I Tsuneyoshi1, Y Kanmura, N Yoshimura. 1. Department of Anesthesiology and Critical Care Medicine, Kagoshima University School of Medicine, Japan.
Abstract
OBJECTIVE: To investigate the functional status of arteries in patients with septic shock, each of whom suffered from severe hypotension. DESIGN: Experimental, comparative study. SETTING: Laboratory in a university hospital. SUBJECTS: Mesenteric artery resected from omentum was obtained from patients (n = 3) with or without (n = 4) sepsis. INTERVENTIONS: To study the effect of modification of the nitric oxide system in human arteries during sepsis, changes in norepinephrine-evoked isometric tension in mesenteric arterial rings were measured. MEASUREMENTS AND MAIN RESULTS: Mesenteric arteries were isolated from omentum resected from three patients with septic shock and from four patients with no inflammatory conditions; in each case, during an intestinal anastomosis. In arterial rings, after a 1-hr equilibration with Krebs solution, changes in isometric tension evoked by norepinephrine were measured for 5 mins every 20 mins. The tension initially evoked in rings from septic patients was lower than in those rings from nonseptic patients and, unlike the controls, it decreased with a short time course. The addition of 300 micromol/L of N(G)-nitro-L-arginine methyl ester or 10 micromol of N(G)-nitro-L-arginine methyl ester or 10 micromol/L of methylene blue reversed this decrease. CONCLUSION: These results indicate that in patients with septic shock, the main cause of reduced sensitivity to pressor agents may be a massive generation of nitric oxide via the L-arginine pathway.
OBJECTIVE: To investigate the functional status of arteries in patients with septic shock, each of whom suffered from severe hypotension. DESIGN: Experimental, comparative study. SETTING: Laboratory in a university hospital. SUBJECTS: Mesenteric artery resected from omentum was obtained from patients (n = 3) with or without (n = 4) sepsis. INTERVENTIONS: To study the effect of modification of the nitric oxide system in human arteries during sepsis, changes in norepinephrine-evoked isometric tension in mesenteric arterial rings were measured. MEASUREMENTS AND MAIN RESULTS: Mesenteric arteries were isolated from omentum resected from three patients with septic shock and from four patients with no inflammatory conditions; in each case, during an intestinal anastomosis. In arterial rings, after a 1-hr equilibration with Krebs solution, changes in isometric tension evoked by norepinephrine were measured for 5 mins every 20 mins. The tension initially evoked in rings from septicpatients was lower than in those rings from nonseptic patients and, unlike the controls, it decreased with a short time course. The addition of 300 micromol/L of N(G)-nitro-L-arginine methyl ester or 10 micromol of N(G)-nitro-L-arginine methyl ester or 10 micromol/L of methylene blue reversed this decrease. CONCLUSION: These results indicate that in patients with septic shock, the main cause of reduced sensitivity to pressor agents may be a massive generation of nitric oxide via the L-arginine pathway.