title: Impaired neuroendocrine response mediates refractoriness to cardiopulmonary resuscitation in spinal anesthesia.
abstract: OBJECTIVE
  To determine the extent of neurogenic control on adrenal secretion in a canine model of high spinal anesthesia and cardiac arrest.
  
  
  METHODS
  Randomized, controlled, acute intensive study.
  
  
  METHODS
  University intensive care laboratory.
  
  
  METHODS
  Nineteen healthy, anesthetized, mongrel dogs.
  
  
  METHODS
  Cardiac arrest was induced in 11 spinally anesthetized dogs and 8 sham-control animals; cardiopulmonary resuscitation (CPR) was started 60 secs later. Epinephrine was injected at 4 mins and every 2 mins thereafter. Arterial blood samples were obtained before anesthesia, before arrest, and after 1, 3, 5, 7, 9, and 11 mins of CPR.
  
  
  RESULTS
  At 1 and 3 mins after cardiac arrest, the control group exhibited significant increases of epinephrine and norepinephrine concentrations (p < .05) that were absent in the spinal anesthesia group. Plasma renin increased in both groups whereas aldosterone and cortisol remained unchanged.
  
  
  CONCLUSIONS
  Spinal anesthesia abolishes the catecholamine release that follows cardiac arrest, while a previously postulated direct adrenal effect of hypoxia stimulating catecholamine release was not confirmed in these experiments. Since epinephrine treatment restores coronary perfusion pressure (CPP) during CPR, we conclude that catecholamine deficiency is the most likely mechanism for inadequate CPP during CPR conducted in the presence of spinal anesthesia.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor 48109-0048, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Rosenberg
authors.forename: J
authors.initials: J
authors.lastname: Wortsman
authors.forename: J A
authors.initials: JA
authors.lastname: Wahr
authors.forename: P E
authors.initials: PE
authors.lastname: Cryer
authors.forename: C E
authors.initials: CE
authors.lastname: Gomez-Sanchez
mesh_terms: D000311:Adrenal Glands / Q000503:physiopathology; D000450:Aldosterone / Q000097:blood; D000775:Anesthesia, Spinal; D000818:Animals; D016887:Cardiopulmonary Resuscitation; D004285:Dogs; D004837:Epinephrine / Q000097:blood / Q000494:pharmacology; D006323:Heart Arrest / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D006854:Hydrocortisone / Q000097:blood; D018377:Neurotransmitter Agents / Q000378:metabolism*; D009638:Norepinephrine / Q000097:blood; D011897:Random Allocation; D012083:Renin / Q000097:blood
chemical_list: D018377:Neurotransmitter Agents; D000450:Aldosterone; D012083:Renin; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine