Muscle Function perfusion

Monitor for adequate perfusion of vital organs through assessment of mental status, creatinine clearance, liver function tests, and a stable HR between 50 and 100 beats per minute. Additionally, adequate skin and muscle blood perfusion and normal pH is desirable. 

In order to study the function of oxygen binding by myoglobin and its effect on muscle function. Cole (Footnote 16) perfused an isolated muscle with hydrogen peroxide. Why did he do this ... 

Cardiac index and blood pressure must be sufficient to ensure adequate organ perfusion, as assessed by alert mental status, creatinine clearance sufficient to prevent metabolic azotemic complications, hepatic function adequate to maintain synthetic and excretory functions, a stable heart rate and rhythm, absence of ongoing myocardial ischemia or infarction, skeletal muscle and skin blood flow sufficient to prevent ischemic injury, and normal arterial pH (7.34 to 7.47) with a normal serum lactate concentration. These goals are most often achieved with a cardiac index greater than 2.2 L/min/m2, a mean arterial blood pressure greater than 60 mm Hg, and PAOP of 25 mm Hg or greater. 

In the area perfused by the affected vessel, inadequate supply of oxygen and glucose impairs the function of heart muscle contractile force declines. In the great majority of cases, the left ventricle (anterior or posterior wall) is involved. 

Dopamine is an intermediate product in the biosynthesis of noradrenaline. Furthermore it is an active transmitter by itself in basal ganglia (caudate nucleus), the nucleus accumbens, the olfactory tubercle, the central nucleus of the amygdala, the median eminence and some areas in the frontal cortex. It is functionally important, for example in the extra-pyramidal system and the central regulation of emesis. In the periphery specific dopamine receptors (Di-receptors) can be found in the upper gastrointestinal tract, in which a reduction of motility is mediated, and on vascular smooth muscle cells of splanchnic and renal arteries. Beside its effect on specific D-receptors, dopamine activates, at higher concentrations, a- and -adrenoceptors as well. Since its clinical profile is different from adrenaline and noradrenaline there are particular indications for dopamine, like situations of circulatory shock with a reduced kidney perfusion. Dopamine can dose-dependently induce nausea, vomiting, tachyarrhythmia and peripheral vasoconstriction. Dopamine can worsen cardiac ischaemia. 

Tsuchida T, Kato T, Yamaga M, Ikebe K, Oniki Y, Irie H, Takagi K (2003) The effect of perfusion with UW solution on the skeletal muscle and vascular endothelial exocrine function in rat hindlimbs. J Surg Res 110 266-271... 

The vitamin has been shown to be able to protect animals from the lethal effects of anoxia and hypoxia. Rats [189] and rabbits [190] fed on vitamin-E-supple-mented diets survived longer in hypoxia than non-supplemented animals. A similar protective effect has been demonstrated in vitro with cardiac muscle [ 167]. In hypoxic Langendorff-perfused rabbit heart, the presence of vitamin E protected the muscle from the deleterious effects of hypoxia, possibly by improving mitochondrial function [168]. However, in clinical studies, the use of vitamin E in ischaemic heart disease has met with little success [191, 192], although the results have been controversial [193]. 

Phenylephrine is a selective ai adrenergic agonist, with a pharmacological structure similar to norepinephrine (noradrenaline), which causes peripheral vasoconstriction. Stimulation of adrenoceptors in the myocardium has an inotropic effect. However, phenylephrine produced no increase in cardiac output, increased systemic vascular resistance and mean arterial pressure and reduced muscle blood flow in anaesthetized horses (Lee et al 1998). Phenylephrine should be reserved for critical conditions where the perfusion of essential organs is compromised and inotropes are not effectively maintaining organ function. The recommended infusion rates are shown in Table 12.3. 

Cardiac Function in the Isolated Perfused Heart and Muscle Strips... 

Endothelin-1 is a potent vasoconstrictor peptide derived from endothelial cells.100 Its physiological function is mediated by two receptors the ET-A and ET-B. Table 1. Figure 11. ET-A and ET-B receptors are located in vascular smooth muscle and their activation causes vasoconstriction, whereas ET-B receptor is also located in the endothelium and its activation results in vasodilation by increasing nitric oxide or prostacyclin. Endothelin is released following myocardial ischemia and reperfusion. Endothelin reduces infarct size in a perfused rat heart model of ischemia and reperfusion through activation of protein kinase C and KATp channel.101 Furthermore, in neonatal rat ventricular myocytes, endothelin is shown to activate the calcineurin-NFAT (nuclear factor of activated cells) pathways and enhance the expression of Bcl-2.102 However, endogenous blockade of endothelin at the level of the ET-A receptor reduced infarct size in a pig model of coronary occlusion and reperfusion.103... 

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