Sevoflurane and propofol anaesthesia differentially modulate the effects of epinephrine and norepinephrine on microcirculatory gastric mucosal oxygenation.
BACKGROUND
Adequate gastrointestinal mucosal oxygenation is regarded to be crucial in the prevention and therapy of critical illness. Epinephrine and norepinephrine are used for perioperative haemodynamic support. However, their per se effects on gastromucosal haemoglobin oxygenation (μHbO(2)) remain unclear. Moreover, respective effects of epinephrine and norepinephrine may be affected by the type of underlying anaesthesia. Thus, we studied the effects of epinephrine and norepinephrine during anaesthesia with sevoflurane or propofol on regional gastromucosal μHbO(2) and systemic O(2)-derived variables.


METHODS
In a double-randomized cross-over study, chronically instrumented dogs (n=6 per group) were anaesthetized randomly with sevoflurane or propofol, ventilated, and then randomly received either epinephrine or norepinephrine (0, 0.05, 0.1, and 0.2 µg kg(-1) min(-1)). We measured gastromucosal μHbO(2), systemic haemodynamics, and O(2)-derived variables.


RESULTS
During sevoflurane anaesthesia, norepinephrine markedly increased μHbO(2) (P<0.0001) and systemic oxygen transport (DO(2)) (P=0.0006). In contrast, epinephrine failed to increase μHbO(2), despite doubling DO(2) (P=0.0002). During propofol anaesthesia, in contrast to sevoflurane, neither epinephrine nor norepinephrine affected μHbO(2), although epinephrine, but not norepinephrine, again resulted in markedly increased DO(2) (P<0.0001).


CONCLUSIONS
The effects of epinephrine and norepinephrine depended on the type of anaesthesia. In addition, regional effects (i.e. μHbO(2)) were not predictable from systemic effects (i.e. DO(2)).
Schwarte
L A
LA
Department of Anaesthesiology, VU University Medical Center, Amsterdam, The Netherlands. l.schwarte@vumc.nl
Schwartges
I
I
Schober
P
P
Scheeren
T W L
TW
Fournell
A
A
Picker
O
O
D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D000818:Animals; D018592:Cross-Over Studies; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology; D008833:Microcirculation / Q000187:drug effects; D009638:Norepinephrine / Q000494:pharmacology; D010101:Oxygen Consumption / Q000187:drug effects; D015742:Propofol / Q000494:pharmacology; D012121:Respiration, Artificial; D000077149:Sevoflurane; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D000077149:Sevoflurane; D009638:Norepinephrine; D015742:Propofol; D004837:Epinephrine