Key result
Left atrial sympathomimetics lower pulmonary arterial drug levels versus central venous delivery without hemodynamic changes.
Why the study?
Does the route of administration (central venous vs left atrial) or the choice of sympathomimetic agent affect systemic and pulmonary hemodynamics in anesthetized dogs?
Does the route of administration (central venous vs left atrial) or the choice of sympathomimetic agent affect systemic and pulmonary hemodynamics in anesthetized dogs?
Left atrial administration of catecholamines decreases pulmonary arterial drug concentrations compared to central venous administration, which may help minimize adverse pulmonary effects when vasopressor or inotropic therapy is needed.
Left atrial sympathomimetic delivery may reduce pulmonary exposure in canines without hemodynamic change; leaves open any clinical translation to human vasopressor use.
Systemic vasopressor or inotropic therapy may exacerbate existing pulmonary hypertension; the optimal agent and route of administration in this situation are unknown. The systemic and pulmonary hemodynamic effects of four sympathomimetic agents (dopamine, epinephrine, norepinephrine, and phenylephrine) during central venous and left atrial administration were investigated in the anesthetized dog. All four drugs increased both systemic and pulmonary artery pressures. Dopamine and epinephrine increased cardiac output and reduced systemic vascular resistance. Phenylephrine decreased cardiac output and increased systemic vascular resistance and left atrial pressure. Norepinephrine did not significantly affect cardiac output, systemic vascular resistance, or left atrial pressure. None of the four drugs affected pulmonary vascular resistance. The ratio of systemic to pulmonary vascular resistance decreased with epinephrine and increased with phenylephrine. There were no hemodynamic differences related to the route of infusion for any of the four drugs. However, pulmonary arterial concentrations of the three drugs measured (dopamine, epinephrine, and norepinephrine) were markedly lower during left atrial compared to central venous drug administration; systemic drug concentrations were similar or increased during left atrial compared to central venous drug administration. It is concluded that the relative effects on the systemic and pulmonary circulations differ for the four drugs; rational choice of a vasopressor will depend upon the hemodynamic situation and the desired effect. Left atrial catecholamine administration is effective in decreasing pulmonary arterial drug concentrations and may decrease adverse pulmonary effects in clinical practice.
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Pearl et al. (1987) studied Anesthetized dogs. Left atrial administration of sympathomimetic agents (dopamine, epinephrine, norepinephrine, phenylephrine) vs. Central venous administration was evaluated on Systemic and pulmonary hemodynamic effects and drug concentrations. Left atrial administration of sympathomimetic drugs resulted in markedly lower pulmonary arterial drug concentrations compared to central venous administration, with no hemodynamic differences.
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