Renal sympathetic and cardiac changes associated with anaphylactic hypotension.

Severe anaphylactic reactions can result in life-threatening hypotension, but little is known about the autonomic changes that accompany the hypotensive response. The aim of this study was to determine the renal sympathetic and cardiac responses to anaphylactic hypotension, and to evaluate the contribution of sinoaortic and vagal afferent inputs in producing these responses. Rats were sensitized with bovine serum albumin (BSA) and, after 10-14 days, were anaesthesized with sodium pentobarbitone and arterial pressure, heart rate (HR), and renal sympathetic nerve activity (RSNA) were recorded. In about two thirds of the rats, injection of BSA evoked a severe and sustained hypotension, while in the remainder, there was either a more transient hypotension or else no significant change in arterial pressure. In control unsensitized rats, BSA injection had no significant effect on arterial pressure, heart rate, or RSNA. The BSA-induced hypotension in sensitized rats was associated with increases in HR and RSNA, the magnitudes of which were correlated with the magnitude of the hypotension. There were two components to the cardiac and renal sympathoexcitatory response: (1) an initial increase in HR and RSNA, which immediately followed the onset of hypotension and which was abolished by sinoaortic denervation and vagotomy, and (2) a delayed and gradual increase in HR and RSNA, which continued even while the arterial pressure was recovering and was reduced but not abolished by sinoaortic denervation and vagotomy. Thus, BSA-induced anaphylactic hypotension causes prolonged tachycardia and renal sympathoexcitation, which is only partly due to reflex effects arising from sinoaortic baroreceptors and cardiopulmonary receptors.

Evidence that venoconstriction reverses the phase II sympathoinhibitory and bradycardic response to haemorrhage.

Severe hypotensive haemorrhage results in a biphasic response, characterized by an initial increase in heart rate and sympathetic vasomotor activity (phase I) followed by a life-threatening hypotension, accompanied by profound sympathoinhibition and bradycardia (phase II). The phase II response is believed to be dependent on inputs from cardiopulmonary receptors, and may be triggered by the reduction in venous return and cardiac filling associated with severe haemorrhage. In this study, we tested the hypothesis that the phase II response could be reversed by venoconstriction, which is known to enhance venous return and cardiac filling, by comparing the effects of phenylephrine (which constricts veins as well as arterioles) with that of vasopressin (which constricts arterioles but not veins). In sodium pentobarbitone-anaesthetised rats, haemorrhage evoked an initial increase in heart rate (HR) and renal sympathetic activity (RSNA) followed by a large decrease in both variables to levels below the pre-haemorrhage baseline levels (phase II response). During the phase II response, an intravenous injection of phenylephrine, sufficient to restore mean arterial pressure to the pre-haemorrhage level, resulted in a gradually developing increase (over 3-4 min) in HR and RSNA back to the baseline levels. In contrast, intravenous injection of an equipressor dose of vasopressin did not result in any increase in RSNA and only a transient increase in HR. Injection of phenylephrine, but not vasopressin, also increased the pulsatile component of central venous pressure, indicative of reduced venous capacitance. The findings indicate that venoconstriction reverses the phase II sympathoinhibition and bradycardia.

Sympathoinhibitory pathway from caudal midline medulla to RVLM is independent of baroreceptor reflex pathway.

Glutamate stimulation of the caudal midline medulla (CMM) causes profound sympathoinhibition due to GABAergic inhibition of presympathetic neurons in the rostral ventrolateral medulla (RVLM). We investigated whether the sympathoinhibitory pathway from CMM to RVLM, like the central baroreceptor reflex pathway, includes a glutamatergic synapse in the caudal ventrolateral medulla (CVLM). In pentobarbital sodium-anesthetized rats, the RVLM on one side was inhibited by a muscimol microinjection. Then the response evoked by glutamate microinjections into the CMM or by baroreceptor stimulation was determined before and after 1) microinjection of the GABA receptor antagonist bicuculline into the RVLM on the other side or 2) microinjections of the glutamate receptor antagonist kynurenate bilaterally into the CVLM. Bicuculline in the RVLM greatly reduced both CMM- and baroreceptor-evoked sympathoinhibition. Compared with the effect of vehicle solution, kynurenate in the CVLM greatly reduced baroreceptor-evoked sympathoinhibition, whereas its effect on CMM-evoked sympathoinhibition was not different from that of the vehicle solution. These findings indicate that the output pathway from CMM sympathoinhibitory neurons, unlike the baroreceptor and other reflex sympathoinhibitory pathways, does not include a glutamatergic synapse in the CVLM.