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• W4236021081 abstract "Cardiopulmonary bypass (CPB) is associated with beta-adrenergic desensitization. Different anesthetic techniques are associated with varying levels of sympathoadrenal stimulation and increased catecholamines may cause beta-adrenergic desensitization. This study was designed to investigate whether a fast track (FT) inhalational anesthesia-based cardiac anesthetic causes more beta-adrenergic dysfunction than narcotic-based (NB) cardiac anesthetic. Methods: In an ongoing, approved study, 15 patients undergoing aortocoronary bypass were randomized to receive FT (n=9) or NB (n=6) anesthesia. Anesthetic induction for FT patients consisted of fentanyl 5-15 mcg/kg, midazolam 0.1 mg/kg, followed by maintenance with sevoflurane and propofol 25-50 mcg/kg/min (upon rewarming). Anesthetic induction for NB patients consisted of fentanyl 25-50 mcg/kg and midazolam 0.05-0.15 mg/kg followed by maintenance with fentanyl (up to 70 mcg/kg) and sevoflurane. Blood samples (25 ml) were taken at induction (baseline) and one hour after separation from CPB (postbypass). Plasma epinephrine (EPI) and norepinephrine (NE) levels were measured using HPLC. Lymphocytes were used to measure beta-adrenergic responsiveness and receptor content. Triplicate lymphocyte sets (1x105) were incubated with isoproterenol (iso)(10 [micro sign]M), prostaglandin E1 (PGE1)(10 [micro sign]M), or forskolin (fors)(200 [micro sign]M), and production of cAMP was measured by RIA. Duplicate sets of lymphocytes (6x105) were incubated with 8 concentrations of125 I iodopindolol +/- propranolol and radioactive counts measured. Scatchard analysis yielded Bmax Results: NE levels were greater in the NB group both baseline and postbypass (0.82 +/- 0.12 pMol/ml and 2.71 +/- 0.50 pMol/ml) than in the FT group (0.49 +/- 0.06 pMol/ml and 1.26 +/- 0.49 pMol/ml). EPI levels were greater in the NB group, both baseline and postbypass (0.1 +/- 0.05 pMol/ml and 0.32 +/- 0.09 pMol/ml) than in the FT group (0.0 +/- 0 pMol/ml and 0.26 +/- 0.06 pMol/ml). Postbypass production of cAMP after stimulation with iso and PGE1 decreased 34.7% and 23.0%, respectively, in the NB group compared to baseline versus a 5.04% decrease and a 8.0% increase, respectively, in the FT group. Postbypass production of cAMP increased after fors stimulation by 7.1% in the NB group and 11.9% in the FT group (Figure 1). Lymphocytic beta-adrenergic receptor content increased after CPB in both the FT (n=4) group (3247 fMol/6x105 lymphocytes postbypass vs. 1701 fMol/6x105 lymphocytes baseline) and the NB (n=2) group (2191 fMol/6x105 lymphocytes postbypass vs. 807 fMol/6x10 (5) lymphocytes baseline).Figure 1: Mean cAMP (+/- SEM) production by lymphocytes (1x105) from patients receiving FT or NB anesthesia at baseline and postbypass after stimulation with iso, PGE1, or fors.Discussion: These data indicate that sympathoadrenal activation is less with FT anesthesia than with NB anesthesia. Overall production of cAMP was greater both at baseline and postbypass in the FT group compared to the NB group, regardless of whether stimulation was with iso, PGE1, or fors. FT cardiac anesthesia is associated with less postbypass beta-adrenergic dysfunction than NB cardiac anesthesia as evidenced by a larger decrease in postbypass production of cAMP in the NB group after stimulation with iso and PGE1. Postbypass downregulation of beta-adrenergic receptors is not present in either group." @default.
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• W4236021081 date "1998-04-01" @default.
• W4236021081 modified "2023-10-18" @default.
• W4236021081 title "Fast-Track Cardiac Anesthesia Is Associated with Less Postbypass Beta-Adrenergic Dysfunction Than Narcotic-Based Cardiac Anesthesia" @default.
• W4236021081 doi "https://doi.org/10.1213/00000539-199804001-00059" @default.
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