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  • Adrenaline  (2)
  • Indocyanine-green extraction  (2)
  • 1
    Digitale Medien
    Digitale Medien
    Glucose and urea production and leucine, ketoisocaproate and alanine fluxes at supraphysiological plasma adrenaline concentrations in volunteers (1994)
    Springer
    Intensive care medicine 20 (1994), S. 113-118 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Adrenaline ; Glucose ; Amino acids ; Urea ; Stable isotopes
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective To determine the magnitude and time course of adrenergic effects on metabolism in volunteers and possible implications for the use of sympathomimetics in the critically ill. Design Descriptive laboratory investigation. Subjects 7 volunteers. Intervention Primed continuous infusions of stable isotope tracers ([15N2]-urea, [6,6-D2]-glucose, [methyl-D3]-L-leucine, [15N]-L-alanine) were used. After isotopic steady state had been reached an infusion of adrenaline (0.1 μg/kg/min) was administered (4 h). Isotopic enrichment was measured using gas chromatography-mass spectrometry and the corresponding rates of appearance were calculated. Measurements and main results Glucose production increased from 14.1±1.2 to 21.5±2.0 μmol/kg/min (p〈0.05) after 80 min of adrenergic stimulation and then decreased again to 17.9±1.2 μmol/kg/min after 240 min. Leucine and ketoisocaproate (KIC) fluxes were 2.3±0.2 and 2.6±0.2 μmol/kg/min, respectively, at baseline and gradually decreased to 1.8±0.2 and 2.2±0.1 μmol/kg/min, respectively, after 240 min of adrenaline infusion (bothp〈0.05). Alanine flux increased from 3.7±0.5 to 6.9±0.9 μmol/kg/min (p〈0.05) after 80 min of adrenergic stimulation. Urea production slightly decreased from 4.8±0.9 to 4.3±0.8 μmol/kg/min during adrenaline (p〈0.05). Conclusions Adrenaline induced an increase in glucose production lasting for longer than 240 min. The decrease in leucine and KIC flux suggests a reduction in proteolysis, which was supported by the decrease in urea production. The increase in alanine flux is therefore most likely due to an increase in de-novo synthesis. The ammonia donor for alanine synthesis in peripheral tissues and the target for ammonia after alanine deamination in the liver remain to be investigated. These results indicate that adrenaline infusion most probably will not promote already enhanced proteolysis in critically ill patients. Gluconeogenesis is an energy consuming process and an increase may deteriorate hepatic oxygen balance in patients.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01707665
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 2
    Digitale Medien
    Digitale Medien
    Aerosolized prostacyclin and inhaled nitric oxide in septic shock – different effects on splanchnic oxygenation? (1996)
    Springer
    Intensive care medicine 22 (1996), S. 880-887 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Septic shock ; Nitric oxide ; Prostacyclin ; Gastric intramucosal pH ; PCO2 gap ; Splanchnic oxygenation ; Indocyanine-green extraction
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objectives: To compare the effects of inhaled nitric oxide and aerosolized prostacyclin (PGI2) on hemodynamics and gas exchange as well as on the indocyanine-green plasma disappearance rate and gastric intramucosal pH in patients with septic shock. Design: Prospective, randomized, interventional clinical study. Setting: Intensive care unit in a university hospital. Patients: Sixteen patients with pulmonary hypertension and septic shock according to the criteria of the ACCP/SCCM consensus conference all requiring norepinephrine and/or epinephrine to maintain mean arterial blood pressure above 65 mmHg. Methods and interventions: Patients were randomly assigned to receive either nitric oxide or aerosolized prostacyclin. Nitric oxide was inhaled using a commercially available delivery system, prostacyclin was administered with a modified ultrasound nebulizer. Both nitric oxide and prostacyclin were incrementally adjusted to obtain a 15% decrease of mean pulmonary artery pressure. Hemodynamics and gas exchange as well as indocyanine-green plasma disappearance rate and gastric intramucosal pH were determined at baseline after 90 min in steady state, after 90 min of nitric oxide inhalation or prostacyclin aerosol administration had elapsed in stable conditions, and after 90 min in stable conditions after nitric oxide or prostacyclin withdrawal. Results: Both inhaled nitric oxide and aerosolized prostacyclin selectively reduced the mean pulmonary artery pressure from 35±4, 30±4 mmHg (p〈0.05) and 34±4 to 30±3 mmHg (p〈0.05) respectively; after removal of nitric oxide and prostacyclin, the mean pulmonary artery pressure returned to the baseline values. Systemic hemodynamics remained unaltered during the vasodilator treatment. While the mean PaO2 was not significantly influenced, it increased in 4/8 of the NO- and 3/8 of the PGI2– treated patients. Neither of the drugs influenced indocyanine-green plasma disappearance rate, but prostacyclin – unlike nitric oxide – significantly increased gastric intramucosal pH (from 7.26±0.07 to 7.30±0.05, p〈0.05) which remained elevated in four of these patients after prostacyclin removal, and decreased the arterial-gastric mucosal pressure of carbon dioxide gap from 19±6 to 15±4 mmHg (p〈0.05). Conclusions: Our data suggest that aerosolized prostacyclin – unlike nitric oxide – has similar beneficial effects on splanchnic perfusion and oxygenation as intravenous prostacyclin without detrimental effects on systemic hemodynamics. The different effects of prostacyclin and nitric oxide might be explained by the longer half-life of prostacyclin associated with a certain spillover into the systemic circulation.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340050182
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 3
    Digitale Medien
    Digitale Medien
    Are the effects of noradrenaline, adrenaline and dopamine infusions on $$\dot VO_2 $$ and metabolism transient?and metabolism transient? (1995)
    Springer
    Intensive care medicine 21 (1995), S. 50-56 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Noradrenaline ; Adrenaline ; Dopamine ; Oxygen consumption ; Blood pressure ; Heart rate
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective To determine whether noradrenaline, adrenaline and dopamine have persistent on $$\dot VO_2 $$ and metabolism. Design Descriptive laboratory investigation. Setting Laboratory of the Department of Anaesthesiology at a University Hospital. Subjects 9 volunteers. Intervention $$\dot VO_2 $$ and the plasma concentration of glucose and free fatty acids were measured prior to and during a 4 h infusion of saline (control), noradrenaline (0.14 μg/kg min) adrenaline (0.08 μg/kg min) or dopamine (7 μg/kg min),n=9 each. $$\dot VO_2 $$ was measured using an open circuit gas exchange system. Measurements and main results $$\dot VO_2 $$ increased from 250±22 ml/min to 280±38 ml/min during noradrenaline, to 298±30 ml/min during adrenaline and to 292±39 ml/min during dopamine infusion. The plasma glucose concentration increased from 6.2±0.6 mmol/l to 8.8±0.8 mmol/l, 13.2±1.4 and 7.3±0.4 mmol/l during infusion of noradrenaline, adrenaline or dopamine, respectively. The plasma free fatty acid concentration increased from 0.28±0.10 mmol/l to 0.79±0.21 mmol/l during noradrenaline and to 0.52±0.09 mmol/l during dopamine. In contrast, free fatty acid values averaged baseline values at the end of the adrenaline infusion after an initial increase to 0.72±0.31 mmol/l. Conclusions Administration of noradrenaline, adrenaline or dopamine resulted in persistent increases in $$\dot VO_2 $$ in volunteers. With the exception of the transient adrenaline effect on fatty acids the metabolic actions were steady during 4 h of adrenergic stimulation. Since the adrenergic effect on $$\dot VO_2 $$ is persistent over time a similar action in patients (e.g. septic shock) during treatment with adrenoceptor agonists may be important. Thus, an increase in $$\dot VO_2 $$ during therapy may not only reflect an oxygen debt but also a pharmacodynamic action of adrenoceptor mediated calorigenic and metabolic induction.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02425154
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 4
    Digitale Medien
    Digitale Medien
    Aerosolized prostacyclin and inhaled nitric oxide in septic shock — different effects on splanchnic oxygenation? (1996)
    Springer
    Intensive care medicine 22 (1996), S. 880-887 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Septic shock ; Nitric oxide ; Prostacyclin ; Gastric intramucosal pH ; PCO2 gap ; Splanchnic oxygenation ; Indocyanine-green extraction
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objectives To compare the effects of inhaled nitric oxide and aerosolized prostacyclin (PGI2) on hemodynamics and gas exchange as well as on the indocyanine-green plasma disappearance rate and gastric intramucosal pH in patients with septic shock. Design Prospective, randomized, interventional clinical study. Setting Intensive care unit in a university hospital. Patients Sixteen patients with pulmonary hypertension and septic shock according to the criteria of the ACCP/SCCM consensus conference all requiring norepinephrine and/or epinephrine to maintain mean arterial blood pressure above 65 mmHg. Methods and interventions Patients were randomly assigned to receive either nitric oxide or aerosolized prostacyclin. Nitric oxide was inhaled using a commercially available delivery system, prostacyclin was administered with a modified ultrasound nebulizer. Both nitric oxide and prostacyclin were incrementally adjusted to obtain a 15% decrease of mean pulmonary artery pressure. Hemodynamics and gas exchange as well as indocyaninegreen plasma disappearance rate and gastric intramucosal pH were determined at baseline after 90 min in steady state, after 90 min of nitric oxide inhalation or prostacyclin aerosol administration had elapsed in stable conditions, and after 90 min in stable conditions after nitric oxide or prostacyclin with-drawal. Results Both inhaled nitric oxide and aerosolized prostacyclin selectively reduced the mean pulmonary artery pressure from 35±4, 30±4 mmHg (p〈0.05) and 34±4 to 30±3 mmHg (p〈0.05) respectively; after removal of nitric oxide and prostacyclin, the mean pulmonary artery pressure returned to the baseline values. Systemic hemodynamics remained unaltered during the vasodilator treatment. While the mean PaO2 was not significantly influenced, it increased in 4/8 of the NO- and 3/8 of the PGI2 — treated patients. Neither of the drugs influenced indocyanine-green plasma disappearance rate, but prostacyclin — unlike nitric oxide — significantly increased gastric intramucosal pH (from 7.26±0.07 to 7.30±0.05,p〈0.05) which remained elevated in four of these patients after prostacyclin removal, and decreased the arterial-gastric mucosal pressure of carbon dioxide gap from 19±6 to 15±4 mmHg (p〈0.05). Conclusions Our data suggest that aerosolized prostacyclin — unlike nitric oxide — has similar beneficial effects on splanchnic perfusion and oxygenation as intravenous prostacyclin without detrimental effects on systemic hemodynamics. The different effects of prostacyclin and nitric oxide might be explained by the longer half-life of prostacyclin associated with a certain spillover into the systemic circulation.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02044111
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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