Dana kardiyak veninde bupivakainin etkileri: Endotelin rolü

Amaç: Bu in vitro çalışmada uzun etkili ve potent bir lokal anestezik olan bupivakainin endotelli ve endotelsiz dana kardiyak ven düz kası üzerine etkileri araştırılmıştır. Gereç ve Yöntem: Dana kardiyak ven halkaları %95 O2 ve %5 CO2 ile gazlandırılan ve sıcaklığı 37°C’de sabit tutulan KHS içeren izole organ banyolarına alındı. Uygulanan ajanlara verilen yanıtlar izometrik olarak kaydedildi. Bulgular: Bupivakain (10-8 – 10-4 M) endotelli ve endotelsiz ven halkalarının bazal tonusunu etkilemedi. 5-HT (10-5 M) ile maksimum kasılma cevabı alındıktan uygulanan bupivakain düşük konsantrasyonlarda (10-8 – 10-6 M) kasılma cevaplarını anlamlı olarak azalttı, yüksek konsantrasyonlarda (10-5 – 10-4 M) ise kardiyak ven halkalarında kasılma gözlendi. 10-4 M bupivakain ilavesinden sonra oluşan maksimum kasılma 5-HT ile elde edilen maksimum kasılma cevabına benzerdi. Dokuların L-NAME (10-3 M) ile inkübasyonu bupivakainin düşük konsantrasyonlarında oluşan gevşeme cevaplarını inhibe etti; 10-5 ve 10-4 M bupivakain varlığında ise ven halkalarının kasılma cevapları kontrol 5-HT kasılmalarına göre anlamlı olarak yüksekti. İndometazinle (10-5 M) inkübe edilen dokularda 10-8 – 10-6 M aralığında verilen bupivakain, kontrol dokulardakine benzer şekilde, doza bağlı olarak artan gevşeme cevapları oluşturdu. Bupivakainin yüksek dozlarında gözlenen kasılma cevapları ise indometazin varlığında inhibe edildi. Endotelsiz ven halkalarında ise banyoya bupivakain ilavesi (10-8 – 10-6 M) 5-HT’ye bağlı maksimum kasılma cevaplarını değiştirmedi Sonuç: Bulgularımız; dana kardiyak veninde bupivakainin bazal tonusunu etkilemediğini, 5-HT ile önkasılma yapılan dokularda ise gevşeme ve kasılma tarzında bifazik cevap oluşturduğunu endotelden salıverilen NO’in bupivakainin gevşetici etkilerinde, sikloooksijenaz ürünlerinin ise kasıcı etkilerinde rol oynadığını göstermektedir.

Objective: In this in-vitro study effects of long acting and potent local anesthetic bupivacaine at intact and endothelium denuded calf cardiac vein were investigated. Material and Methods: Calf cardiac vein rings were placed in tissue bath containing Krebs-Henseleit Solution gassed with %95 O2 and %5 CO2 at 37°C. Changes in tension produced by the agents recorded isometrically. Results: Cumulative bupivacaine did not affect basal tonus of intact and endothelium denuded vein rings. After maximum contraction response taken with 5-HT (10-5 M), lower concentrations of (10-8 – 10-6 M) bupivacaine significantly reduced contraction responses precontracted with 5-HT. At higher concentrations (10-5 – 10-4 M ) bupivacaine produced contraction. Incubation with 10-3 M L-NAME inhibited relaxation responses to low concentrations of bupivacaine. At higher concentrations (10-5 – 10-4 M ) bupivacaine produced contraction significantly higher than control . Incubation with 10-5 M indomethacin produced dose dependent relaxation responses similar with control at low concentrations of (10-8 – 10-6 M) bupivacaine. Contraction response to higher concentrations (10-5 – 10-4 M ) of bupivacaine inhibited by Indomethacin. At endothelium denuded rings cumulative bupivacaine did not alter maximum contraction response preduced with 5-HT (10-5 M). Conclusion: Results demonstrate that bupivacain did not affect basal tonus of calf cardiac vein rings and produced biphasic effects, from relaxation to contraction at 5-HT precontracted rings. Endothelium derived NO seems to have role on bupivacaine induced relaxation and cyclooxygenase products seems to have role on bupivacaine induced contraction.

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