Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-23T02:36:48.408Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of the effects of dexmedetomidine and esmolol on myocardial oxygen consumption in dogs

Published online by Cambridge University Press:  28 January 2005

H. M. M. Willigers ,
F. W. Prinzen  and
P. M. H. J. Roekaerts
H. M. M. Willigers
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology, Maastricht, The Netherlands University Hospital Maastricht, The Cardiovascular Research Institute of Maastricht (CARIM), Maastricht, The Netherlands
F. W. Prinzen
Affiliation:
University Hospital Maastricht, The Cardiovascular Research Institute of Maastricht (CARIM), Maastricht, The Netherlands
P. M. H. J. Roekaerts
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology, Maastricht, The Netherlands University Hospital Maastricht, The Cardiovascular Research Institute of Maastricht (CARIM), Maastricht, The Netherlands
Get access

Extract

Summary

Background and objective: The beta-adrenergic blocker esmolol and the alpha 2-adrenergic agonist dexmedetomidine have the potential to decrease perioperative myocardial ischaemia. The pathophysiological mechanisms involved in these anti-ischaemic properties have not been thoroughly studied. We compared the effects of esmolol and dexmedetomidine on two indices of overall myocardial oxygen demand and on directly measured myocardial oxygen consumption of the left anterior coronary artery territory.

Methods: Eleven mongrel dogs were instrumented to measure aortic and left ventricular pressure, aortic and left anterior coronary artery flow and myocardial wall thickening. Variables related to myocardial oxygen metabolism were also determined. Measurements were performed during four sequential experimental conditions in each dog (Control 1: esmolol; Control 2: dexmedetomidine).

Results: Esmolol and dexmedetomidine decreased haemodynamic indices of myocardial oxygen demand to a similar extent: esmolol decreased the rate–pressure product by 16 ± 3% and the pressure–work index (PWI) by 16 ± 3%, dexmedetomidine decreased the rate–pressure product by 26 ± 3% and the PWI by 16 ± 7%. However, these similar decreases resulted from different haemodynamic effects of the two study drugs. Dexmedetomidine had a more pronounced bradycardic effect than esmolol (P = 0.01) and increased systolic aortic pressure (SAP) by 15 ± 4% while esmolol decreased SAP by 8 ± 2% (P < 0.01). dP/dtmax and regional myocardial area decrease were lower after esmolol than after dexmedetomidine. Neither drug had an effect on myocardial oxygen consumption.

Conclusions: Esmolol and dexmedetomidine decreased two haemodynamic indices of overall myocardial oxygen demand to a similar extent but neither drug decreased directly measured myocardial oxygen consumption in the territory of the left anterior descending artery.

Keywords

SYMPATHOLYTICS, ADRENERGIC BETA-ANTAGONISTS, esmololSYMPATHOLYTICS, ADRENERGIC ALPHA-AGONISTS, dexmedetomidineHEART, CORONARY CIRCULATION, drug effectsMYOCARDIUM, METABOLISMHEART, MYOCARDIAL CONTRACTION
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 12 , December 2004 , pp. 957 - 966
Copyright
© 2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Stevens RD, Burri H, Tramer MR. Pharmacologic myocardial protection in patients undergoing noncardiac surgery: a quantitative systematic review. Anesth Analg 2003; 97: 623–633.Google Scholar
Eagle KA, Berger PB, Calkins H, et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery – Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg 2002; 94: 1052–1064.Google Scholar
Urban MK, Markowitz SM, Gordon MA, Urquhart BL, Kligfield P. Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth Analg 2000; 90: 1257–1261.Google Scholar
Raby KE, Brull SJ, Timimi F, et al. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg 1999; 88: 477–482.Google Scholar
Talke P, Li J, Jain U, et al. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The study of Perioperative Ischemia Research Group. Anesthesiology 1995; 82: 620–633.Google Scholar
Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg 2000; 90: 834–839.Google Scholar
Lang RM, Marcus RH, Neumann A, et al. A time-course study of the effects of pentobarbital, fentanyl, and morphine chloralose on myocardial mechanics. J Appl Physiol 1992; 73: 143–150.Google Scholar
Flacke WE, Flacke JW, Bloor BC, McIntee DF, Sagan M. Effects of dexmedetomidine on systemic and coronary hemodynamics in the anesthetized dog. J Cardiothorac Vasc Anesth 1993; 7: 41–49.Google Scholar
Dyck JB, Maze M, Haack C, Azarnoff DL, Vuorilehto DL, Shafer SL. Computer-controlled infusion of intravenous dexmedetomidine hydrochloride in adult human volunteers. Anesthesiology 1993; 78: 821–828.Google Scholar
Rooke GA, Feigl EO. Work as a correlate of canine left ventricular oxygen consumption, and the problem of catecholamine oxygen wasting. Circ Res 1982; 50: 273–286.Google Scholar
Arts T, Veenstra PC, Reneman RS. Epicardial deformation and left ventricular wall mechanics during ejection in the dog. Am J Physiol 1982; 12: 379–390.Google Scholar
Arts T, Reneman RS. Measurement of deformation of canine epicardium in vivo during cardiac cycle. Am J Physiol 1980; 239: H432–H437.Google Scholar
Scheinin M, Karhuvaara S, Ojala-Karlsson P, Kallio A, Koulu M. Plasma 3,4-dihydroxyphenylglycol (DHPG) and 3-methoxy-4-hydroxyphenylglycol (MHPG) are insensitive indicators of alpha 2-adrenoceptor mediated regulation of norepinephrine release in healthy human volunteers. Life Sci 1991; 49: 75–84.Google Scholar
Koulu M, Scheinin M, Kaarttinen A, et al. Inhibition of monoamine oxidase by moclobemide: effects on monoamine metabolism and secretion of anterior pituitary hormones and cortisol in healthy volunteers. Br J Clin Pharmacol 1989; 27: 243–255.Google Scholar
Kal JE, Van Wezel HB, Vergroesen I. A critical appraisal of the rate pressure product as index of myocardial oxygen consumption for the study of metabolic coronary flow regulation. Int J Cardiol 1999; 71: 141–148.Google Scholar
Hoeft A, Sonntag H, Stephan H, Kettler D. Validation of myocardial oxygen demand indices in patients awake and during anesthesia. Anesthesiology 1991; 75: 48–56.Google Scholar
Schipke JD, Burkhoff D, Kass DA, Alexander Jr J, Schaefer J, Sagawa K. Hemodynamic dependence of myocardial oxygen consumption indexes. Am J Physiol 1990; 258: H1281–H1291.Google Scholar
Roekaerts PM, Prinzen FW, de Lange S. Beneficial effects of dexmedetomidine on ischaemic myocardium of anaesthetized dogs. Br J Anaesth 1996; 77: 427–429.Google Scholar
Lawrence CJ, Prinzen FW, de Lange S. The effect of dexmedetomidine on the balance of myocardial energy requirement and oxygen supply and demand. Anesth Analg 1996; 82: 544–550.Google Scholar
Lawrence CJ, Prinzen FW, de Lange S. Hemodynamic and coronary vascular effects of dexmedetomidine in the anesthetized goat. Acta Anaesthesiol Scand 1997; 41: 830–836.Google Scholar
Sidi A, Rush W. Decreased regional lactate production and output due to intracoronary continuous infusion of esmolol during acute coronary occlusion in dogs. J Cardiothorac Vasc Anesth 1991; 5: 237–242.Google Scholar
Sidi A, Davis RF. Esmolol decreases the adverse effects of acute coronary artery occlusion on myocardial metabolism and regional myocardial blood flow in dogs. Anesth Analg 1988; 67: 124–130.Google Scholar
Kirshenbaum JM, Kloner RA, Antman EM, Braunwald E. Use of an ultra short-acting beta-blocker in patients with acute myocardial ischemia. Circulation 1985; 72: 873–880.Google Scholar
Menkhaus PG, Reves JG, Kissin I, et al. Cardiovascular effects of esmolol in anesthetized humans. Anesth Analg 1985; 64: 327–334.Google Scholar
Reilly CS, Wood M, Koshakji RP, Wood AJ. Ultra-short-acting beta-blockade: a comparison with conventional beta-blockade. Clin Pharmacol Ther 1985; 38: 579–585.Google Scholar
Deegan R, Wood AJ. Beta-receptor antagonism does not fully explain esmolol-induced hypotension. Clin Pharmacol Ther 1994; 56: 223–228.Google Scholar
Jacobs JR, Maier GW, Rankin JS, Reves JG. Esmolol and left ventricular function in the awake dog. Anesthesiology 1988; 68: 373–378.Google Scholar
Gorczynski RJ, Murthy VS, Hwang TF. Beta-blocking and hemodynamic effects of ASL-8052. J Cardiovasc Pharmacol 1984; 6: 1548–1559.Google Scholar
Shah N, Del Valle O, Edmondson R, et al. Esmolol infusion during nitroprusside-induced hypotension: impact on hemodynamics, ventricular performance, and venous admixture. J Cardiothorac Vasc Anesth 1992; 6: 196–200.Google Scholar
Girard D, Shulman BJ, Thys DM, Mindich BP, Mikula SK, Kaplan JA. The safety and efficacy of esmolol during myocardial revascularization. Anesthesiology 1986; 65: 157–164.Google Scholar
Dyck JB, Maze M, Haack C, Vuorilehto L, Shafer SL. The pharmacokinetics and hemodynamic effects of intravenous and intramuscular dexmedetomidine hydrochloride in adult human volunteers. Anesthesiology 1993; 78: 813–820.Google Scholar
Schmeling WT, Kampine JP, Roerig DL, Warltier DC. The effects of the steroisomers of the α2-adrenergic agonist medetomidine on systemic and coronary hemodynamics in conscious dogs. Anesthesiology 1991; 75: 499–511.Google Scholar
Kallio A, Scheinin M, Koulu M, et al. Effects of dexmedetomidine, a selective α2-adrenoceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther 1989; 46: 33–42.Google Scholar
Van Citters RL, Franklin DL, Rushmer RF. Left ventricular dynamics in dogs during anesthesia with alpha-chloralose and sodium pentobarbital. Am J Cardiol 1964; 13: 349–354.Google Scholar
Covert RF, Schreiber MD, Leff AR, White SR, Munoz NM, Torgerson LJ. Oxygen metabolism and catecholamine secretion during chloralose anesthesia in lambs. J Dev Physiol 1992; 17: 125–132.Google Scholar
Covert RF, Drummond WH, Gimotty PA. Chloralose alters circulatory response to α-receptor stimulation and blockade. Am J Physiol 1988; 255: H419–H425.Google Scholar
Harwood TN, Butterworth J, Prielipp RC, et al. The safety and effectiveness of esmolol in the perioperative period in patients undergoing abdominal aortic surgery. J Cardiothorac Vasc Anesth 1999; 13: 555–561.Google Scholar
Ruesch S, Levy JH. Treatment of persistent tachycardia with dexmedetomidine during off-pump cardiac surgery. Anesth Analg 2002; 95: 316–318.Google Scholar
Vainio O, Ojala M. Medetomidine, an alpha 2-agonist, alleviates post-thoracotomy pain in dogs. Lab Anim 1994; 28: 369–375.Google Scholar
Quon CY, Gorczynski RJ. Pharmacodynamics and onset of action of esmolol in anesthetized dogs. J Pharmacol Exp Ther 1986; 237: 912–918.Google Scholar
Gorczynski RJ, Shaffer JE, Lee RJ. Pharmacology of ASL-8052, a novel β-adrenergic receptor antagonist with an ultrashort duration of action. J Cardiovasc Pharmacol 1983; 5: 668–677.Google Scholar
Daniell HB. Coronary flow alterations on myocardial contractility, oxygen extraction, and oxygen consumption. Am J Physiol 1973; 225: 1020–1025.Google Scholar
Modin A, Pernow J, Lundberg JM. Neuropeptide Y and differential sympathetic control of splenic blood flow and capacitance function in the pig and dog. Acta Physiol Scand 1993; 147: 15–25.Google Scholar
Supple EW, Graham RM, Powell Jr WJ. Direct effects of alpha 2-adrenergic receptor stimulation on intravascular systemic capacity in the dog. Hypertension 1988; 11: 352–359.Google Scholar
Flamm SD, Taki J, Moore R, et al. Redistribution of regional and organ blood volume and effect on cardiac function in relation to upright exercise intensity in healthy human subjects. Circulation 1990; 81: 1550–1559.Google Scholar
Laub M, Hvid-Jacobsen K, Hovind P, Kanstrup IL, Christensen NJ, Nielsen SL. Spleen emptying and venous hematocrit in humans during exercise. J Appl Physiol 1993; 74: 1024–1026.Google Scholar
Trippodo NC. Total circulatory capacity in the rat. Effects of epinephrine and vasopressin on compliance and unstressed volume. Circ Res 1981; 49: 923–931.Google Scholar
Fan FC, Chen RY, Schuessler GB, Chien S. Effects of hematocrit variations on regional hemodynamics and oxygen transport in the dog. Am J Physiol 1980; 238: H545–H552.Google Scholar