Effect of adrenergic drugs on cerebral blood flow, metabolism, and evoked potentials after delayed cardiopulmonary resuscitation in dogs.
OBJECTIVE
Epinephrine administration during cardiopulmonary resuscitation increases cerebral blood flow by increasing arterial pressure. We tested whether potential beta-adrenergic effects of epinephrine directly influence cerebral blood flow and oxygen consumption independently of raising perfusion pressure.


METHODS
Four groups of seven anesthetized dogs were subjected to 8 minutes of fibrillatory arrest followed by 6 minutes of chest compression, ventricular defibrillation, and 4 hours of spontaneous circulation. Cerebral perfusion pressure was increased to approximately equivalent ranges during resuscitation by either 1) epinephrine infusion, 2) epinephrine infusion after pretreatment with the lipophilic beta-adrenergic antagonist pindolol, 3) infusion of the alpha-adrenergic agonist phenylephrine, or 4) descending aortic balloon inflation without pressor agents.


RESULTS
We found no difference in cerebral blood flow, oxygen extraction, or oxygen consumption during chest compression among groups. After ventricular defibrillation, depressed levels of cerebral blood flow, cerebral oxygen consumption, and somatosensory evoked potential amplitude were not different among groups.


CONCLUSIONS
We detected no evidence that after 8 minutes of complete ischemia, epinephrine administration during resuscitation substantially influences cerebral blood flow or cerebral oxygen consumption independent of its action of raising arterial pressure or or that epinephrine has a negative impact on immediate metabolic or electrophysiological recovery attributable to its beta-adrenergic activity.
Gervais
H W
HW
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
Schleien
C L
CL
Koehler
R C
RC
Berkowitz
I D
ID
Shaffner
D H
DH
Traystman
R J
RJ
D000818:Animals; D001775:Blood Circulation; D001794:Blood Pressure; D001921:Brain / Q000378:metabolism*; D016887:Cardiopulmonary Resuscitation; D002404:Catheterization; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003326:Coronary Circulation; D004285:Dogs; D004837:Epinephrine / Q000494:pharmacology*; D005071:Evoked Potentials / Q000187:drug effects*; D007583:Jejunum / Q000502:physiology; D007668:Kidney / Q000502:physiology; D009132:Muscles / Q000502:physiology; D010101:Oxygen Consumption / Q000187:drug effects*; D010656:Phenylephrine / Q000494:pharmacology; D010869:Pindolol / Q000494:pharmacology; D013997:Time Factors; D014059:Tongue / Q000502:physiology
D010656:Phenylephrine; D010869:Pindolol; D004837:Epinephrine