Is post cardiopulmonary bypass dysfunction a special form of stunning?
It has been suggested that cardioplegic arrest during cardiopulmonary bypass (CPB) produces global myocardial ischemia with a risk of myocardial stunning. It has also been postulated that anesthetic technique may affect the course of post-CPB myocardial stunning via exaggerated myocardial depression. However, we have previously found that global ventricular and regional myocardial responses to halothane do not differ in post-CPB and pre-CPB dogs. Our examination of the effects of CPB on the beta-adrenergic function revealed that beta-adrenergic receptor function is only slightly decreased immediately following (i.e., 1 min) and 30 minutes post-CPB. A dose-response relationship was established for dobutamine, with decreased responsiveness noted at both times. Since other data show normal inotropic stimulation of stunned myocardium, decreases in dobutamine responsiveness cannot be explained by beta-receptor desensitization. Overall, these data indicate that CPB does not result in myocardial stunning. The differences between these data and others showing myocardial stunning following CPB may be due to several factors, such as anesthetic regimen, lack of coronary blood flow abnormalities, and a reduction in sarcoplasmic reticular damage due to the hypothermic conditions used.
Leone
B J
BJ
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710.
Spahn
D R
DR
D000777:Anesthetics / Q000009:adverse effects; D000818:Animals; D009202:Cardiomyopathies / Q000209:etiology* / Q000503:physiopathology*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002316:Cardiotonic Agents / Q000009:adverse effects; D006801:Humans; D009200:Myocardial Contraction / Q000187:drug effects; D017202:Myocardial Ischemia / Q000209:etiology / Q000503:physiopathology; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology
D000777:Anesthetics; D002316:Cardiotonic Agents