title: Inhibition of autonomic storm by epidural anesthesia does not influence cardiac inflammatory response after brain death in rats.
abstract: BACKGROUND
  After brain death (BD) donors usually experience cardiac dysfunction, which is responsible for a considerable number of unused organs. Causes of this cardiac dysfunction are not fully understood. Some authors argue that autonomic storm with severe hemodynamic instability leads to inflammatory activation and myocardial dysfunction.
  
  
  OBJECTIVE
  To investigate the hypothesis that thoracic epidural anesthesia blocks autonomic storm and improves graft condition by reducing the inflammatory response.
  
  
  METHODS
  Twenty-eight male Wistar rats (250-350 g) allocated to four groups received saline or bupivacaine via an epidural catheter at various times in relation to brain-death induction. Brain death was induced by a sudden increase in intracranial pressure by rapid inflation of a ballon catheter in the extradural space. Blood gases, electrolytes, and lactate analyses were performed at time zero, and 3 and 6 hours. Blood leukocytes were counted at 0 and 6 hours. After 6 hours of BD, we performed euthanasia to measure vascular adhesion molecule (VCAM)-1, intracellular adhesion molecule (ICAM)-1, interleukin (IL)-1β, tumor necrosis factor (TNF)-α, Bcl-2 and caspase-3 on cardiac tissue.
  
  
  RESULTS
  Thoracic epidural anesthesia was effective to block the autonomic storm with a significant difference in mean arterial pressure between the untreated (saline) and the bupivacaine group before BD (P < .05). However, no significant difference was observed for the expressions of VCAM-1, ICAM-1, TNF-α, IL-1β, Bcl-2, and caspase-3 (P > .05).
  
  
  CONCLUSIONS
  Autonomic storm did not seem to be responsible for the inflammatory changes associated with BD; thoracic epidural anesthesia did not modify the expression of inflammatory mediators although it effectively blocked the autonomic storm.
authors.affiliation: Laboratory of Cardiovascular Surgery, Heart Institute (InCor) of Sao Paulo University Medical School, Sao Paulo, Brazil. isaacazevedo@yahoo.com
authors.forename: I A
authors.initials: IA
authors.lastname: Silva
authors.forename: C J
authors.initials: CJ
authors.lastname: Correia
authors.forename: R
authors.initials: R
authors.lastname: Simas
authors.forename: C D J
authors.initials: CD
authors.lastname: Correia
authors.forename: J W M C
authors.initials: JW
authors.lastname: Cruz
authors.forename: S G
authors.initials: SG
authors.lastname: Ferreira
authors.forename: F L
authors.initials: FL
authors.lastname: Zanoni
authors.forename: L
authors.initials: L
authors.lastname: Menegat
authors.forename: P
authors.initials: P
authors.lastname: Sannomiya
authors.forename: L F P
authors.initials: LF
authors.lastname: Moreira
mesh_terms: D000767:Anesthesia, Epidural; D000818:Animals; D001341:Autonomic Nervous System / Q000503:physiopathology*; D001926:Brain Death; D008297:Male; D009205:Myocarditis / Q000503:physiopathology*; D051381:Rats; D017208:Rats, Wistar