Effects of acute hypovolaemia by furosemide on tracheal transepithelial potential difference and mucus in dogs.

Furosemide is a potent diuretic that affects water transfer across the respiratory epithelium, which is closely related to the transepithelial potential difference (PD). Water is a critical factor that determines mucus transport; an important lung defence mechanism that removes particles and microorganisms from the respiratory system. The aim of the present study was to investigate the acute effects of furosemide and hypovolaemia on tracheal PD and mucus properties. A total of 36 male mixed-breed dogs were submitted to anaesthesia, mechanical ventilation and haemodynamic monitoring. They were randomly assigned to three groups consisting of: a control group, a furosemide (40 mg i.v.) + hypovolaemia group, and a furosemide (40 mg i.v.) + volume replacement group. Tracheal PD and mucus samples were collected at time 0, 1 and 2 h after intervention. Mucus properties were analysed by means of a magnetic microrheometer and in vitro mucociliary transportability on the frog palate. Compared to controls, furosemide decreased PD to intermediate values, and only significantly when associated with hypovolaemia (-13+/-5 and -8+/-2 mV, time 0 and 2 h, respectively). In addition to the direct effect of furosemide, these results indicate that hypovolaemia also affects ion transport in the tracheal membrane. Furosemide and hypovolemia have no acute effects on respiratory mucus properties.

Issues related to smoking cessation among substance abusers.

Initial studies have found that stop-smoking treatments for newly recovering substance abusers have been neither harmful to sobriety nor effective in achieving smoking cessation. The development of more effective stop-smoking treatments for this population could be aided by delineating their particular smoking-related characteristics. This article describes the biopsychosocial characteristics of newly recovering substance abusers that are relevant to smoking cessation, and suggests that there are notable differences between abusers and nonabusers that may contribute to abusers' greater difficulty in quitting smoking. It also recommends changes in existing treatment protocols where applicable and identifies key areas for future research.

Developmental changes in the delayed rectifier K+ channels in mouse heart.

Expression of cardiac transient outward current and inwardly rectifying K+ current is age dependent. However, little is known about age-related changes in cardiac delayed rectifier K+ current (IK, with rapidly and slowly activating components, IKr and IKs, respectively). Accordingly, the purpose of the present study was to assess developmental changes in IK channels in fetal, neonatal, and adult mouse ventricles. Three techniques were used: conventional microelectrode to measure the action potential, voltage clamp to record macroscopic currents of IK, and radioligand assay to examine [3H]dofetilide binding sites. The extent of prolongation of action potential duration at 95% repolarization (APD95) by a selective IKr blocker, dofetilide (1 mumol/L), dramatically decreased from fetal (137% +/- 18%) to day-1 (75% +/- 29%) and day-3 (20% +/- 15%) neonatal mouse ventricular tissues (P < .01). Dofetilide did not prolong APD95 in adult myocardium. IKr is the sole component of IK in day-18 fetal mouse ventricular myocytes. However, both IKr and IKs were observed in day-1 neonatal ventricular myocytes. With further development, IKs became the dominant component of IK in day-3 neonates. In adult mouse ventricular myocytes, neither IKr nor IKs was observed. Correspondingly, a high-affinity binding site for [3H]dofetilide was present in fetal mouse ventricles but was absent in adult ventricles. The complementary data from microelectrode, voltage-clamp, and [3H]dofetilide binding studies demonstrate that expression of the IK channel is developmentally regulated in the mouse heart.

Hypomagnesemia: characterization of a model of sudden cardiac death.

OBJECTIVES: We sought to compare the incidence of sudden death in rats treated with magnesium-deficient and control diets and to address the electrophysiologic characteristics associated with these end points. BACKGROUND: Although magnesium deficiency is associated with an increased incidence of sudden cardiac death in patients, there has been no clear cause and effect relation because of a number of covariables, including diuretic use, hypokalemia, digitalis use and left ventricular dysfunction. METHODS: Hypomagnesemic rats and their paired control rats underwent in vivo electrophysiologic studies and measurements of the total calcium and magnesium content of their cardiac ventricles RESULTS: Serum magnesium levels were 0.5 +/- 0.3 mEq/liter (mean +/- SD) in hypomagnesemic animals and 1.2 +/- 0.9 mEq/liter in control animals. A modest but significant prolongation of the repolarization time was seen at the apical epicardial site (83 +/- 8 ms in hypomagnesemic rats vs. 68 +/- 13 ms in control rats, p < 0.05), but not at the other sites studied. Bradyarrhythmias and tachyarrhythmias were observed in 82% of the hypomagnesemic rats during the in vivo electrophysiologic studies, compared with 0% in the control group. During these studies, sudden, unexpected asystolic deaths were observed in 4 of 11 hypomagnesemic rats and 0 of 8 control rats. Polymorphic nonsustained ventricular tachycardia was provoked by rapid pacing in 5 to 11 hypomagnesemic rats and 0 of 8 control rats. Three of six hypomagnesemic rats exposed to auditory stimuli developed seizures, followed immediately by sudden deaths-two due to asystole and one due to ventricular fibrillation-although no end points occurred in the control animals. CONCLUSIONS: In this model, magnesium deficiency results in sudden cardiac death. The presence of startle induction of sudden death preceded by seizures suggests that sudden cardiac death results from a neurologic trigger.

Pulmonary and pericardial limitations to diastolic filling of the left ventricle of the lamb.

To determine which tissues limit left ventricular (LV) filling during the early neonatal period we studied LV end-diastolic pressure-diameter relationships in two groups of halothane-anesthetized lambs (five 1-h-old lambs and six 2- to 17-day-old lambs). First, we assessed LV end-diastolic pressure-diameter relations over a range of 5-20 mmHg, when the chest and the pericardium were closed; second, after the chest wall and lungs had been retracted from the heart; and finally, after the pericardium was retracted. In the oldest lambs LV diameter increased significantly [3.5 +/- 0.3% (SE) at an end-diastolic pressure of 10 mmHg; P < 0.05] after retracting the chest wall and the lungs and when the pericardium was still intact. By contrast, retracting the chest wall and lungs did not significantly change LV diameter in the youngest lambs. In both age groups LV diameters were greatest (P < 0.05) after the pericardium was subsequently retracted (the increase was evident at all end-diastolic pressures and averaged 9.0% relative to the closed-chest, closed-pericardium series). These studies confirm that the thoracic tissues substantially limit LV filling in young lambs. Immediately after birth this limitation is almost exclusively related to the pericardium, whereas in older lambs the chest wall-lung combination and the pericardium each contribute.

Changes in pericardial pressure during the perinatal period.

BACKGROUND: To determine how the tissues that surround the heart affect diastolic and systolic function during the perinatal period, we studied the pressure-diameter relation of the left ventricle in partially delivered fetal lambs. METHODS AND RESULTS: We anesthetized (1.5-2.0% halothane, balance O2) and ventilated six pregnant ewes (142-144 days of gestation) and then partially delivered each lamb by cesarean section. Each lamb was instrumented to record left ventricular anteroposterior diameters (endocardial ultrasonic transducers), pericardial pressure (liquid-containing balloon), and left ventricular pressure (transducer-tipped catheter). Left ventricular pressure-diameter relations were recorded under three conditions: initially, with a closed chest and closed pericardium (before ventilation); second, after interruption of the umbilical circulation and 1 hour of ventilation; and finally, when the lungs and the pericardium were retracted from the heart. Pericardial pressure (recorded at a common diameter, i.e., the maximal end-diastolic diameter recorded before ventilation) decreased by 48% after 1 hour of ventilation (p < 0.05). After ventilation, left ventricular anteroposterior diameters were 4-5% greater (p < 0.05) at each end-diastolic pressure compared (12.5, 15.0, 17.5, and 20 mm Hg). Thus, ventilation appeared to increase left ventricular diastolic compliance. Contractility also appeared to increase after ventilation when evaluated using ventricular stroke work as a function of end-diastolic pressure as preload. When we used a more appropriate measure of preload (i.e., transmural end-diastolic pressure), ventilation did not change left ventricular diastolic compliance or contractility. Thus, left ventricular systolic function increased because of an increase in preload. CONCLUSIONS: The tissues surrounding the fetal heart significantly augment pericardial pressure and limit left ventricular preload. The initiation of ventilation reduces pericardial pressure, increases left ventricular preload, and increases left ventricular systolic function. At birth, a decrease in pericardial pressure and the resulting increase in preload may help increase left ventricular output through the Frank-Starling mechanism.

Fever in young lambs: temperature, metabolic and cardiorespiratory responses to a small dose of bacterial pyrogen.

Experiments were done on ten lambs ranging in age from 15 to 25 days to define the temperature, metabolic and cardiorespiratory responses to intravenous administration of a small dose of bacterial pyrogen (SAE). Administration of SAE but not normal saline produced a short-lived fever of about 0.7 degrees C. The increase in body-core temperature was preceded by a surge in total body oxygen consumption and the onset of shivering which was influenced by behavioral state (ie, shivering was inhibited during active sleep). The increase in total body oxygen consumption was initially met by an increase in total body oxygen extraction and then by an increase in systemic oxygen delivery. Systemic arterial blood pressure did not change significantly during the febrile response; however, pulmonic arterial blood pressure increased significantly. Thus, our experiments provide new data on oxygen supply and demand during the development of fever and that shivering thermogenesis is inhibited in active sleep following the administration of bacterial pyrogen in young lambs. The influence of active sleep on the overall febrile response, and whether or not there is a shift from shivering thermogenesis to non-shivering thermogenesis remains to be determined.

Influence of carotid denervation on the arousal and cardiopulmonary responses to upper airway obstruction in lambs.

Experiments were done on five lambs to determine if carotid denervation influences the arousal and cardiopulmonary responses to upper airway obstruction during sleep. Each lamb was anesthetized and instrumented for recordings of electrocorticogram, electro-oculogram, nuchal and diaphragm electromyograms, and measurements of arterial blood pressure and arterial Hb oxygen saturation. A tracheotomy was done and a fenestrated tracheotomy tube placed in the trachea. During the study, a 5 F balloon-tipped catheter was inserted into the tracheotomy tube so that air flow could be obstructed by inflating the balloon. No sooner than 3 d after surgery, measurements were made in quiet sleep and active sleep during control periods when the animal was breathing room air and during experimental periods of upper airway obstruction. Carotid denervation significantly affected the arousal response to upper airway obstruction. Arousal occurred during 14 of 14 epochs in quiet sleep and during 12 of 13 epochs in active sleep before the arterial Hb oxygen saturation decreased to 30%. However, the time to arousal was increased and the arterial Hb oxygen saturation at arousal was decreased in carotid-denervated lambs compared with what we have previously observed in carotid-intact lambs. These data provide evidence that the carotid chemoreceptors and/or carotid baroreceptors play a major role in causing arousal from sleep during upper airway obstruction in lambs. Our results may have implications for sudden infant death syndrome, because it is possible that alterations in the arousal response to respiratory stimuli play a role in sudden infant death.

Influence of sleep on the cardiovascular and metabolic responses to a decrease in ambient temperature in lambs.

Experiments were done on seven lambs between the ages of 10 and 24 days to investigate the effects of sleep on the cardiovascular and metabolic responses to a decrease in ambient temperature. Each lamb was anesthetized and instrumented for recordings of electrocorticogram, electro-oculogram, and nuchal electromyograms and measurements of cardiac output, systemic and pulmonic pressures and hemoglobin oxygen saturations as well as body core temperature. No sooner than three days after surgery, measurements were made during periods of quiet wakefulness, quiet sleep and active sleep at ambient temperatures of 25 degrees C and 18 degrees C. Decreasing the environmental temperature from 25 degrees C to 18 degrees C elicited a similar thermogenic response during quiet wakefulness, quiet sleep and active sleep as evidenced by an increase in total body oxygen consumption. The increased metabolic oxygen demand was met by an increase in systemic oxygen transport as well as by an increase in total body oxygen extraction. Since shivering was absent during active sleep, it is likely that nonshivering thermogenesis played a major role in the metabolic response. Our data provide evidence that sleep does not significantly alter the cardiovascular and metabolic responses to a modest decrease in ambient temperature in young lambs.

Influence of carotid-denervation on the arousal and cardiopulmonary responses to alveolar hypercapnia in lambs.

Experiments were done on five lambs to determine if carotid-denervation influences the arousal and cardiopulmonary responses to alveolar hypercapnia during sleep. Each lamb was anaesthetized and instrumented for recordings of electrocorticogram, electro-oculogram, nuchal and diaphragm electromyograms and measurements of systemic arterial blood pressure and arterial haemoglobin oxygen saturation. The carotid chemoreceptors and baroreceptors were denervated, a tracheostomy was done and a fenestrated tracheostomy tube placed in the trachea so that the inspired gas mixture could be changed quickly. No sooner than three days after surgery, measurements were made in quiet sleep and active sleep during control periods when the animal was breathing room air and during experimental periods of alveolar hypercapnia when the lamb was breathing 10% carbon dioxide in air. Alveolar hypercapnia was terminated during an experimental period by changing the gas mixture back to room air once the animal aroused from sleep. If an animal did not arouse within 2 min, the gas mixture was changed back to room air. Arousal occurred during only 6 of 12 epochs in quiet sleep and during only 2 of 10 epochs in active sleep. These data provide evidence that the carotid chemoreceptors and/or carotid baroreceptors play a major role in causing arousal from sleep during alveolar hypercapnia in lambs.

Influence of carotid denervation on the arousal and cardiopulmonary response to rapidly developing hypoxemia in lambs.

Experiments were done on five lambs to determine if carotid denervation influences the arousal and cardiopulmonary responses to rapidly developing hypoxemia during sleep. Each lamb was anesthetized and instrumented for recordings of electrocorticogram, electrooculogram, nuchal and diaphragm electromyograms, and measurements of arterial blood pressure and arterial hemoglobin oxygen saturation. The carotid chemoreceptors and baroreceptors were denervated, a tracheostomy was done, and a fenestrated tracheostomy tube was placed in the trachea so that the inspired oxygen mixture could be changed quickly. No sooner than 3 d after surgery, measurements were made in quiet sleep and active sleep during control periods when the animal was breathing 21% oxygen and during experimental periods of rapidly developing hypoxemia when the animal was breathing 5% oxygen. Rapidly developing hypoxemia was terminated during each epoch by changing the inspired gas mixture back to 21% oxygen once the animal aroused from sleep or once the arterial Hb oxygen saturation decreased to 30%. Arousal occurred during only 4 of 11 epochs in quiet sleep and during only 3 of 14 epochs in active sleep before the arterial IIb oxygen saturation decreased to 30%. These data provide evidence that the carotid chemoreceptors and/or carotid baroreceptors play a major role in causing arousal from sleep during rapidly developing hypoxemia in lambs.