title: Adenocaine and Mg(2+) reduce fluid requirement to maintain hypotensive resuscitation and improve cardiac and renal function in a porcine model of severe hemorrhagic shock*.
abstract: OBJECTIVE
  Hypotensive resuscitation is gaining clinical acceptance in the treatment of hemorrhagic shock. Our aims were to investigate: 1) the effect of 7.5% NaCl with adenocaine (adenosine and lidocaine, AL) and AL with Mg (ALM) on fluid requirement to maintain a minimum mean arterial pressure of 50 mm Hg, and 2) the effect of a second bolus of 0.9% NaCl with AL during return of shed blood on cardiac and renal function in a porcine model of hemorrhagic shock.
  
  
  METHODS
  Pigs were randomized to: Sham (n = 5), Sham + ALM/AL (n = 5), hemorrhage control (n = 11), or hemorrhage + ALM/AL (n = 9). Hemorrhage animals were bled to a mean arterial pressure of 35 mm Hg. After 90 mins, pigs were fluid resuscitated with Ringers acetate and 20 mL 7.5% NaCl with ALM to maintain a target mean arterial pressure of minimum 50 mm Hg. Shed blood and 0.9% NaCl with AL were infused 30 mins later. Hemorrhage control group was subjected to the same protocol but without ALM/AL. Hemodynamics, cardiodynamics (pressure-volume analysis), oxygen consumption, and kidney function were measured for 6 hrs.
  
  
  METHODS
  University hospital laboratory.
  
  
  METHODS
  Female farm-bred pigs.
  
  
  RESULTS
  Fluid volume infused during hypotensive resuscitation was 40% less in the 7.5% NaCl-/ALM-treated pigs than controls (25 vs. 41 mL/kg, p < .05). ALM was associated with a significant increase in dp/dtmax, end-systolic blood pressure, and systemic vascular resistance. Return of shed blood and 0.9% NaCl/AL reduced whole body oxygen consumption by 27% (p < .05), and significantly improved the end-systolic pressure-volume relationship and preload recruitable stroke work compared to controls. Glomerular filtration rate in the ALM/AL group returned to 83% of baseline compared to 54% in controls (p = .01).
  
  
  CONCLUSIONS
  Resuscitation with 7.5% NaCl ALM increases cardiac function and reduces fluid requirements during hypotensive resuscitation, whereas a second AL infusion during blood resuscitation transiently reduces whole body oxygen consumption and improves cardiac and renal function.
authors.affiliation: Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark. granfeldt@gmail.com
authors.forename: Asger
authors.initials: A
authors.lastname: Granfeldt
authors.forename: Torben K
authors.initials: TK
authors.lastname: Nielsen
authors.forename: Christoffer
authors.initials: C
authors.lastname: Sølling
authors.forename: Janus A
authors.initials: JA
authors.lastname: Hyldebrandt
authors.forename: Jørgen
authors.initials: J
authors.lastname: Frøkiær
authors.forename: Lise
authors.initials: L
authors.lastname: Wogensen
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Dobson
authors.forename: Jakob
authors.initials: J
authors.lastname: Vinten-Johansen
authors.forename: Else
authors.initials: E
authors.lastname: Tønnesen
mesh_terms: D000241:Adenosine / Q000494:pharmacology*; D000818:Animals; D004195:Disease Models, Animal; D004338:Drug Combinations; D005260:Female; D005440:Fluid Therapy; D006321:Heart / Q000503:physiopathology*; D007022:Hypotension / Q000188:drug therapy / Q000628:therapy*; D007668:Kidney / Q000503:physiopathology*; D008012:Lidocaine / Q000494:pharmacology*; D008274:Magnesium / Q000494:pharmacology*; D012151:Resuscitation; D012720:Severity of Illness Index; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D013552:Swine
chemical_list: D004338:Drug Combinations; C572495:adenocaine; D008012:Lidocaine; D008274:Magnesium; D000241:Adenosine