Anesthesia and Cardiovascular Disease (eBook)

Front Cover 1
Advances in Pharmacology: Anesthesia and Cardiovascular Disease 4
Cpopyright Page 5
Contents 6
Contributors 22
Preface 30
Part I: Cardiac Muscle 32
Chapter 1. Regulation of the Calcium Slow Channels of Heart by Cyclic Nucleotides and Effects of Ischemia 32
I. Introduction 32
II. Types of Calcium Channels 33
III. Cyclic AMP Stimulation of Slow Calcium Channels 37
IV. Phosphorylation Hypothesis 38
V. Protein Kinase A Stimulation 40
VI. Cyclic GMP Inhibition of Slow Calcium Current 40
VII. Protein Kinase G Inhibition 45
VIII. Inhibition by Muscarinic Agonists 47
IX. Protein Kinase C and Calmodulin Protein Kinase 49
X. Comparison with Vascular Smooth Muscle and Skeletal Muscle 49
XI. Direct Stimulation of Slow Calcium Channels by Gs Proteins and ß-Receptors 51
XII. Summary 51
References 52
Chapter 2. Functional Adaptation to Myocardial Ischemia: Interaction with Volatile Anesthetics in Chronically Instrumented Dogs 56
I. Introduction 56
II. Chronic Instrumentation and Monitoring 57
III. Effects of Ischemic Preconditioning on Functional Recovery from Stunning in Conscious Dogs 60
IV. Discussion 62
References 67
Chapter 3. Excitation–Contraction Uncoupling and Vasodilators for Long-Term Cold Preservation of Isolated Hearts 70
I. Introduction 70
II. Long-Term Cardiac Perfusion 73
III. Preservation of Isolated Hearts 77
IV. Discussion 85
References 90
Chapter 4. Troponin T as a Marker of Perioperative Myocardial Cell Damage 94
I. Introduction 94
II. Cardiac Troponin 95
III. Troponin T in Coronary Artery Bypass Patients with Unstable Angina 96
IV. Troponin T versus Conventional Markers of Myocardial Cell Damage in Perioperative Settings 101
V. Summary 102
References 103
Chapter 5. Silent Myocardial Ischemia: Pathophysiology and Perioperative Management 106
I. Introduction 106
II. Pathophysiology of Silent Myocardial Ischemia 107
III. Detection of Silent Myocardial Ischemia 110
IV. Which Laboratory Methods Should Be Used for Screening Purposes? 111
V. Perioperative Medical Management of Silent Myocardial Ischemia 113
VI. Summary 116
References 116
Chapter 6. Effect of Halothane on Sarcolemmal Calcium Channels during Myocardial Ischemia and Reperfusion 120
I. Introduction 120
II. Canine Model for Myocardial Ischemia and Reperfusion 121
III. Isolation of Sarcolemma-Enriched Preparation 123
IV. Binding Capacity of Isradipine 123
V. Summary 126
References 126
Chapter 7. Myocardial Ischemic Preconditioning 130
I. Introduction 130
II. Myocardial Ischemia 131
III. Effects on Infarct Size 134
IV. Discussion 137
References 138
Chapter 8. Effects of Hypoxia/Reoxygenation on Intracellular Calcium Ion Homeostasis in Ventricular Myocytes during Halothane Exposure 140
I. Introduction 140
II. Intracellular Calcium Measurements 142
III. Effects of Hypoxia, with or without Halothane, on Myocyte Morphology 144
IV. Effects of Hypoxia, with or without Halothane, on Intracellular Calcium 145
V. Effects of Hypoxia, with or without Halothane, on Electrically Induced Calcium Transients 147
VI. Effects of Hypoxia, with or without Halothane, on Caffeine-Induced Calcium Transients 148
VII. Discussion 148
References 153
Chapter 9. Mechanical Consequences of Calcium Channel Modulation during Volatile Anesthetic-Induced Left Ventricular Systolic and Diastolic Dysfunction 156
I. Introduction 156
II. Materials and Methods 158
III. Effects of Anesthetics and Calcium Channel Modulation 161
IV. Discussion 166
References 170
Chapter 10. Anesthetic Actions on Calcium Uptake and Calcium-Dependent Adenosine Triphosphatase Activity of Cardiac Sarcoplasmic Reticulum 176
I. Introduction 176
II. Sarcoplasmic Reticulum 178
III. Calcium Uptake and ATPase Activity 181
IV. Discussion 187
References 193
Chapter 11. Interaction of Anesthetics and Catecholamines on Conduction in the Canine His–Purkinje System 198
I. Introduction 198
II. Catecholamine–Anesthetic Interaction 199
III. Summary 211
References 212
Chapter 12. Anesthetics, Catecholamines, and Ouabain on Automaticity of Primary and Secondary Pacemakers 216
I. Introduction 216
II. Isolated and Chronic Atrial Preparations 217
III. Anesthetic Interactions with Ouabain and Catecholamines 221
IV. Discussion 228
V. Conclusions 234
VI. Future Directions 234
References 234
Chapter 13. The Role of L-Type Voltage-Dependent Calcium Channels in Anesthetic Depression of Contractility 238
I. Introduction 238
II. Isolated Heart Preparation 241
III. Effects of Anesthetics on Isradipine Binding 242
IV. Discussion 244
References 245
Chapter 14. Effects of Inhibition of Transsarcolemmal Calcium Influx on Content and Releasability of Calcium Stored in Sarcoplasmic Reticulum of Intact Myocardium 246
I. Introduction 246
II. Isolated Papillary Muscle Preparation 247
III. Calcium Influx and Release 247
IV. Discussion 251
References 251
Chapter 15. Arrhythmogenic Effect of Inhalation Anesthetics: Biochemical Heterogeneity between Conduction and Contractile Systems and Protein Unfolding 254
I. Introduction 254
II. Cyclic AMP and the Conduction System 255
III. Myocardial Sensitizing Agents and Phosphodiesterase 256
IV. Mode of Anesthetic–Protein Interaction 257
V. Unfolding of Proteins 259
VI. Specific Binding: Lack of Definition 262
References 263
Part II: Coronary Circulation 266
Chapter 1. Potassium Channel Current and Coronary Vasodilatation by Volatile Anesthetics 266
I. Introduction 266
II. Isolated Vessel Ring Experiments 267
III. Patch Clamp Experiments 269
IV. Effects of Anesthetics on Isolated Coronary Vessels 270
V. Effects of Anesthetics on Whole-Cell Potassium Current 272
VI. Effects of Anesthetics on Single Potassium Channel Current 274
VII. Discussion 279
References 282
Chapter 2. Potassium Channel Opening and Coronary Vasodilation by Halothane 284
I. Introduction 284
II. Isolated Coronary Vessel Preparation 285
III. Effects of Endothelin 289
IV. Effects of Methacholine 291
V. Effects of Potassium 294
VI. Discussion 294
References 297
Chapter 3. Volatile Anesthetics and Coronary Collateral Circulation 300
I. Introduction 300
II. Chronic Animal Instrumentation 301
III. Regional Myocardial Function and Perfusion 302
IV. Coronary Steal Prone Anatomy Model 304
V. Hemodynamic Effects of' Isoflurane, Sevoflurane, and Adenosine 306
VI. Regional Myocardial Perfusion: Isoflurane, Sevoflurane, and Adenosine 309
VII. Discussion 311
References 314
Chapter 4. Myocardial Oxygen Supply–Demand Relations during Isovolemic Hemodilution 316
I. Introduction 316
II. Experimental Studies 317
III. Summary 342
References 342
Part III: Cellular Targets 344
Chapter 1. Plasma Membrane Ca2+-ATPase as a Target for Volatile Anesthetics 344
I. Introduction 344
II. Isolation and Activity Assay of Ca2+-ATPase 346
III. Effects of Anesthetics 347
IV. Discussion 351
References 352
Chapter 2. Enhancement of Halothane Action at the Ryanodine Receptor by Unsaturated Fatty Acids 354
I. Introduction 354
II. Calcium Efflux 355
III. Calcium Release from Heavy Sarcoplasmic Reticulum Fraction 356
IV. Discussion 359
References 361
Chapter 3. Adrenergic Receptors: Unique Localization in Human Tissues 364
I. Introduction 364
II. Methods Used to Study Receptor Distribution 368
III. Localization of Receptors in Human Tissue 369
IV. Summary 371
References 372
Chapter 4. Volatile Anesthetic Effects on Inositol Triphosphate-Gated Intracellular Calcium Stores in GH3 Cells 374
I. Introduction 374
II. Intracellular Calcium Measurements 368
III. Effects of Anesthetics 369
IV. Summary 371
References 372
Part IV: Reflex Regulation 382
Chapter 1. Differential Control of Blood Pressure by Two Subtypes of Carotid Baroreceptors 382
I. Introduction 382
II. Carotid Baroreceptors 384
III. Carotid Sinus Nerve Activity 388
IV. Discussion 392
V. Anesthetic Implications 395
References 397
Chapter 2. Sympathetic Activation with Desflurane in Humans 400
I. Introduction 400
II. Sympathetic Microneurography 401
III. Anesthetics and Sympathetic Activation 402
IV. Discussion 406
V. Summary 408
References 409
Chapter 3. Randomized, Prospective Comparison of Halothane, Isoflurane, and Enflurane on Baroreflex Control of Heart Rate in Humans 410
I. Introduction 410
II. Baroreflex Function in Humans 411
III. Effects of Anesthetics 412
IV. Discussion 414
References 417
Chapter 4. Baroreflex Modulation by Isoflurane Anesthesia in Normotensive and Chronically Hypertensive Rabbits 420
I. Introduction 420
II. Chronically Hypertensive Rabbit Model and Experimental Protocol 421
III. Effect of Isoflurane on Arterial Pressure–Renal Sympathetic Nerve Activity and Arterial Pressure–Heart Rate Barocurves 425
IV. Discussion 432
References 437
Part V: Peripheral Circulation 440
Chapter 1. Effects of lsoflurane on Regulation of Capacitance Vessels under Normotensive and Chronically Hypertensive Conditions 440
I. Introduction 440
II. Hypertensive Rabbit Preparation 442
III. Mesenteric Reflex Measurements 442
IV. Circulatory Responses to Baroreflex and Chemoreflex Responses in Normotensive and Hypertensive Animals 444
V. Effects of Isoflurane on Hypoxia and Baroreflex- Mediated Responses 450
Vl. Effects of Isoflurane on Prestimulation Baseline Measurements 452
VII. Discussion 452
References 459
Chapter 2. Effect of Volatile Anesthetics on Baroreflex Control of Mesenteric Venous Capacitance 462
I. Introduction 462
II. Measurement of Venous Capacitance 463
III. Response to Baroreceptor Stimulaton 465
IV. Response to Electric Stimulation 471
V. Discussion 471
References 477
Chapter 3. Effect of General Anesthesia on Modulation of Sympathetic Nervous System Function 480
I. Introduction 480
II. Effect of Intravenous and Inhalational Anesthetics on Norepinephrine Kinetics 481
III. ß-Adrenergic Receptor-Mediated Release of Norepinephrine 485
IV. Effect of Inhalational Anesthesia on Prejunctional Norepinephrine Release in Viuo 487
V. Conclusions 488
References 488
Chapter 4. Inhibition of Nitric Oxide-Dependent Vasodilaton by Halogenated Anesthetics 490
I. Introduction 490
II. Methods 491
III. Effects of Anesthetics on Endotheliurn-Dependent Relaxations of Isolated Blood Vessels 493
IV. Effects of Halothane and Isoflurane on Nitric Oxide-, Nitroglycerin-, and Carbon Monoxide-Induced Relaxations of Rat Aorta 494
V. Effects of Halothane on Nitric Oxide-Stimulated Cyclic GMP 495
VI. Interactions of Halothane and Nitric Oxide in Absence of Tissues 496
VII. Discussion 498
References 500
Chapter 5. Effects of Epidural Anesthesia on Splanchnic Capacitance 502
I. Introduction 502
II. Epidural Anesthesia 503
III. Splanchnic Capacitance 504
IV. Summary 513
References 513
Chapter 6. Anesthetic Modulation of Pulmonary Vascular Regulation 516
I. Introduction 516
II. Measurement of Pulmonary Vasoregulation 517
III. Anesthesia and Pulmonary Vasoregulation 519
IV. Summary 533
References 534
Chapter 7. Pulmonary Mechanics Changes Associated with Cardiac Surgery 536
I. Introduction 536
II. Dynamic Lung Compliance 537
III. Effects of Sternotomy 537
IV. Discussion 540
References 543
Chapter 8. Inhaled Nitric Oxide in Adult Respiratory Distress Syndrome and Other Lung Diseases 544
I. Introduction 544
II. Pulmonary Hypertension in Adult Respiratory Distress Syndrome 545
III. Nitric Oxide 545
IV. Rationale for Use of Inhaled Nitric Oxide in Patients with Adult Respiratory Distress Syndrome 546
V. Laboratory Studies of Inhaled Nitric Oxide 546
VI. Clinical Studies of Nitric Oxide Inhalation in Adult Respiratory Distress Syndrome 550
VII. Inhaled Nitric Oxide in Other Lung Diseases Associated with Pulmonary Hypertension 553
VIII. Toxicity of Nitric Oxide 555
IX. Guidelines for Nitric Oxide Inhalation 556
References 558
Chapter 9. First Pass Uptake in the Human Lung of Drugs Used during Anesthesia 562
I. Introduction 562
II. First Pass Drug Uptake in Human Lung 563
III. Factors Affecting Pulmonary Drug Uptake 569
IV. Conclusions 578
References 578
Chapter 10. Lactic Acidosis and pH on the Cardiovascular System 582
I. Introduction 582
II. Induction of Lactic Acidosis 583
III. Cardiovascular Effects of Acute Acidosis 569
IV. Discussion 578
References 578
Part VI: CerebraI Circulation 596
Chapter 1. Role of Oxygen Free Radicals and Lipid Peroxidation in Cerebral Reperfusion Injury 596
I. Introduction 596
II. Free Radicals 597
III. Mechanisms of Brain Injury 598
IV. Potential Therapeutic Agents 599
V. Conclusion 602
References 603
Chapter 2. Effects of Volatile Anesthetics on Cerebrocortical Laser Doppler Flow: Hyperemia, Autoregulation, Carbon Dioxide Response, Flow Oscillations, and Role of Nitric Oxide 608
I. Introduction 608
II. Measurement of Laser Doppler Flow 610
III. Resting Flow 612
IV. Autoregulation 613
V. Hypocapnia and Hypercapnia 615
VI. Role of Nitric Oxide 617
VII. Spontaneous Flow Oscillations 619
VIII. Conclusions 622
References 622
Chapter 3. Cerebral Blood Flow during Isovolemic Hemodilution: Mechanistic Observations 626
I. Introduction 626
II. Influence of Hemodiluton on Cerebral Blood Volume 627
III. Influence of Focal Cortical Brain Lesion on Regional Cerebral Blood Flow Response to Hemodilution 628
IV. Comparison of Cerebrovascular and Metabolic Changes Produced by Hypoxia and Hemodilution 630
V. Role of Nitric Oxide in the Cerebral Blood Flow Response to Hemodilution 633
VI. Discussion 634
References 634
Chapter 4. Cerebral Physiology during Cardiopulmonary Bypass: Pulsatile versus Nonpulsatile Flow 638
I. Introduction 638
II. Pulsatile versus Nonpulsatile Bypass 641
III. Influence of Arterial Pressure Waveform 642
IV. Summary 645
References 645
Chapter 5. Anesthetic Actions of Cardiovascular Control Mechanisms in the Central Nervous System 648
I. Introduction 648
II. Studies Performed in Cats 650
III. Studies in Mongrel Dogs 652
IV. Central Nervous System Pressor Site Responses in Cats and Intermediolateral Cell Column Evoked Potential 654
V. Anesthetic Responses in Dogs 656
VI. Histological Documentation of Electrode Sites 665
VII. Discussion 665
References 670
Index 674
Contents of Previous Volumes 686