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PubMed1997

Microcirculation: what is the role of calcium antagonists?

This review article discusses some of the potentially beneficial effects of calcium antagonists on the coronary microcirculation. These include their vasodilating action on coronary resistance vessels as well as their effects on extravascular resistance (i.e. intramyocardial pressure). Examples are presented of how the non-invasive measurement of myocardial blood flow and flow reserve by means of positron emission tomography can contribute to the understanding of the effects of drug treatment on the coronary microcirculation. The action of calcium antagonists on the coronary microcirculation may help explain the efficacy of these drugs against ischaemia and ischaemia-reperfusion damage.

Animals↗

PubMed2002

Effects of quinupristin/dalfopristin on vasomotor tone in the intact peripheral microcirculation.

The purpose of this study was to determine whether quinupristin/dalfopristin modulates vasomotor tone in the intact peripheral microcirculation. Using intravital microscopy, we found that superfusion of quinupristin/dalfopristin (120 mg/L) on the intact hamster cheek pouch microcirculation had no significant effects on arteriolar diameter. In addition, superfusion of quinupristin/dalfopristin (120 mg/L) had no significant effects on vasodilation evoked by bradykinin and acetylcholine, two endothelium-dependent agonists, or by vasoactive intestinal peptide, an endothelium-independent agonist, on to the cheek pouch. Collectively, these data indicate that quinupristin/dalfopristin has no significant effects on vasomotor tone in the intact peripheral microcirculation.

Animals↗

PubMed1987

Testicular blood flow and microcirculation in rats after treatment with ethane dimethyl sulfonate.

The effects of ethane dimethyl sulfonate (EDS) on total testicular blood flow, microcirculation, and the testicular interstitial fluid volume (IFV) in rats were studied. In agreement with previous studies, treatment of control rats with human chorionic gonadotropin (hCG) induced an increase in IFV and total testicular blood flow as measured with radioactive microspheres. These effects of hCG were completely abolished in rats pretreated with EDS; in EDS-treated rats not receiving any hCG, there were decreases in IFV when compared with untreated control rats. Furthermore, the pulsatile pattern of testicular microcirculation registered with laser-Doppler flowmetry was abolished after EDS treatment, and this effect was not influenced by hCG treatment. The hCG-induced increase in IFV is associated with an increased accumulation of polymorphonuclear leukocytes locally in the testis, but this accumulation of leukocytes was not observed in rats pretreated with EDS. It was concluded from the present study that hCG-induced changes in total testicular blood flow and testicular microcirculation require functionally intact Leydig cells.

Animals↗

PubMed1991

Priming interactions between platelet activating factor and histamine in the in vivo microcirculation.

To elucidate whether priming exists between platelet-activating factor (PAF) and histamine in the microcirculation, we measured the clearance of FITC-dextran 150 in response to the topical applications of substimulatory concentrations of PAF and histamine. Maximal priming by PAF was observed when a 5-min interval separated the applications of 10(-9) M PAF and 10(-6) M histamine. The mean (+/- SEM) clearance resulting from this sequence of agonist administration was 7529 +/- 659 nl.2 h-1.g-1, representing a 4.5-fold enhancement in FITC-dextran 150 clearance compared with that evoked by 10(-6) M histamine alone (1664 +/- 397 nl.2 h-1.g-1). Lowering the PAF priming dose to 10(-11) M, or reversing the order of agonist addition to the microcirculation, resulted in diminished but significant responses of 3545 +/- 1143 and 4467 +/- 1170 nl.2 hr-1.g-1, respectively. Coapplication of PAF and histamine or increasing the time interval between the agonists to 15 min greatly reduced the responses to 1906 +/- 678 and 2770 +/- 837, respectively. The PAF receptor antagonist WEB 2086 (2 mg/kg i.v.), the H1 blocker pyrilamine (10 mg/kg i.v.), and leukocyte depletion with cyclophosphamide (150 mg/kg i.p.) completely abolished the PAF priming effect. In addition, the 5-lipoxygenase inhibitor RG 5901 (1 or 10 mg/kg i.v.) produced a two-thirds attenuation in PAF priming. We conclude that 1) PAF has the ability to prime the in vivo microvascular actions of histamine in both a concentration and time-dependent fashion; 2) this primed response is receptor mediated; and 3) histamine can prime the microcirculation for enhanced responses to PAF. Our data also demonstrate that leukocytes and the release of leukotrienes participate in PAF priming.

Animals↗

PubMed2003

The dose-dependent effects of fentanyl on rat skeletal muscle microcirculation in vivo.

Determining the effects of analgesia on the microcirculation is difficult because the surgery needed to allow in vivo observation often requires anesthesia. In this study, we used the dorsal microcirculatory chamber (DMC) to determine the effects of large (LF) and small (SF) dose IV fentanyl on the microcirculation compared with a conscious control. Male Wistar rats (130 g, n = 5) were implanted with the DMC to enclose a single layer of striated muscle. Animals were allowed 3 wk to recover from surgery and then, over the following 2 wk (1 infusion/wk) using intravital microscopy, the microcirculation was viewed in conscious animals (t = 0-30 min), followed by an induction bolus dose (t = 40-45 min), then a "step-up" maintenance infusion of one of the following, LF (40-90 microg x kg(-1) x h(-1)), SF (10-60 microg x kg(-1) x h(-1)), or saline (5-10 microg x kg(-1) x h(-1)) (t = 45-105 min). Small arterioles (<30 micro m) dilated (23.6% +/- 7.1%) after induction with LF, but constricted (-21.3% +/- 7.1%) with SF (P < 0.05). During maintenance, constriction increased with increasing dose of LF (-21.9% +/- 4.0%) and SF (-16.7% +/- 9.1%) (t = 105 min, P < 0.05). Similar patterns were observed in all arterioles (10-120 microm) and venules (15-250 microm). We conclude that the DMC provides an excellent technique for observing microcirculatory responses to fentanyl, and in rat skeletal muscle in vivo, an i.v. infusion of fentanyl produces significant constriction of arterioles.

Analgesics, Opioid↗

PubMed1994

Elimination of the diatrizoate-induced effects on the microcirculation by the prostacyclin derivative, iloprost.

RATIONALE AND OBJECTIVES: Contrast media, especially high-osmolar ionic compounds elicit drastic effects on the microcirculation. In some areas of the microcirculatory network, blood flow decreases up to total stasis; in other areas, blood velocity increases. The authors studied the effect of the stable prostacyclin derivative, iloprost, added to the diatrizoate formulation on the number of perfused microvessels in the rat intestine. METHODS: Diatrizoate (600 mg iodine/kg) and increasing concentrations of iloprost, ranging from a total dose of 0 to 560 ng/kg, were injected intravenously into groups of four anesthetized male rats. The number of unperfused microvessels in the intestine were determined by in vivo microscopy. Each animal received two treatments at an interval of 35 minutes. One treatment consisted of diatrizoate alone, the other treatment consisted of diatrizoate plus iloprost. Two animals of each group received first diatrizoate alone and then diatrizoate plus iloprost. The other two animals first received diatrizoate plus iloprost and then diatrizoate alone. RESULTS: Diatrizoate alone reduced the number of perfused microvessels by 45%. The addition of iloprost resulted in a dose-dependent improvement of microcirculation. At a dose of 280 ng/kg, the effects of diatrizoate were completely abolished. Increasing the dose further diminished this effect. CONCLUSIONS: The addition of iloprost to diatrizoate eliminates the deleterious effects of diatrizoate on microcirculation.

Animals↗

PubMed1995

Changes in the microcirculation of the intact rat heart after iodinated and gadolinium-containing contrast media.

RATIONALE AND OBJECTIVES: A new model was developed to study microcirculation in the intact heart of the anesthetized rat, and the effects of roentgenography and magnetic resonance imaging contrast media were investigated. METHODS: Roentgenography contrast media (600 mg iodine/kg), gadopentetate (0.25 mmol/kg), or physiological saline were injected intraarterially into anesthetized rats (N = 10) whose chests had been opened in a pressurized container. The effects on arterial and venous vasomotion and microhemodynamics of the capillary network were determined in vivo by combined incidental light-fluoroscopic microscopy using continuous 35-mm cine film and video recordings from 5 minutes before until 20 minutes after injection. The amplitude and frequency spectra were evaluated according to the Prony method and by Fourier analysis. Additionally, the number of perfused vessel bifurcations were counted. RESULTS: Gadopentetate exhibited no effects on microcirculation, and diatrizoate exhibited the largest ones. The deformation of the vasomotion spectrum reached 28%, and bifurcations were reduced by 21%. The effects were reversible within 10 minutes of injection. Iotrolan showed minimal disturbance. The other contrast media (iopromide, iopamidol, ioxaglate) fell between these two extremes. CONCLUSION: High-osmolar ionic roentgenography contrast media resulted in a transient deregulation of vasomotion and in a disturbed microcirculation in the rat heart. Isotonic or low-osmolar nonionic roentgenography contrast media or gadopentetate did not show this effect or showed it only to a minimal extent.

Animals↗

PubMed1983

The intracerebral microcirculation of the rat in hemorrhagic shock.

The intracerebral microcirculation of the isocortex was studied in unanesthetized rats under hemorrhagic shock. To observe the microvessels, three markers were separately injected intravenously during the shock period: (a) Evans blue for fluorescence microscopic visualization of the vessels. (b) India ink for gross and light microscopic evidence of retention of carbon. (c) Horseradish peroxidase (HRP) for light and electron microscopic study. Lack of spontaneous recovery from shock was associated with: (a) 55-65% blood loss, a low blood pressure (30-40 mm Hg), and a dramatic increase in pulse rate; (b) marked Evans blue fluorescence along the vessels; (c) no retention of India ink in the microcirculation; (d) peroxidase activity on the luminal surface of the endothelium. Absence of India ink in the microcirculation of the isocortex during the shock period, as shown by light and electron microscopy, suggests that there is sufficient cerebral blood flow to clear the carbon particles from the blood stream and that there are no openings greater than 30 nm in the endothelial layer allowing seepage of carbon particles through or between endothelial cells. Vascular Evans blue fluorescence and peroxidase activity were both demonstrated on the luminal surface of the endothelial cells, by light microscopy, indicating that these markers are abnormally retained. Ultrastructural demonstration of increased HRP uptake and adherence onto the endothelial cells confirms these observations. These results show that regional endothelial alterations occur in this model of hemorrhagic shock.

Anesthesia, Inhalation↗

PubMed1993

The effects of heparin and dietary fish oil on embolic events and the microcirculation downstream from a small-artery repair.

In recent studies we demonstrated that platelet emboli induced by arterial injury impair the microcirculation. The present study was performed to determine if heparin or dietary cod liver oil reduces the incidence of emboli following the same arterial injury and, in turn, whether these agents prevent the associated decrease in microcirculatory blood flow. The cremaster muscle of 29 male Sprague-Dawley rats was isolated on a single neurovascular bundle consisting of the iliac artery and vein and the genitofemoral nerve. Emboli were generated by a thrombogenic injury of the iliac artery, and their number and their subsequent effect on capillary perfusion in the downstream microcirculation were measured. Nine animals received heparin (10-unit IV bolus plus 10 units/hour IV infusion), 10 were fed cod liver oil (10 percent by weight of food) for 3 weeks prior to the experiment, and 9 animals receiving no treatment served as controls. The number of emboli was significantly reduced in the heparin group, but there was no accompanying improvement in capillary perfusion. In contrast, in the cod liver oil group, the number of emboli was not reduced, but there was significant improvement in capillary perfusion. These findings suggest that the harmful effect that platelet emboli have on the microcirculation is probably biochemical in nature (vasoconstriction) rather than related to simple mechanical obstruction to flow.

Anastomosis, Surgical↗

PubMed1993

Dynamic in vivo observation of rat islet microcirculation.

In vivo fluorescent microscopy with direct observation of flow through the islet was used to investigate the islet microcirculation. In urethane-anesthetized rats (n = 18), the pancreas was exposed and an islet was identified under direct microscopy. The vertical illuminator for fluorescent microscopy was turned on and fluorescein-albumin conjugate or fluorescent microspheres were injected intravenously or intraarterially. Each study was videotaped; on slow motion playback, the flow of the conjugate or microspheres was followed through the islet, the islet capillaries, and then to venules exiting the islet. One islet in the head of the pancreas in 12 rats was studied. The arterioles first reached the surrounding mantle of the islet where they divided into capillaries that carried conjugate or microspheres to other portions of the mantle or the core of the islet. Flow of conjugate traversed the core and returned to different portions of the mantle. The fluorescent microsphere study permitted a more detailed study of the pathways followed, the individual microspheres being seen to travel through numerous tortuous pathways through the islet. The flow of microspheres was nonhomogeneous in that individual microspheres in one portion of the islet would stop, then move on, while other microspheres flowed freely. The capillaries joined two to six venules that carried the conjugate or microspheres out of the islet. One or two of the exiting microvessels entered the adjacent acinar microcirculation; the others entered larger collecting venules. In six tail islets studied, the microcirculation was similar to that of the islets in the head of the pancreas.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1991

Increase in survival of liver grafts after rinsing with warm Ringer's solution due to improvement of hepatic microcirculation.

Temperature increases membrane fluidity and decreases vascular resistance in isolated organs. Therefore, these studies were designed to determine if a rinse with warm buffer could increase survival time in the rat model of orthotopic liver transplantation by improving hepatic microcirculation. Brief periods of warm ischemia (3-8 min) did not damage the liver as indexed by minimal release of LDH. Survival of rats for 30 days was greater than 90% in this model when livers were stored for 1 hr in Ringer's solution; yet grafts stored for 8 hr in Euro-Collins solution and rinsed with 20 ml of cold (0-4 degrees C) Ringer's solution survived postoperatively only around 3 days. However, livers stored for 8 hr in Euro-Collins and rinsed with 20 ml of warm (37 degrees C) Ringer's survived longer than 30 days (i.e., permanently). Serum transaminase levels reached peak values around 6000 U/L one day postoperatively in the cold-rinsed group, and liver injury assessed histologically was substantial. Under these conditions, pulmonary infiltration of inflammatory cells was observed in about 23% of lung tissue examined and was associated with massive bleeding. Following a warm rinse, however, maximal SGOT levels and injury to both liver and lung were reduced significantly by 80-90% 24 hr postoperatively. Moreover, the warm rinse improved hepatic microcirculation. It accelerated blood flow into the liver approximately two-fold, as indexed by the half-time of changes in hemoglobin reflectance from the liver surface, improved the distribution of colloidal carbon in the organ observed macroscopically, and decreased vascular resistance by over 50%. These data support the hypothesis that a brief rinse of liver grafts with warm buffer markedly improves the hepatic microcirculation, leading to dramatic improvement in graft survival. This work demonstrates clearly that a brief warm rinse may be useful clinically in liver transplantation.

Animals↗

PubMed1999

The effect of graded steatosis on flow in the hepatic parenchymal microcirculation.

BACKGROUND: Steatosis is a major cause of microcirculatory impairment and graft dysfunction after liver transplantation. The mechanism of this circulatory compromise is unclear. The aim of this study was to evaluate in vivo the effect of steatosis on parenchymal microcirculation and on total hepatic blood flow in an animal model. METHODS: Four groups of New Zealand White rabbits (n=24) were investigated. Group 1 were fed on normal diet (controls). In groups 2, 3, and 4 graded steatosis was induced by feeding on a high cholesterol diet (1.5%) for 4, 8, and 12 weeks, respectively. After laparotomy and exposure of the liver, total hepatic blood flow (THBF) and the hepatic parenchymal microcirculation (HPM) were measured. These parameters were correlated with the degree of histological fat infiltration classified as mild (<30%), moderate (30-60%), or severe (>60%). RESULTS: The 4-, 8-, and 12-week cholesterol diets resulted in mild, moderate, and severe steatosis, respectively. There was an inverse correlation between the degree of fat infiltration and both HPM (Spearman r=-0.967, P<0.0001) and THBF (r=-0.893, P<0.0001). THBF was 137+/-6 ml/min in controls, which reduced to 121+/-3, 99+/-5, and 63+/-5 ml/min in steatotic livers of groups 2, 3, and 4, respectively. HPM was 226+/-5 flux units in the controls and 197+/-7, 119+/-8, and 37+/-9 flux units in steatotic livers of groups 2, 3, and 4 respectively. Comparing with controls using analysis of covariance, the fall in HPM and THBF was found to be significant (P<0.002) in the moderate and severe groups, but not significant (P>0.050) in the mild group. Parenchymal perfusion was reduced to a greater extent than total liver blood flow in moderate and severe grades of steatosis. CONCLUSIONS: Fatty infiltration reduces hepatic blood flow and parenchymal microcirculation. The latter is more markedly reduced with severe steatosis. This may explain the development of microcirculatory impairment and graft failure after transplantation of fatty livers despite adequate liver blood flow.

Animals↗

PubMed1999

Improvements in diabetic microangiopathy after successful simultaneous pancreas-kidney transplantation: a computer-assisted intravital microscopy study on the conjunctival microcirculation.

A computer-assisted intravital microscopy technology has been developed to noninvasively and objectively study diabetic microangiopathy in the conjunctival microcirculation of type-1 diabetics. Quantitative characterization of the conjunctival microcirculation was performed on 12 patients pre- and 18 months postsimultaneous pancreas-kidney transplantation (SPK). Healthy nondiabetic volunteers (n=12), solitary kidney (K) transplanted type-1 diabetics (n=5), and nontransplanted type-1 diabetics (n=12) served as controls. Pre-SPK diabetics showed abnormal-sized venules (diameter=66+/-7 microm) and reduced presence of arterioles (arteriole length/area=18+/-6 microm(-1)) compared with nondiabetic controls (53+/-4 microm; 31+/-8 microm(-1); P<0.05). The computed vascular perfusion capacity of the conjunctival microvasculature was diminished in the same patients (pre-SPK diabetics=49+/-9%; nondiabetic healthy controls=71+/-6%; P<0.05). Significant improvement in microangiopathy was observed in all post-SPK diabetics (diameter=58+/-6 microm; arteriole length/area=26+/-9 microm(-1); vascular perfusion=63+/-8%; P<0.05) 18 months post-SPK. Blood flow velocities in the conjunctival microcirculation in the same post-SPK patients showed noticeable but not significant improvements (nondiabetic controls=2.94+/-0.57 mm/sec; pre-SPK=1.23+/-0.49 mm/sec; post-SPK=1.65+/-0.42 mm/sec). The solitary kidney transplant controls (post-K) showed no significant improvements in diabetic microangiopathy, confirming the unique role of the pancreas in SPK. In general, significant improvements (P<0.05) in diabetic microangiopathy were observed in all 12 diabetics 18 months post-SPK but not in the controls.

Adult↗

PubMed2001

Impairment of microcirculation in the early reperfusion period predicts the degree of graft pancreatitis in clinical pancreas transplantation.

BACKGROUND: Graft pancreatitis is thought to be induced by ischemia/reperfusion. Animal experiments have suggested that an impaired microcirculation is crucial in this process. We have therefore studied the relevance of microcirculation in clinical pancreas transplantation. METHODS: In 17 patients undergoing pancreas transplantation, tissue pO2 was monitored continuously by an electrode implanted into the pancreatic tail. A catheter was inserted in the distal part of the splenic vein of the pancreas graft. After reperfusion blood samples were taken from this catheter and blood flow was measured by the venous outflow method. The degree of graft pancreatitis was assessed by peak-C-reactive protein (CRP) defined as highest CRP within 3 days after transplantation. RESULTS: Tissue pO2 increased within 5 min after reperfusion. Thereafter, in most patients a transient decrease was noted, indicating impairment of nutritive perfusion. During this period there was an increasing negative correlation between peak-CRP and tissue pO2 which was highly significant at 60 min after reperfusion (r=-0.70, P<0.002). Also donor age correlated significantly with peak-CRP (r=0.64, P<0.005) and to a somewhat lesser extend with tissue pO2 60 min after reperfusion (r= -0.55, P<0.03). CONCLUSION: These data show that the degree of organ damage in clinical pancreas transplantation is directly related to an impairment of microcirculation in the early reperfusion period. These data also support the idea that grafts from older donors have a higher probability to develop graft pancreatitis and that this might be due to an increased incidence of microcirculatory disturbances in these organs.

Adult↗

PubMed2001

Effect of ischemia-reperfusion injury on the microcirculation of the steatotic liver of the Zucker rat.

BACKGROUND: Much discussion has been focused on the use of steatotic livers for transplantation due to the prevalence of steatosis in the potential donor liver pool (1). The aim of this study was to investigate the possibility that the microcirculation of steatotic liver is more sensitive to the ischemia-reperfusion (IR) injury than normal liver. METHODS: The left liver lobe of obese (n=9) and lean Zucker rats (n=9) were subjected to 40 min of warm ischemia followed by 60 min of reperfusion. Fluorescent probes rhodamine 123 (Rh123), bisbenzimide (Bis), and rhodamine 6G (Rh6G) were administered for the identification by intravital fluorescence microscopy (IVFM) of mitochondrial membrane potential, hepatocyte nuclei and leukocytes, respectively before hepatic ischemia and at 15, 30, 45, and 60 min after reperfusion. Blood samples were obtained before and after 60 min of reperfusion. Liver tissue was taken at the end of experiment for histological analysis. RESULTS: The liver of the obese rats showed prominent macro- and microvesicular fatty changes (MAFC and MIFC) and hepatocyte swelling. Under IVFM, the obese animals had significantly wider hepatic cords (23.1+/-0.8 microm) than the lean ones (15.9+/-0.5 microm) (P<0.01), whereas no significant difference in sinusoidal diameters was noted. The number of functional sinusoids significantly decreased after 30 min of reperfusion in both groups but no significant change was noted in the nucleus count throughout the experiment. Rh123 fluorescence intensity dropped significantly in the obese group after 60 min of reperfusion but not in the lean rats. Leukocyte adherence showed a significant rise after reperfusion in both groups. Plasma AST and ALT levels were 40- and 24-fold higher respectively for the obese animals after IR compared with their preischemic values, whereas the corresponding increase were 4.2- and 3.4-fold for the lean animals, respectively. CONCLUSIONS: Our results indicate that the liver of the obese Zucker rat is steatotic and presents with an abnormal microcirculation manifested by a reduced sinusoidal density. IR led to significantly greater hepatic injury in the steatotic than in the normal liver. This injury was accompanied by a significant reduction in the functional sinusoidal density and mitochondrial membrane potential as assessed by Rh123-associated fluorescence in the steatotic liver. In conclusion, the increased sensitivity of the steatotic liver to IR injury would appear to involve both alterations in blood flow in the microcirculation and to cellular changes.

Alanine Transaminase↗

PubMed2002

Enhanced vasoconstriction to endothelin-1, angiotensin II and noradrenaline in carriers of the GNB3 825T allele in the skin microcirculation.

Hypertension is associated with enhanced peripheral vascular resistance, which may be mediated by enhanced vasoconstriction. The impact of the recently detected G-protein beta3-subunit gene C825T polymorphism on the response to the major pressor mediators has been studied in vivo in the human microcirculation. We assessed the effects of endothelin-1 (ET-1), angiotensin II (AT), endothelin-antagonists (BQ-123 and BQ-788) and noradrenaline (NA, each 10-16-10-8 mol) on vasoconstriction in the human skin microcirculation in vivo in 25 healthy male volunteers (13 with CC genotype, 12 TC/TT genotype) using laser Doppler flowmetry. The effects of endothelium-derived vasodilation on NA-induced effects were studied using the NO-synthase inhibitor l-nitro-monomethyl-arginine (L-NMMA) and the alpha2-adrenoceptor-antagonist yohimbine (YO). ET-1, AT and NA caused a dose-dependent vasoconstriction (P < 0.001). In carriers of the 825T allele the response to ET-1, AT and NA was significantly enhanced leading to a shift to the left of the dose-response curve of up to two log units (ET-1: P < 0.001 vs. CC; AT: P < 0.01 vs. CC; NA: P < 0.05 vs. CC). After pretreatment with L-NMMA or YO, NA induced vasoconstriction was no longer different between subjects with the CC- and CT/TT genotypes. However, following combined pretreatment with both L-NMMA and YO, vasoconstriction to NA was significantly potentiated in carriers of the T-allele. Vasodilatation to an ETA-antagonist (BQ-123) was more pronounced in the CT/TT genotype, while ETB-antagonism (BQ-788) led to a more pronounced vasoconstriction in the CT/TT genotype (not significant vs. CC). Healthy, normotensive carriers of the 825T-allele have enhanced vasoconstriction to ET-1, AT and NA in the skin microcirculation. This enhanced vasoconstriction appears to be partially antagonized by an enhanced release of endothelium derived vasodilators mediated by the stimulation of endothelial alpha2-adrenoceptors. The GNB3 C825T polymorphism is potentially an attractive pharmacogenetic marker to predict hormone-mediated responses in humans.

Adrenergic alpha-Antagonists↗

PubMed2006

Effects of vasopressin, norepinephrine, and L-arginine on intestinal microcirculation in endotoxemia.

OBJECTIVE: The effects of vasopressin, norepinephrine, and L-arginine alone or combined on intestinal microcirculation were evaluated in the septic mouse by intravital microscopy, with which we measured the erythrocyte flux and velocity in villus tip arterioles and the density of perfused villi. DESIGN: Controlled animal study. SETTING: University research laboratory. SUBJECTS: Female BALB/c mice weighing between 18 and 21 g. INTERVENTIONS: Anesthetized and ventilated mice received at t0 an intravenous injection of Escherichia coli endotoxin (2 mg/kg bolus intravenously), inducing after 1 hr (t60) a decrease in mean arterial blood pressure to 40-50 mm Hg associated with a significant decrease in erythrocyte flux and velocity in villus tip arterioles and in the density of perfused villi. The mice then received a randomly different treatment for endotoxin-induced shock. Treatments consisted in continuous intravenous infusion for 1 hr with either saline (control group), norepinephrine, vasopressin, L-arginine, vasopressin+L-arginine, or norepinephrine+L-arginine. The doses of vasopressors (used alone or combined with L-arginine) were titrated to restore mean arterial pressure to the baseline level. MEASUREMENTS AND MAIN RESULTS: At the end of the treatment (t120), we observed in the control group further decreases in arteriolar flux and velocity and in the density of perfused villi. In the groups treated by a vasopressor alone, mean arterial pressure returned to baseline and there were no additional decreases in arteriolar flux and velocity or in the density of perfused villi. However, these latter three variables did not return to their preshock baseline values. Even though L-arginine did not restore mean arterial pressure, the infusion of L-arginine alone prevented the decrease in flux or erythrocyte velocity occurring between t60 and t120 and conserved to some extent the density of perfused villi compared with that in the control groups. In addition, we found that simultaneous administration of norepinephrine or vasopressin with L-arginine improved all microcirculation variables more efficiently than either vasopressor alone. CONCLUSIONS: From these data, we conclude that a) restoring mean arterial pressure after 1 hr of endotoxemia was not sufficient to restore ad integrum intestinal mucosa microvascular perfusion; b) L-arginine could have a beneficial effect at the microcirculatory level, which was independent of mean arterial pressure; and c) administration of L-arginine combined with the maintenance of perfusion pressure by vasopressive drugs allowed a better preservation of intestinal microcirculation at an early stage of endotoxemia.

Animals↗

PubMed2006

Comparison of buccal microcirculation between septic and hemorrhagic shock.

OBJECTIVE: Microcirculatory perfusion is disturbed in sepsis, and global hemodynamics does not necessarily reflect microcirculatory blood flow. In this study, we investigated the effect of the same level of mean arterial pressure (MAP) or cardiac index on the changes in buccal microcirculation between septic and hemorrhagic shock. DESIGN: Prospective, controlled laboratory study. SETTING: University-affiliated research laboratory. INTERVENTIONS: A total of 20 Sprague-Dawley rats were divided into four groups: 1) septic shock induced by cecal ligation and perforation: when MAP decreased to 80 mm Hg, saline was infused at a rate of 25 mL.kg.hr for 2 hrs; 2) both time- and MAP-matched hemorrhagic shock: approximately 30% of total blood volume was withdrawn during the corresponding interval, followed by infusion aiming to restore MAP as required when MAP decreased to 80 mm Hg; 3) both time- and cardiac index-matched hemorrhagic shock: approximately 40% of total blood volume was withdrawn during the corresponding interval until MAP decreased to 50 mm Hg, which generally generated a cardiac index similar to those in septic animals, followed by infusion at the same rate for 2 hrs; and 4) sham control: animals underwent the same procedure except no cecal ligation and perforation, bleeding, and infusion. MEASUREMENTS AND MAIN RESULTS: Buccal microcirculation was visualized with the aid of an orthogonal polarization spectral image device. A semiquantitative score was calculated for vessels of <20 mum, primarily representing the capillaries. Impaired buccal capillary blood flows in septic animals were more severe than those in MAP-matched hemorrhagic animals and were similar to those in cardiac index-matched hemorrhagic animals during the hypoperfusion period before infusion. Significantly improved global hemodynamics after resuscitation cannot effectively improve the buccal capillary blood flows in septic animals, in contrast to those in MAP-matched and cardiac index-matched hemorrhagic animals. CONCLUSIONS: Impaired microcirculatory alteration in septic shock is more severe than hemorrhagic shock; microcirculation is relatively independent of improved systemic hemodynamics, in contrast to those in hemorrhagic shock.

Animals↗