Circulation, Vol 66, 49-55, Copyright © 1982 by American Heart Association
JG Reves, RB Karp, EE Buttner, S Tosone, LR Smith, PN Samuelson, GR Kreusch and S Oparil
Cardiopulmonary bypass (CPB) alters systemic hemodynamics and affects
several biochemical systems involved in cardiovascular regulation. We
investigated the changes in levels of circulating epinephrine (E) and
norepinephrine (NE) and related them to events during CPB. Twenty-eight
patients undergoing various surgical procedures were studied. Plasma E and
NE were determined by radioenzymatic assay at eight stages of the
operation. A ninefold increase in arterial E (from 75 +/- 13 to 708 +/-
117.3 pg/ml) occurred from prebypass (stage 1) measurements to the end of
aortic cross-clamping (stage 4). The values at stage 4 were significantly
higher (p less than 0.05) than at all other stages. E decreased rapidly, to
360 +/- 84.3 pg/ml, after myocardial and pulmonary reperfusion (stage 5).
Arterial NE increased twofold from stage 1 to stage 4 (from 426 +/- 66.9 to
825 +/- 84.2, p less than 0.05). The increase in NE from initial CPB values
(stage 2) to 30 minutes of aortic cross-clamping (stage 3) was associated
with an increase in mean blood pressure (r = 0.51, p = 0.02). The peak
increases in catecholamines occurred when the heart and lungs were excluded
from the circulation, which suggests that either or both contributed to the
increase. Because the increase in E was markedly greater than that in NE,
the predominant humoral response to CPB appears to be adrenomedullary
release of E. This significant increase in catecholamines could jeopardize
myocardial protective measures during CPB.
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Neuronal and adrenomedullary catecholamine release in response to cardiopulmonary bypass in man
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