Santos JE, Theodorakis MJ. Is there a place for inhaled nitric oxide in the therapy of acute pulmonary embolism? American Journal of Respiratory Medicine 2002; 1: 167–76.[Medline]
3. Tanus-Santos JE, Moreno H Jr, Zappellini A, de Nucci G. Small-dose inhaled nitric oxide attenuates hemodynamic changes after pulmonary air embolism in dogs. Anesth Analg 1999; 88: 1025–9.[Abstract/Free Full Text]
4. Tanus-Santos JE, Moreno H Jr, Moreno RA, et al. Inhaled nitric oxide improves hemodynamics during a venous air infusion (VAI) in dogs. Intensive Care Med 1999; 25: 983–9.[Web of Science][Medline]
5. Tanus-Santos JE, Gordo WM, Udelsmann A, et al. Nonselective endothelin-receptor antagonism attenuates hemodynamic changes after massive pulmonary air embolism in dogs. Chest 2000; 118: 175–9.[Abstract/Free Full Text]
6. Tanus-Santos JE, Gordo WM, Udelsmann A, Moreno H Jr. The hemodynamic effects of endothelin receptor antagonism during a venous air infusion in dogs. Anesth Analg 2000; 90: 102–6.[Abstract/Free Full Text]

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