Abstract
Deliberate hypotension decreases blood loss and transfusion but it may be accompanied by adverse effects due either to the hypotensive agents themselves or to haemodynamic alterations. Prostaglandin E1 (PGE1) has the advantage of a diuretic effect coupled with systemic hypotension. To elucidate the mechanisms by which PGE1 induces diuresis we compared the haemodynamic, diuretic and hormonal responses to PGE1 infusion simultaneously with epidural lidocaine (EP-L n = 7), epidural fentanyl (EP-F n = 8) or epidural saline (CONT n = 7) in halothane anaesthetized mongrel dogs. All groups developed a decrease in mean arterial pressure during PGE1 infusion (from 105 ± 24 to 77 ± 18 mmHg in EP-L; 106 ± 19 to 79 ± 13 mmHg in the EP-F; and 129 ± 14 to 106 ± 18 mmHg in the CONT groups (mean ± SD)) (P < 0.05). In the EP-F and CONT groups urinary output increased during PGE1 infusion (from 4.31 ± 1.89 to 6.15 ± 2.03 ml · min−1 and 2.71 ± 1.23 to 4.48 ± 1.66 ml · min−1 (P < 0.05), respectively) and was accompanied by increases in renal blood flow (from 87.0 ± 40.7 to 111.0 ± 42.8 ml · min−1 and from 121.6 ± 46.6 to 158.4 ± 64.9 ml · min−1 (P < 0.05), respectively) and in fractional excretion of sodium (FENa) (from 4.78 ± 3.88 to 7.63 ± 5.20% in CONT group). Plasma epinephrine concentration increased after laparotomy in the CONT group (from 0.09 ± 0.08 to 0.17 ± 0.14 pg · min−1) (P < 0.05) and antidiuretic hormone (ADH) concentration increased after laparotomy (from 6.9 ± 5.2 to 21.0 ± 13.0 pg · ml−1 in EP-F and from 8.1 ± 6.2 to 45.8 ± 29.9 pg · ml−1 in CONT groups). Plasma renin activity increased after laparotomy in the EP-L group (from 2.00 ± 1.37 to 4.72 ± 2.73 mg · ml−1 hr−1) (P < 0.05). The results suggest that the mechansim of the PGE1− induced diuretic effect includes increases in renal blood flow while renal sympathetic innervation is maintained and in FENa in the presence of elevated plasma ADH concentration.
Résumé
L’hypotension contrôlée diminue les pertes sanguines et le nombre de transfusions mais peut aussi s’accompagner des effets indésirables des agents hypotenseurs ou de ceux des changements hémodynamiques. La prostaglandine E1 (PGE1) a l’avantage de provoquer la diurèse tout en exerçant son activité hypotensive. Pour élucider les mécanismes selon lesquel la PGE1 induit la diurèse, nous avons comparé simultanément les réponses hémodynamiques, diurétiques et hormonales à la perfusion de PGE1 pendant une épidurale à la lidocaïne (EP-L n = 7), au fentanyl (EP-F n = 8) ou au soluté physiologique (CONTn = 7) chez des chiens batards anesthésiés a l’halothane. Tous présentent une baisse de la pression artérielle moyenne pendant la perfusion de PGE1 (de 105 ±24 à 77 ±18 mmHg pour le groupe EP-L, de 106 ± 19 a 79 ± 13 mmHg pour le groupe EP-F; de 129 ± 14 à 106 ± 18 pour le groupe contrôle: moyenne ±SD, P < 0,05). Dans les groupes EP-F et CONT le débit urinaire augmente pendant la perfusion de PGE1 (de 4,31 ± 1,89 à 6,15 ± 2,03 ml · min−1 et de 2,71 ± 1,23 à 4,48 ± 1,66 ml · min−1 respectivement: P < 0,05) et s’accompagne d’une augmentation du débit sanguin rénal (de 87,0 ±40,7 à 111,0 ±42 ml · min−1 et de 121,6 ± 46,6 à 158,4 ± 64,9 ml · min−1 respectivement: P < 0,05); dans le groupe CONT, l’excrétion fractionnée de sodium (FENa) augmente (de 4,78 ± 3,88% à 7,63 ± 5,20%). La concentration d’épinéphrine plasmatique augmente après la laparotomie dans le groupe CONT (de 0,09 ± 0,08 à 0,17 ± 0,14 pg · ml−1; P < 0,05) et la concentration d’ADH augmente après la laparotomie (de 6,9 ± 5,2 à 21,0 ± 13,0 pg · min−1 dans le groupe EP-F et 8,1 ± 6,2 à 45,8 ± 29,9 pg · min−1 dans le groupe CONT). L’activité de la rénine plasmatique augmente après la laparotomie dans le groupe EP-L (de 2,00 ± 1,37 à 4,72 ± 2,73 mg · min−1 h−1: P < 0,05). Ces résultats suggèrent que les mécansismes de l’induction de la diurèse par la PGE1 comprennent des augmentations du débit sanguin rénal lorsque l’innervation sympathique est conservée et de la FENa en présence d’une élévation de la concentration plasmatique d’ADN.
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This work was supported by the 1991 and 1992 fiscal year Academic Project funds of University of Tsukuba, Japan.
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Yamaguchi, H., Harukuni, I. & Naito, H. Haemodynamic, diuretic and hormonal responses to prostaglandin E1, infusion in halothane anaesthetized dogs: comparison among epidural lidocaine, epidural fentanyl and epidural saline. Can J Anaesth 42, 425–433 (1995). https://doi.org/10.1007/BF03015491
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DOI: https://doi.org/10.1007/BF03015491