Adrenergic drugs alter both the fluid kinetics and the hemodynamic responses to volume expansion in sheep

Carl Arne Ewaldsson, Luiz A. Vane, George Kramer, Robert G. Hahn

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background. Plasma volume expansion is often performed during adrenergic therapy in the intensive care unit, but little is known about their combined effects. Materials and methods. The influence of three adrenergic drugs (50 μg/kg/min of dopamine, 0.1 μg/kg/min of isoprenaline, or 3 μg/kg/min of phenylephrine) on the relationship between plasma dilution (an index of volume expansion) and the central hemodynamic responses to volume loading with 24 ml/kg of 0.9% saline were evaluated in 6 adult sheep. Kinetic analysis was also applied to the data on plasma dilution and the urinary excretion measured during and after volume loading. Results. The adrenergic agents markedly changed the baseline values for all hemodynamic parameters. The kinetic analysis showed that phenylephrine, which is an alpha-adrenergic receptor agonist, promoted renal excretion of infused fluid at the expense of fluid distribution to the periphery (P < 0.05 versus controls). Isoprenaline, which stimulates adrenergic beta-receptors, had the opposite effect. During volume expansion, cardiac atrial pressures increased by 25 to 90%, cardiac output by 13-80% and the arterial pressures by 2 to 22%. Plasma dilution during and after volume loading correlated, in a linear fashion, with these hemodynamic responses. The correlations were strong (r > 0.80) in the control and phenylephrine groups, but weaker in the dopamine and isoprenaline groups. Dopamine was associated with the most variable hemodynamic responses overall. Conclusions. Adrenergic drugs altered the hemodynamics at baseline (direct effects), changed the distribution and elimination of infused 0.9% saline (indirect effects) and, finally, modified most hemodynamic responses to plasma dilution (interaction effects).

Original languageEnglish (US)
Pages (from-to)7-14
Number of pages8
JournalJournal of Surgical Research
Volume131
Issue number1
DOIs
StatePublished - Mar 2006

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Adrenergic Agents
Sheep
Hemodynamics
Phenylephrine
Dopamine
Isoproterenol
Adrenergic alpha-Agonists
Plasma Volume
Intensive Care Units
Control Groups
Therapeutics

Keywords

  • Dopamine
  • Isoprenaline
  • Normal saline
  • Pharmacokinetics
  • Phenylephrine
  • Volume expansion

ASJC Scopus subject areas

  • Surgery

Cite this

Adrenergic drugs alter both the fluid kinetics and the hemodynamic responses to volume expansion in sheep. / Ewaldsson, Carl Arne; Vane, Luiz A.; Kramer, George; Hahn, Robert G.

In: Journal of Surgical Research, Vol. 131, No. 1, 03.2006, p. 7-14.

Research output: Contribution to journalArticle

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abstract = "Background. Plasma volume expansion is often performed during adrenergic therapy in the intensive care unit, but little is known about their combined effects. Materials and methods. The influence of three adrenergic drugs (50 μg/kg/min of dopamine, 0.1 μg/kg/min of isoprenaline, or 3 μg/kg/min of phenylephrine) on the relationship between plasma dilution (an index of volume expansion) and the central hemodynamic responses to volume loading with 24 ml/kg of 0.9{\%} saline were evaluated in 6 adult sheep. Kinetic analysis was also applied to the data on plasma dilution and the urinary excretion measured during and after volume loading. Results. The adrenergic agents markedly changed the baseline values for all hemodynamic parameters. The kinetic analysis showed that phenylephrine, which is an alpha-adrenergic receptor agonist, promoted renal excretion of infused fluid at the expense of fluid distribution to the periphery (P < 0.05 versus controls). Isoprenaline, which stimulates adrenergic beta-receptors, had the opposite effect. During volume expansion, cardiac atrial pressures increased by 25 to 90{\%}, cardiac output by 13-80{\%} and the arterial pressures by 2 to 22{\%}. Plasma dilution during and after volume loading correlated, in a linear fashion, with these hemodynamic responses. The correlations were strong (r > 0.80) in the control and phenylephrine groups, but weaker in the dopamine and isoprenaline groups. Dopamine was associated with the most variable hemodynamic responses overall. Conclusions. Adrenergic drugs altered the hemodynamics at baseline (direct effects), changed the distribution and elimination of infused 0.9{\%} saline (indirect effects) and, finally, modified most hemodynamic responses to plasma dilution (interaction effects).",
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N2 - Background. Plasma volume expansion is often performed during adrenergic therapy in the intensive care unit, but little is known about their combined effects. Materials and methods. The influence of three adrenergic drugs (50 μg/kg/min of dopamine, 0.1 μg/kg/min of isoprenaline, or 3 μg/kg/min of phenylephrine) on the relationship between plasma dilution (an index of volume expansion) and the central hemodynamic responses to volume loading with 24 ml/kg of 0.9% saline were evaluated in 6 adult sheep. Kinetic analysis was also applied to the data on plasma dilution and the urinary excretion measured during and after volume loading. Results. The adrenergic agents markedly changed the baseline values for all hemodynamic parameters. The kinetic analysis showed that phenylephrine, which is an alpha-adrenergic receptor agonist, promoted renal excretion of infused fluid at the expense of fluid distribution to the periphery (P < 0.05 versus controls). Isoprenaline, which stimulates adrenergic beta-receptors, had the opposite effect. During volume expansion, cardiac atrial pressures increased by 25 to 90%, cardiac output by 13-80% and the arterial pressures by 2 to 22%. Plasma dilution during and after volume loading correlated, in a linear fashion, with these hemodynamic responses. The correlations were strong (r > 0.80) in the control and phenylephrine groups, but weaker in the dopamine and isoprenaline groups. Dopamine was associated with the most variable hemodynamic responses overall. Conclusions. Adrenergic drugs altered the hemodynamics at baseline (direct effects), changed the distribution and elimination of infused 0.9% saline (indirect effects) and, finally, modified most hemodynamic responses to plasma dilution (interaction effects).

AB - Background. Plasma volume expansion is often performed during adrenergic therapy in the intensive care unit, but little is known about their combined effects. Materials and methods. The influence of three adrenergic drugs (50 μg/kg/min of dopamine, 0.1 μg/kg/min of isoprenaline, or 3 μg/kg/min of phenylephrine) on the relationship between plasma dilution (an index of volume expansion) and the central hemodynamic responses to volume loading with 24 ml/kg of 0.9% saline were evaluated in 6 adult sheep. Kinetic analysis was also applied to the data on plasma dilution and the urinary excretion measured during and after volume loading. Results. The adrenergic agents markedly changed the baseline values for all hemodynamic parameters. The kinetic analysis showed that phenylephrine, which is an alpha-adrenergic receptor agonist, promoted renal excretion of infused fluid at the expense of fluid distribution to the periphery (P < 0.05 versus controls). Isoprenaline, which stimulates adrenergic beta-receptors, had the opposite effect. During volume expansion, cardiac atrial pressures increased by 25 to 90%, cardiac output by 13-80% and the arterial pressures by 2 to 22%. Plasma dilution during and after volume loading correlated, in a linear fashion, with these hemodynamic responses. The correlations were strong (r > 0.80) in the control and phenylephrine groups, but weaker in the dopamine and isoprenaline groups. Dopamine was associated with the most variable hemodynamic responses overall. Conclusions. Adrenergic drugs altered the hemodynamics at baseline (direct effects), changed the distribution and elimination of infused 0.9% saline (indirect effects) and, finally, modified most hemodynamic responses to plasma dilution (interaction effects).

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