title: Altered reactivity to acetylcholine in the pulmonary circulation after cardiopulmonary bypass is part of reperfusion injury.
abstract: OBJECTIVE
  To investigate whether a time sequence of acetylcholine (ACH) reactivity indicative of endothelial reperfusion injury could be demonstrated in the pulmonary circulation in patients after cardiopulmonary bypass (CPB).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Operating theater and intensive care unit of a university hospital.
  
  
  METHODS
  10 ASA physical status III and IV patients with ischemic or valvular heart disease.
  
  
  METHODS
  Pulmonary vascular resistance index (PVRI) was measured before and during an infusion of ACH. This procedure was done after induction of anesthesia but before surgery, immediately after weaning from bypass, and at 1 to 1.5 and 4 hours after CPB.
  
  
  RESULTS
  ACH caused a decrease in PVRI before (p < 0.01) and directly after CPB (p < 0.05) but not at 1 to 1.5 or 4 hours after bypass.
  
  
  CONCLUSIONS
  The maintained reactivity to ACH directly after CPB, followed by no reaction at 1 to 1.5 and 4 hours, was in agreement with experimental findings and indicates endothelial reperfusion injury caused by the period with no blood flow through the pulmonary artery during CPB and subsequent reperfusion.
authors.affiliation: Department of Surgical Sciences, Karolinska Institute, Stockholm, Karolinska Hospital, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Angdin
authors.forename: G
authors.initials: G
authors.lastname: Settergren
authors.forename: R
authors.initials: R
authors.lastname: Astudillo
authors.forename: J
authors.initials: J
authors.lastname: Liska
mesh_terms: D000109:Acetylcholine; D000368:Aged; D002315:Cardiopulmonary Bypass; D005112:Extracorporeal Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis*; D011292:Premedication; D011479:Protamines / Q000494:pharmacology; D011652:Pulmonary Circulation / Q000187:drug effects*; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology
chemical_list: D011479:Protamines; D000109:Acetylcholine