scholarly journals Optimal Duration of the Apnea Test for Determining Brain Death: Benefit of the Short-Term Apnea Test

Author(s):  
Seung Min Baik ◽  
Jin Park ◽  
Tae Yoon Kim ◽  
Jung Hwa Lee ◽  
Kyung Sook Hong

Abstract Background: The criteria for brain death determination have not been unified globally, and there is no global consensus on the apnea test, which is essential for determining brain death. Since the apnea test is associated with many complications, we aimed to determine an optimal duration of the apnea test.Methods: We analyzed the results of the apnea test performed for brain death determination between August 2013 and February 2021 at a single institution in South Korea. Elevations in the partial pressure of carbon dioxide and mean arterial blood pressure fluctuations over time in the apnea test were recorded.Results: In the 1st and 2nd tests, the mean partial pressure of carbon dioxide increased by more than 20 mmHg at 3 min after the apnea test compared to before the test (P < 0.05). At 4 min in the 1st test and 5 min in the 2nd test, the partial pressure of carbon dioxide exceeded 60 mmHg (P < 0.05). The fluctuation in the mean arterial blood pressure observed for 5 min during the apnea test was not significant. There was no significant fluctuation in the mean arterial blood pressure over time in the apnea test between patients with normal chest radiography findings and those with abnormal chest radiography findings (P = 0.888).Conclusion: Our study proposes that a short-term apnea test protocol is valid for the preservation of organs for donation.

Author(s):  
G.F. Stegmann

Xylazine, midazolam and a midazolam / ketamine combination were administered to 6 goats in a randomised 3-way block design. All goats received all treatments with at least a 7-day interval between treatments. Statistically significant (P < 0.05) changes were observed in some of the measured cardiopulmonary variables for xylazine and midazolam/ ketamine. Xylazine administration resulted in statistically significant decreases in minute volume, arterial partial pressure of oxygen, heart rate andmeanarterial blood pressure. The increase in arterial partial pressure of carbon dioxide was not statistically significant. For the midazolam / ketamine combination, the decrease in tidal volume was statistically significant, but not the decrease in minute volume and increase in arterial partial pressure of carbon dioxide. The decrease in the arterial partial pressure of oxygen was also statistically significant. The mean arterial blood pressure for the combination was statistically significantly higher compared to xylazine. The changes in cardiopulmonary variables after midazolam administration were not statistically significant, such as tidal and minute volume, arterial partial pressure of oxygen and carbon dioxide. However, clinically significant effects such as hypoventilation and hypoxia were observed after its administration. The change in mean arterial blood pressure was minimal.


1990 ◽  
Vol 68 (6) ◽  
pp. 2391-2393 ◽  
Author(s):  
T. Matsuse ◽  
Y. Fukuchi ◽  
T. Suruda ◽  
T. Nagase ◽  
Y. Ouchi ◽  
...  

We examined the effect of endothelin-1 (ET-1), a novel 21-residue vasoconstrictor peptide, on pulmonary resistance (RL) in Wistar rats. The lung volume, tracheal flow, and transpulmonary pressure of tracheotomized and paralyzed rats were measured with a fluid-filled esophageal catheter and a pressure-sensitive body plethysmograph. RL was calculated by the method of von Neergaard. The femoral artery was cannulated to measure the mean arterial blood pressure. Intravenous bolus administration of synthetic ET-1 provoked a dose-dependent increase in RL in rats. The bronchoconstricting effect reached maximum at 500 pmol/kg. This bronchoconstriction was observed in less than 5 min, increased up to 15 min, and was sustained for 60 min. ET-1 increased the mean arterial blood pressure in a dose-dependent manner. We conclude that ET-1 is a hitherto unknown potent bronchoconstrictor that has a sustained effect in vivo. The potential physiological and pathophysiological role of this new peptide in the development of respiratory disease warrants further investigation.


1959 ◽  
Vol 196 (4) ◽  
pp. 715-718 ◽  
Author(s):  
Leslie A. Kuhn ◽  
Lot B. Page ◽  
John K. Turner ◽  
Julian Frieden

Effects of progressive hemorrhage during severe cold exposure were studied in 17 unanesthetized dogs. The amount of blood required to be withdrawn to reduce the mean arterial blood pressure to 50 mm Hg by a standardized bleeding procedure was determined in the same animals at air temperatures of +25°C and –25°C. Cold-exposed dogs showed a statistically significant increased ‘resistance’ to hemorrhage in that an average withdrawal of 20% more blood was required to reduce mean arterial blood pressure to shock levels in the cold than in the same dogs at comfortable temperature. In six animals it was necessary to draw a minor, but measurably greater, amount of blood from a given dog to produce hypotension during cold exposure than when the procedure was performed at a comfortable temperature and, in two animals, a minor, but measurably less, amount of blood was withdrawn during cold exposure. In seven animals a significantly greater amount of blood was drawn in the cold than in a neutral environment, but in some of these animals the control bleeding was apparently substandard. In two animals the control bleedings were in the normal range and bleedings were substandard in the cold. Cortisone administration did not alter resistance to hemorrhage during cold exposure.


2002 ◽  
Vol 172 (2) ◽  
pp. 303-310 ◽  
Author(s):  
E Bojanowska ◽  
B Stempniak

To date, glucagon-like peptide 1(7-36) amide (tGLP-1) has been found to affect the neurohypophysial and cardiovascular functions in normotensive and normovolaemic rats. The aim of the present study was to investigate possible effects of tGLP-1 on the mean arterial blood pressure and the release of vasopressin and oxytocin under conditions of blood volume depletion in the rat. In the first series of experiments, the animals were injected i.p. with either 0.15 M saline or 30% polyethylene glycol (PEG). PEG caused an 18% reduction of blood volume 1 h after injection. No significant changes in the mean arterial blood pressure were found in either normo- or hypovolaemic rats during the experiment. tGLP-1 injected i.c.v. at a dose of 1 microg/5 microl 1 h after the i.p. injection increased similarly the arterial blood pressure in normo- and hypovolaemic rats. The plasma vasopressin/oxytocin concentrations were markedly elevated in hypovolaemic animals and tGLP-1 further augmented the release of both hormones. In the second study, hypovolaemia was induced by double blood withdrawal. The haemorrhage resulted in a marked decrease of the mean arterial blood pressure and in the elevated plasma vasopressin/oxytocin concentrations. tGLP-1 injected immediately after the second blood withdrawal increased the arterial blood pressure. In parallel, tGLP-1 enhanced significantly vasopressin and oxytocin secretion when compared with haemorrhaged, saline-injected rats. The results of this study indicate that tGLP-1 may affect the arterial blood pressure and the secretion of neurohypophysial hormones under pathological conditions brought about by blood volume depletion.


1975 ◽  
Vol 48 (6) ◽  
pp. 501-508 ◽  
Author(s):  
B. J. Chapman ◽  
W. R. Withey ◽  
K. A. Munday

1. Dogs cooled to 27°C were compared with control dogs maintained at 38°C. The mean arterial blood pressure, renal blood flow and glomerular filtration rate were lower in the hypothermic animals. 2. The relation between mean arterial blood pressure and renal blood flow was investigated. Autoregulation of renal blood flow occurred in the kidneys of normothermic and hypothermic animals. Thus the reduction in renal blood flow during hypothermia is not due simply to the fall in mean arterial blood pressure. 3. Similarities between recordings of renal blood flow obtained at 38°C and 27°C suggest that its autoregulation occurs by the same mechanism at the two temperatures. 4. Autoregulation of renal blood flow occurred in hypothermic kidneys in the presence of a cold-induced vasoconstriction. The observed responses to cold and to alterations in mean arterial blood pressure may take place in different areas of the renal vasculature.


1984 ◽  
Vol 62 (1) ◽  
pp. 94-100 ◽  
Author(s):  
Ismail Laher ◽  
Chris Triggle

The mean arterial blood pressure (MAP) and the sensitivity of a variety of isolated smooth muscle preparations to noradrenaline were determined in spontaneously hypertensive rats (SHR), normotensive Wistar–Kyoto (WKY) rats, and a number of genetically related animals obtained by cross-breeding SHR and WKY (F1, F2, and F3; and "backcrossod" strains BC1(S) and BC1(W)). The major objective of this study was to determine whether there was a clear relationship between the postsynaptic sensitivity of smooth muscle to noradrenaline and the blood pressure of the animal and, in addition, determine how neuronal uptake1 activity could modify postsynaptic sensitivity. The mean arterial blood pressure profile of the animals studied was for the 6- to 8-week animals: SHR > F1 > WKY; for the 12- to 16-week group: SHR = BC1(S) > F1 > BC1(W) > WKY; and for the > 52 week group: SHR > BC1(S) = F1 > BC1(W) > WKY [F1 obtained from SHR × WKY; BC1(S) = SHR × F1; BC1(W) = WKY × F1]. With the exception of the aorta from F1 animals, the noradrenaline mean effective dose (ED50) recorded from thoracic aortae, tail artery, portal vein, and anococcygeus tissues were not significantly different. After a 20-min pretreatment of tissues from 12- to 16-week rats (but not from 6- to 8-week rats) with 4 × 10−5 M cocaine, there was a significantly greater leftward shift, as indicated by the noradrenaline ED50 before: noradrenaline ED50 after cocaine ratio, in the tail artery preparation from the SHR compared with the WKY; however, no significant differences in the ED50 ratios were noted for the thoracic aorta, the portal vein, or the anococcygeus tissues. In addition, there was a good correlation, r = 0.59, between the mean arterial blood pressure of the SHR and related rats, and the ED50 ratio in the tail artery preparation but less so in other tissues: portal vein, 0.09; anococcygeus, 0.33. The results from the older >52-week group of rats again revealed similar noradrenaline ED50 values for the thoracic aorta, tail artery, portal vein, and anococcygeus tissues prior to cocaine treatment, and after cocaine treatment there was, with the exception of aortic tissues, a good correlation between the mean arterial blood pressure of the rat and the noradrenaline ED50 ratio in the tail artery, r = 0.60; with lower r values for portal vein (0.47) and anococcygeus (0.33). The present findings indicate that innervated arterial smooth muscle, as represented by the tail artery from >52-week SHR, has an elevated postjunctional sensitivity to noradrenaline which is masked by an elevated uptake1 activity; the ED50 ratio for the tail artery preparation from the 12- to 16-week animals is also higher in the SHR than WKY, suggesting elevated uptake1 activity; but the postjunctional sensitivity, after cocaine, is similar for SHR, F1, and WKY. No such differences, in either age group, are noted in the noninnervated thoracic aorta preparation. A comparison of the results from portal vein and anococcygeus indicates no significant differences in tissue sensitivity prior to cocaine treatment, but an elevated uptake1 activity in both portal vein and anococcygeus and elevated postjunctional sensitivity in the anococcygeus from SHR of the >52 weeks, but not the 12- to 16-weck group. Thus, elevated uptake1 activity is present at an earlier age in arterial smooth muscle from SHR than in venous or nonvascular smooth muscle, indicating selective changes occur in uptake1 in the arterial smooth muscle of the SHR prior to changes in nonarterial smooth muscle.


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