title: Dose-dependent hemodynamic and metabolic effects of vasoactive medications in normotensive, anesthetized neonatal piglets.
abstract: The developmentally regulated hemodynamic effects of vasoactive medications have not been well characterized. We used traditional and near-infrared spectroscopy monitoring technologies and investigated the changes in heart rate, blood pressure, common carotid artery (CCA) blood flow (BF), cerebral, renal, intestinal, and muscle regional tissue O2 saturation, and acid-base and electrolyte status in response to escalating doses of vasoactive medications in normotensive anesthetized neonatal piglets. We used regional tissue O2 saturation and CCA BF as surrogates of organ and systemic BF, respectively, and controlled minute ventilation and oxygenation. Low to medium doses of dopamine, epinephrine, dobutamine, and norepinephrine increased blood pressure and systemic and regional BF in a drug-specific manner, whereas milrinone exerted minimal effects. At higher doses, dopamine, epinephrine, and norepinephrine but not dobutamine decreased systemic, renal, intestinal, and muscle BF, while cerebral BF remained unchanged. Epinephrine induced significant increases in muscle BF and serum glucose and lactate concentrations. The findings reveal novel drug- and dose-specific differences in the hemodynamic response to escalating doses of vasoactive medications in the neonatal cardiovascular system and provide information for future clinical studies investigating the use of vasoactive medications for the treatment of neonatal cardiovascular compromise.
authors.affiliation: Department of Pediatrics, Clinica Alemana, Santiago de Chile 1900, Chile.
authors.forename: Raul A
authors.initials: RA
authors.lastname: Nachar
authors.forename: Erin A
authors.initials: EA
authors.lastname: Booth
authors.forename: Philippe
authors.initials: P
authors.lastname: Friedlich
authors.forename: Matthew
authors.initials: M
authors.lastname: Borzage
authors.forename: Sadaf
authors.initials: S
authors.lastname: Soleymani
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wider
authors.forename: Istvan
authors.initials: I
authors.lastname: Seri
mesh_terms: D000818:Animals; D000831:Animals, Newborn / Q000502:physiology*; D002317:Cardiovascular Agents / Q000494:pharmacology*; D017536:Carotid Artery, Common / Q000502:physiology; D004280:Dobutamine; D004298:Dopamine; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine; D006439:Hemodynamics / Q000187:drug effects*; D006863:Hydrogen-Ion Concentration; D007422:Intestines / Q000098:blood supply; D007668:Kidney / Q000098:blood supply; D018482:Muscle, Skeletal / Q000098:blood supply; D009638:Norepinephrine; D010100:Oxygen / Q000378:metabolism*; D012039:Regional Blood Flow / Q000187:drug effects; D019265:Spectroscopy, Near-Infrared; D013552:Swine; D014882:Water-Electrolyte Balance
chemical_list: D002317:Cardiovascular Agents; D004280:Dobutamine; D010100:Oxygen; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine