Perfusion pressure control by adenosine triphosphate given during cardiopulmonary bypass.
Administration of exogenous adenosine triphosphate (ATP) as a vasodilator during cardiopulmonary bypass was assessed in consecutive adult patients (n = 24) who demonstrated a high arterial perfusion pressure (mean, > 90 mm Hg). The action of ATP was characterized by rapid induction and stabilization of the blood pressure level. The dose of ATP ranged from 0.68 to 2.68 mg/min. Within 1 minute after the administration, there was a significant reduction in the perfusion pressure from 102 +/- 18 mm Hg (mean +/- standard deviation) to 72 +/- 19 mm Hg. The ATP was then able to maintain the desired pressure of 69 +/- 12 mm Hg at 5 minutes, 67 +/- 12 mm Hg at 10 minutes, and consistent values thereafter. After the ATP administration was discontinued, there was a prompt recovery of pressure without bradyarrhythmia. The frequency and amount of inotropes used were consistent with the control group (n = 26). Although the administration of ATP reduced the increase in serum catecholamine concentration, there were no significant changes in other vasoactive mediators (eicosanoid, angiotensin II, endothelin) between the two groups during cardiopulmonary bypass. There was neither an accumulation of metabolic products (uric acid, phosphate) nor a decrease in the level of divalent cation (Ca2+), which is observed when the cations combine with phosphates or adenosine nucleotides. This study confirmed the efficacy and safety of ATP infusion during cardiopulmonary bypass.
Hashimoto
K
K
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
Kurosawa
H
H
Horikoshi
S
S
Miyamoto
H
H
Suzuki
K
K
D000255:Adenosine Triphosphate / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000804:Angiotensin II / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D016232:Endothelins / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery; D006331:Heart Diseases / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011460:Prostaglandins F / Q000097:blood; D013929:Thromboxane B2 / Q000097:blood; D014655:Vascular Resistance / Q000187:drug effects* / Q000502:physiology; D014665:Vasodilator Agents / Q000008:administration & dosage*
D016232:Endothelins; D011460:Prostaglandins F; D014665:Vasodilator Agents; D000804:Angiotensin II; D013929:Thromboxane B2; D000255:Adenosine Triphosphate; C100006:prostaglandin F1; D009638:Norepinephrine; D004837:Epinephrine