Subarachnoid blockade alters homeostasis by modifying compensatory splanchnic responses to hemorrhagic hypotension.
To demonstrate that sympathetic responses transmitted by the splanchnic nerve help maintain intravascular stability, 12 mongrel dogs (35-45 kg each), anesthetized with pentobarbital, were given two separate but identical hypotensive stimuli (mean arterial blood pressure of 60 mm Hg for 15 min) by the withdrawal of appropriate amounts of blood. The first stimulus was performed in the absence of drug or surgical manipulation. The second stimulus was performed after animals were subjected to no intervention (n = 4), bilateral splanchnic nerve section (n = 4), or spinal anesthesia (n = 4). Before and 10 min after the onset of hypotension, arterial epinephrine concentration and adrenal medullary and abdominal organ blood flow were measured. In the group without intervention, the second hypotensive stimulus (like the first) elicited 3-fold increases in adrenal medullary blood flow, 40-fold increases in arterial epinephrine concentration, and a 61% reduction in abdominal organ blood flow (P greater than 0.002). The volume of blood withdrawn to produce hypotension was similar (approximately 21 ml.kg-1). Bilateral splanchnic nerve section attenuated the adrenal medullary blood flow, arterial epinephrine concentration, and abdominal organ blood flow responses to hypotension by 86, 64, and 66%, respectively (P less than 0.008), and the blood volume withdrawn was reduced by 42% (P less than 0.02). Spinal anesthesia eliminated the adrenal medullary blood flow response to hypotension, attenuated the arterial epinephrine concentration and abdominal organ blood flow responses by 78 and 57%, respectively (P less than 0.01), and decreased the blood volume extracted by 55% (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Anesthesiology, Columbia University, College of Physicians and Surgeons, New York, New York.
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Jordan
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Miller
D000313:Adrenal Medulla / Q000098:blood supply; D000775:Anesthesia, Spinal; D000818:Animals; D004285:Dogs; D006470:Hemorrhage / Q000150:complications*; D006706:Homeostasis / Q000502:physiology*; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology*; D008012:Lidocaine; D013153:Splanchnic Nerves / Q000502:physiology*; D013346:Subarachnoid Space
D008012:Lidocaine