J.Jpn. Surg. Soc.. 57(2): 239-259, 1956
CLINICAL AND EXPERIMENTAL STUDIES ON SYMPATHOMIMETIC AMINES IN SURGERY
|
Department of Surgery, Branch Hospital of Tokyo University Hospital (Director: Assist. Prof. Takeo HAYASHIDA) Yoshio KONDO |
Part I. In animal experiments, the effects of several sympathomimetic amines were studied in dogs and rats on the following items : caliber of capillary vessels, circulatory velocity in capillary, systolic and diastolic pressure, cardiac output, transmission velocity of aortic pulse wave, caval venous pressure in its proximal protion, pulse interval, electrocardiogram, cardiac contracting forces, coronary flow, urinary output, respiratory change, artificial hypothermia and hypotension and the change in cardiac arrest.
Used agents were Adrenalin (A.), Noradrenalin (N-A.), Neosynephrine (N-S.) and Ephedrine (E.) and for comparison Vitacampher (V.) and Théraptique (T.) were added.
Simultaneously, clinical effects of N-S., N-A. and T. were studied on various cases except for surgical shock.
Part II. To determine the indications of vasopressor drugs for various surgical shock, effects of constant intravenous infusion of N-S. on circulatory system in experimental hemorrhage, high intestinal obstruction and burn in dogs were studied statistically.
Effects of blood infusion were studied in parallel. In clinical study, N-S. was in 34 cases of shock and hypotension during operation obtaining excellent results.
Results:
1. A., N-A., N-S. and E. were proved to have prominent vascular action in normal dog or rat, whereas cardiac action was showed by N-S. least.
Cardiac action of N-A. was much stronger but bathmotropic action was relatively weak. E. and A. were most powerful in cardiac action.
V. and T. showed strong respiratory effects, though vascular effects were minimal.
Accordingly N-S. was proved to be indicated liberally even in the state of circulatory failure accompanying surgery, where the irritability of the heart was increased. Though N-A showed more cardiac irritation, it was worthy for controlling the hypotension because it is inactivated rapidly.
2. Effects of these agents on capillary flow, caliber of the capillary vessels, caval venous pressure in its proximal portion and transmission velocity of aortic pulse wave were newly observed in this study.
Bradicardia in rising blood pressure induced by rapid intravenous injection of these material was shown to be affected by ventriculo-auricular reflex, or by additional arrhythmia especially with A. and N.A.
N-S. was proved to have inhibitory effect of nodal rhythm by experiment of infusion through isolated dog heart, therefore indicated for circulatory control after ventricular defibrillation.
3. Effects of N-S. in various surgical shock in dog were following: Rise of mean arterial pressure, increase of transmission velocity of aortic pulse wave, decrease or no change of pulse rate, increase or no change of cardiac output, increase or no change of total peripheral resistance and increase of circulating plasma volume and blood volume.
These results are dissolving a problem in mechanism of vasopressor drugs in circulatory failure of shock, that is, N-S is thought to rise the blood pressure constricting the depressed peripheral vessels, mobilise pooled blood in peripheral vein and portal system, increasing coronary and cerebral blood flow.
4. In clinical cases, N-S. was effective in prevention of hypotension by spinal anesthesia, N-S., N-A. or T. was excellent for molibund circulatory depression as analeptica. And N.S. was used in controlling the circulation after resuscitation in a case of ventricular fibrillation with favorable results.
5. 34 cases of surgical shock and hypotension during operation including severe shock were treated with blood transfusion and N-S. recovering completely without any unfavorable effect except for two cases.
6. Vasopressor drugs, judiciously selected in view of surgical aspects, were not contraindicated for various shock. Their effects should be appreciated in addition to fluid or blood infusion therapy, especially in the cases of hypotension during operation, spinal anesthesia shock and shock due to peritonitis or intestinal obstruction.
(author's abstract)
To read the PDF file you will need Adobe Reader installed on your computer.