Cardiovascular system autonomic control

Autonomic nervous system. The portion of the nervous system outside of the brain and spinal cord that is responsible for monitoring and controlling the digestive system, cardiovascular system, and other organs that are not under direct conscious control. 

Many of the pharmacodynamic interactions of most interest to the anaesthetist occur in pathways associated with the various divisions of the nervous system, central and autonomic, and thus influence the control of the cardiovascular system. 

Another group of transmitters involved in the control of the cardiovascular system by the autonomous nervous system includes the catecholamines, adrenaline and noradrenaline. In acinar submandibular gland cells of the rat the administration of 10 4 mol/1 adrenaline elicits a reduction in dye coupling from 97 to 75.3% dye-coupled cells [Kanno et al., 1993]. This could not be mimicked with isoprenaline, but was inhibited with phenoxybenzamine. Thus, the uncoupling effect of adrenaline in this preparation is mediated by stimulation of the a-adre-noceptor, whereas a stimulation of the P-adrenoceptor has no effect. 

Corr PB, Yamada KA, Witkowski FX. Mechanisms controlling cardiac autonomic function and their relation to arrhythmogenesis. In Fozzard HA, et ak, eds. The Heart and Cardiovascular System. New York Raven Press, 1986. 

Autonomic and hormonal control of cardiovascular function. Note that two feedback loops are present the autonomic nervous system loop and the hormonal loop. The sympathetic nervous system directly influences four major variables peripheral vascular resistance, heart rate, force, and venous tone. It also directly modulates renin production (not shown). The parasympathetic nervous system directly influences heart rate. In addition to its role in stimulating aldosterone secretion, angiotensin II directly increases peripheral vascular resistance and facilitates sympathetic effects (not shown). The net feedback effect of each loop is to compensate for changes in arterial blood pressure. Thus, decreased blood pressure due to blood loss would evoke increased sympathetic outflow and renin release. Conversely, elevated pressure due to the administration of a vasoconstrictor drug would cause reduced sympathetic outflow, reduced renin release, and increased parasympathetic (vagal) outflow. 

The human nervous system can be divided into two major functional areas the somatic nervous system and the autonomic nervous system (ANS). The somatic division is concerned primarily with voluntary function—that is, control of the skeletal musculature. The ANS is responsible for controlling bodily functions that are largely involuntary, or automatic, in nature. For instance, the control of blood pressure (BP) and other aspects of cardiovascular function is under the influence of the ANS. Other involuntary, or vegetative, functions such as digestion, elimination, and thermoregulation are also controlled by this system. 

In the peripheral nervous system, norepinephrine is an important neurotransmitter in the sympathetic branch of the autonomic system. Sympathetic nerve transmission operates below the level of consciousness in controlling physiological function of many organs and tissues of the body. The sympathetic system plays a particularly important role in regulating cardiovascular function in response to postural, exertional, thermal, and mental stress. With sympathetic activation, the heart rate is increased, peripheral arterioles are constricted, skeletal arterioles are dilated, and the blood pressure is elevated. In addition, sympathetic nerve stimulation dilates pupils inhibits smooth muscles of the intestines, bronchi, and bladder and closes the sphincters. Sympathetic signals work in balance with the parasympathetic portion of the autonomic nervous system to maintain a stable internal environment. 

Blood pressure (BP) is a product of the total peripheral resistance (TPR) times the cardiac output (CO). The CO is equal to the heart rate (HR) times the stroke volume (SV). The autonomic (neural) system helps regulate the BP through feedback control involving the baroreceptors, the cardiovascular centers in the brain stem, and the PANS and SANS, which act in an opposing but coordinated manner to regulate the pressure. 

The heart is innervated by both sympathetic and parasympathetic nerve fibers of the autonomic nervous system. Although the heart can generate its own heartbeat independently of nervous control, stress, exercise, and physical trauma make it advantageous to adjust cardiac contraction to meet the needs at the time. Thus, the cardiovascular control system (Figure 6.20.5), which is located in the brain, controls the contractility of the myocardium (the muscle of the heart), and produces both inotrophic (force of contraction) and chronotrophic (rate of contraction) effects. 

Fetotoxicity Cocaine exposure in utero may have a direct effect on autonomic nervous system regulation, cardiac control mechanisms, and cardiovascular functioning in neonates [33 ]. In 21 prenatally cocaine-exposed infants and 23 non-exposed controls, studied within 120 hours of birth, there was a positive interaction between prenatal cocaine exposure and orthostatic stress. Whereas both exposed and non-exposed infants had increased heart rates and heart rate variability, the responses of the exposed... 

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