Premium
Alternative to ganglionic blockade with anticholinergic and alpha‐2 receptor agents: the ALACARTE method
Author(s) -
Sviggum Hans Peder,
Wilkins Brad W.,
Liu Zhong,
Nicholson Wayne T.,
Moyer Thomas P.,
Joyner Michael J.,
Eisenach John H.
Publication year - 2006
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.20.5.a1423-a
Ganglionic blocking agents are no longer produced. Our goal was to establish an alternative to ganglionic blockade with an anticholinergic (glycopyrrolate, Gly) and alpha‐2 receptor agonist (dexmedetomidine, Dex) to mimic trimethaphan. Valsalva maneuvers (30 mm Hg intrathoracic pressure for 15 seconds) were performed under a control condition vs. combined Gly (bolus dose: 10 μg/kg, maintenance: 6 μg/kg/hr) and Dex (bolus dose: 0.25 μg/kg, maintenance: 0.5 μg/kg/hr). Blood pressure (Finometer) and heart rate (ECG) and were continuously recorded. Presented in the figure are the blood pressure (A) and heart rate (B) responses to Valsalva maneuver during Gly/Dex in a typical subject. Heart rate increased 14 ± 5 bpm with Valsalva during control and 4 ± 2 bpm during Gly/Dex infusion. The blood pressure change with Valsalva (phase IIb) was −1 ± 1 mm Hg during control and −26 ± 7 mm Hg during Gly/Dex infusion. We conclude that combination Gly/Dex is similar to trimethaphan in its ability to block the baroreflex response to a Valsalva maneuver.Support: K23RR17520, NRSA HL78019, GCRC RR‐00585, NS‐32352