Summary
Urine concentrations and excretion rates of norepinephrine were measured in 28 patients anaesthetized with halothane or morphine before, during and for two hours after aortocoronary artery grafting procedures. All patients were paralyzed with d-tubocurarine, incubated and respiration was controlled. Urine was obtained for 90 minutes before induction, during induction, before, during and after bypass and postoperatively. In patients anaesthetized with halothane, urinary norepinephrine concentrations and excretion rates were not significantly different from preoperative values until the postoperative period. Patients anaesthetized with morphine did not have urine norepinephrine concentrations different from preoperative values until bypass, when they became significantly increased. All subsequent urine norepinephrine concentrations and excretion rates were significantly elevated when compared to preoperative values. These findings do not indicate a mechanism but they do demonstrate that morphine anaesthesia is associated with increased urinary and probably also increased plasma levels of norepinephrine during and after cardiopulmonary bypass in patients undergoing coronary artery operations.
RéSUMé
Nous avons mesuré la concentration urinaire et la vitesse d’excrétion de la norépinéphrine chez 28 patients anesthésiés à l’halothane ou à la morphine avant, pendant et après pontages aorto-coronariens. Tous les patients furent curarisés par la d-tubocurarine, intubés et la respiration contrôlée. L’urine fut prélavée durant 90 minutes avant l’induction, au cours de l’induction, avant, pendant et après la C.E.C., puis au cours des deux premières heures post-opératoires. Chez les patients anesthésiés à l’halothane, la concentration urinaire et la vitesse d’excrétion de la norépinéphrine ne furent pas différentes, de façon significative, des valeurs pré-opératoires, sauf durant la période post-opératoire. Les patients anesthésiés à la morphine n’ont pas eu de concentrations urinaires en norépinephrine différentes des valeurs pré-opératoires jusqu’à la C.E.C, alors qu’elles devinrent plus élevées. Toutes les valeurs subséquentes de concentration urinaire et de vitesse d’excrétion de norépinéphrine furent augmentées de façon significative, comparativement aux valeurs pré-opératoires. Ces résultats n’indiquent pas par quel mécanisme, mais démontrent que l’anesthésie à la morphine s’accompagne d’une augmentation de la norepinéphrine dans les urines, et probablement aussi dans le plasma, durant et après la circulation extra-corporelle chez les patients opérés pour pontage aortocoronarien.
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Stanley, T.H., Isern-Amaral, J. & Lathrop, G.D. The effects of morphine and halothane anaesthesia on urine norepinephrine during and after coronary artery surgery. Canad. Anaesth. Soc. J. 22, 478–485 (1975). https://doi.org/10.1007/BF03004863
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DOI: https://doi.org/10.1007/BF03004863