Adverse effect of therapeutic vasoconstrictors in experimental acute pancreatitis

E. Klar, D. W. Rattner, Carolyn Compton, G. Stanford, B. Chernow, A. L. Warshaw

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Alpha-adrenergic drugs commonly are used to treat hypotension resulting from severe acute pancreatitis. It was shown previously that although systemic arterial pressure is increased by phenylephrine, pancreatic microcirculatory perfusion is decreased. Because inadequate tissue perfusion may be critical in the progression of edematous pancreatitis to parenchymal necrosis, it was hypothesized that vasoconstrictors might be harmful in pancreatitis. Therefore the effect of phenylephrine on cerulein-induced mild pancreatitis were studied. Sprague-Dawley rats (n = 54) were randomly allocated to 6 experimental groups and subjected to the following infusion regimens: (1) cerulein (cae) + phenylephrine (phe), (2) cae + saline (NS), (3) NS + phe, (4) cae + phenoxybenzamine (pbz) + phe, (5) NS + pbz + phe, and (6) NS. Initial and terminal hematrocrit, serum amylase activity, and blood ionized calcium concentration were determined. The animals were killed 9 hours after starting the infusion. Macroscopic and histologic changes were scored by a 'blinded' pathologist. Phenylephrine increased the severity of cerulein-induced pancreatitis as manifested by statistically significant adverse changes in serum amylase, hematocrit, ionized calcium, peripancreatitic soap formation, and acinar cell vacuolization. These changes were antagonized by alpha-adrenergic receptor blockade with phenoxybenzamine. It is concluded that phenylephrine is deleterious in acute experimental pancreatitis, the first demonstration of such an effect by a pharmacologic vasoconstrictor, and suggested that microcirculatory changes may be important in the transition of mild to severe pancreatitis. Caution in the use of vasoconstrictor drugs in patients with acute pancreatitis is recommended.

Original languageEnglish (US)
Pages (from-to)168-174
Number of pages7
JournalAnnals of Surgery
Volume214
Issue number2
StatePublished - Aug 1991
Externally publishedYes

Fingerprint

Phenylephrine
Vasoconstrictor Agents
Therapeutic Uses
Pancreatitis
Ceruletide
Phenoxybenzamine
montirelin
Amylases
Perfusion
Calcium
Receptors, Adrenergic, alpha
Soaps
Acinar Cells
Serum
Hematocrit
Adrenergic Agents
Hypotension
Sprague Dawley Rats
Arterial Pressure
Necrosis

ASJC Scopus subject areas

  • Surgery

Cite this

Klar, E., Rattner, D. W., Compton, C., Stanford, G., Chernow, B., & Warshaw, A. L. (1991). Adverse effect of therapeutic vasoconstrictors in experimental acute pancreatitis. Annals of Surgery, 214(2), 168-174.

Adverse effect of therapeutic vasoconstrictors in experimental acute pancreatitis. / Klar, E.; Rattner, D. W.; Compton, Carolyn; Stanford, G.; Chernow, B.; Warshaw, A. L.

In: Annals of Surgery, Vol. 214, No. 2, 08.1991, p. 168-174.

Research output: Contribution to journalArticle

Klar, E, Rattner, DW, Compton, C, Stanford, G, Chernow, B & Warshaw, AL 1991, 'Adverse effect of therapeutic vasoconstrictors in experimental acute pancreatitis', Annals of Surgery, vol. 214, no. 2, pp. 168-174.
Klar E, Rattner DW, Compton C, Stanford G, Chernow B, Warshaw AL. Adverse effect of therapeutic vasoconstrictors in experimental acute pancreatitis. Annals of Surgery. 1991 Aug;214(2):168-174.
Klar, E. ; Rattner, D. W. ; Compton, Carolyn ; Stanford, G. ; Chernow, B. ; Warshaw, A. L. / Adverse effect of therapeutic vasoconstrictors in experimental acute pancreatitis. In: Annals of Surgery. 1991 ; Vol. 214, No. 2. pp. 168-174.
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