Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000200005
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos cardiovasculares e renais da injeção intra-arterial de contraste radiológico iônico em cães com restrição hídrica

Cardiovascular and renal effects of intra-arterial injection of ionic radiological contrast in dogs under fluid restriction

Marisa Aparecida Lima Verderese; Pedro Thadeu Galvão Vianna; Yara Marcondes Machado Castiglia; Luiz Antonio Vane

http://dx.doi.org/10.1590/S0034-70942005000200005 Braz J Anesthesiol, vol.55, n2, p.188-196, 2005
PDF Português
PDF English
Downloads: 0
Views: 1001

Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo desta pesquisa foi estudar os efeitos agudos do contraste radiológico em situações de restrição de volume, avaliando-se os efeitos renais e cardiovasculares após a injeção intra-arterial de contraste radiológico de alta osmolaridade. MÉTODO: Participaram do estudo 16 cães anestesiados com tiopental sódico (15 mg.kg-1) e fentanil (15 µg.kg-1) em bolus, seguido de infusão contínua nas doses de 40 µg.kg-1.min-1 (tiopental sódico) e 0,1 µg.kg-1.min-1 (fentanil). Foi feita hidratação com solução de glicose a 5% (0,03 mL.kg-1.min-1) e a ventilação pulmonar foi controlada mecanicamente com ar comprimido. Foram verificados os seguintes atributos: freqüência cardíaca (FC); pressão arterial média (PAM); pressão da veia cava inferior (PVI); débito cardíaco (DC); hematócrito (Ht); fluxo plasmático efetivo renal (FPER); fluxo sangüíneo renal (FSR); ritmo de filtração glomerular (RFG); fração de filtração; resistência vascular renal (RVR); volume urinário (VU); osmolaridade plasmática e urinária; depuração osmolar, depuração de água livre e depuração de sódio e de potássio; sódio e potássio plasmáticos; excreção urinária e fracionária de sódio e potássio e temperatura retal. Estes atributos foram avaliados em quatro momentos: 30 (M1), 60 (M2), 90 (M3) e 120 (M4) minutos após o início da infusão de para-aminohipurato de sódio e creatinina (início da experiência). No momento 2, no grupo G1 foi feita injeção intra-arterial de solução fisiológica a 0,9% (1,24 mL.kg-1), e no grupo G2 foi injetado contraste radiológico (1,24 mL.kg-1) pela mesma via. RESULTADOS: O grupo G1 apresentou aumento da FC, do FPER, do FSR, da osmolaridade plasmática, da depuração de sódio e da excreção urinária de sódio; apresentou ainda diminuição da osmolaridade urinária, do potássio plasmático, da depuração de potássio e da temperatura retal. No grupo G2 ocorreu aumento da FC, da RVR, do VU, da depuração osmolar, da depuração de sódio e da excreção urinária e fracionária de sódio; ocorreu também redução do (a): hematócrito, ritmo de filtração glomerular, fração de filtração, osmolaridade urinária, depuração de água livre, sódio e potássio urinários, potássio plasmático e temperatura retal. CONCLUSÕES: Neste estudo, conclui-se que a injeção intra-arterial do contraste radiológico causou efeito bifásico na função renal. Inicialmente, provocou aumento da diurese e da excreção de sódio, mas, posteriormente, houve piora das condições hemodinâmicas e, conseqüentemente, da função renal, com aumento da resistência vascular renal e diminuição do ritmo de filtração glomerular.

Palavras-chave

ANIMAIS, MEIOS DE CONTRASTE, RIM, SISTEMA CARDIOVASCULAR

Abstract

BACKGROUND AND OBJECTIVES: This study aimed at evaluating acute radiological contrast effects in fluid restriction situations, observing renal and cardiovascular effects after intra-arterial injection of high osmolarity radiological contrast. METHODS: Participated in this study 16 dogs anesthetized with sodium thiopental (15 mg.kg-1) and fentanyl (0.03 mL.kg-1), followed by continuous infusion of 40 µg.kg-1.min-1 (sodium thiopental) and 0.1 µg.kg-1.min-1 (fentanyl). Hydration was achieved with 5% glucose solution (0.03 mL.kg-1.min-1) and ventilation was mechanically controlled with compressed air. The following attributes were evaluated: heart rate (HR); mean blood pressure (MBP); inferior vena cava pressure (IVP); cardiac output (CO); hematocrit (Ht); effective renal plasma flow (ERPF); renal blood flow (RBF); glomerular filtration rate (GFR); filtration fraction; renal vascular resistance (RVR), urinary volume (UV); plasma and urinary osmolarity; osmolar clearance; free water clearance; sodium and potassium clearance; plasma sodium and potassium; sodium and potassium urinary fractional excretion and rectal temperature. These attributes were evaluated in four moments: 30 (M1), 60 (M2), 90 (M3) and 120 (M4) minutes after sodium para-aminohipurate and creatinine administration (beginning of experiment). In moment 2, G1 received intra-arterial 0.9% saline (1.24 mL.kg-1) and G2 received intra-arterial radiological contrast (1.4 mL.kg-1). RESULTS: Group G1 has presented increased HR, ERPF, RBF, plasma osmolarity, sodium clearance and sodium urinary excretion, in addition to decreased urinary osmolarity, plasma sodium, potassium clearance and rectal temperature. Group G2 has presented increased HR, RVR, UV, osmolar clearance, sodium clearance and sodium urinary and fractional excretion; there has also been decrease in hematocrit, glomerular filtration rate, filtration fraction, urinary osmolarity, free water clearance, urinary sodium and potassium, plasma potassium and rectal temperature. CONCLUSIONS: This study has concluded that intra-arterial radiological contrast has promoted a two-phase effect on renal function. Initially it has promoted increased diuresis and sodium excretion but then the hemodynamic conditions impaired, and consequently renal function impaired, with increased renal vascular resistance and decreased glomerular filtration rate.

Keywords

ANIMALS, CARDIOVASCULAR SYSTEM, CONTRAST MEDIA, KIDNEY

References

Hou SH, Bushinsky DA, Wish JB. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983;74:243-248.

Solomon R. Radiocontrast-induced nephropathy. Semin Nephrol. 1998;18:551-557.

Gupta RK, Kapoor A, Tewari S. Captopril for prevention of contrast-induced nephropathy in diabetic patients: a randomized study. Indian Heart J. 1999;51:521-526.

Shammas NW, Kapalis MJ, Harris M et al. Aminophylline does not protect against radiocontrast nephropathy in patients undergoing percutaneous angiographic procedures. J Invasive Cardiol. 2001;13:738-740.

Berns AS. Nephrotoxicity of contrast media. Kidney Int. 1989;36:730-740.

Birck R, Krzossok S, Markowetz F. Acetylcysteine for prevention of contrast nephropathy: meta-analysis. Lancet. 2003;362:598-603.

Baker CS, Wragg A, Kumar S. A rapid protocol for the prevention of contrast-induced renal dysfunction: the RAPPID study. J Am Coll Cardiol. 2003;41:2114-2118.

Morcos SK, Thomsen HS, Webb JA. Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol. 1999;9:1602-1613.

Lepor NE, Mathur VS. Radiocontrast nephropathy. Curr Interv Cardiol Rep. 2000;2:335-341.

Nygren A, Ulfendahl HR. Effects of high- and low-osmolar contrast media on renal plasma flow and glomerular filtration rate in euvolaemic and dehydrated rats: A comparison between ioxithalamate, iopamidol, iohexol and ioxaglate. Acta Radiol. 1989;30:383-389.

Sunnegardh O, Hietala SO, Holtz E. Systemic, pulmonary and renal haemodinamic and renal morphologic effects of intravenously infused iodixanol: A study in the pig of a new iso-osmolar contrast medium. Acta Radiol. 1990;31:513-518.

Brooks DP, DePalma PD. Blockade of radiocontrast-induced nephrotoxicity by the endothelin receptor antagonist, SB 209670. Nephron. 1996;72:629-636.

Jakobsen JA, Berg KJ, Waaler A. Renal effects of the non-ionic contrast medium tiopental after intravenous injection in healthy volunteers. Acta Radiol. 1990;31:87-91.

Buyan N, Arab M, Hasanoglu E. The effects of contrast media on renal function in children: comparison of ionic and non-ionic agents. Turk J Pediatr. 1995;37:305-313.

Braz JRC, Vianna PTG, Hossne WS. Efeitos do fentanil, droperidol e inoval sobre a função renal e eletrólitos (sódio e potássio): estudo experimental no cão. Rev Bras Anestesiol. 1976;26:56-73.

Castiglia YMM, Braz JRC, Vianna PTG. Effects of high-dose fentanyl on renal function in dogs. São Paulo Med J. 1997;115:1433-1439.

Forrest JB, Howards SS, Gillenwater JY. Osmotic effects of intravenous contrast agents on renal function. J Urol. 1981;125:147-150.

Katzberg RW, Morris TW, Schulman G. Reactions to intravenous contrast media.: Part II: Acute renal response in euvolemic and desidrated dogs. Radiology. 1983;147:331-334.

Katholi RE, Taylor GJ, Woods WT. Nephrotoxicity of nonionic low-osmolality versus ionic high-osmolality contrast media: a prospective double-blind randomized comparison in human beings. Radiology. 1993;186:183-187.

Jakobsen JA, Berg KJ, Brodahl U. Renal effects of nonionic contrast media after cardioangiography. Acta Radiol. 1994;35:191-196.

Laranja SM, Ajzen H, Schor N. Nephrotoxicity of low-osmolality contrast media. Ren Fail. 1997;19:307-314.

Weinstein JM, Heyman S, Brezis M. Potential deleterious effect of furosemide in radiocontrast nephropathy. Nephron. 1992;62:413-415.

Solomon R, Werner C, Mann D. Effects of saline, mannitol, and furosemide to prevent acute decreases in renal function induced by radiocontrast agents. N Engl J Med. 1994;331:1416-1420.

Apelqvist J, Torffvit O, Agardh CD. The effect of the non-ionic contrast medium iohexol on glomerular and tubular function in diabetic patients. Diabet Med. 1996;13:487-492.

Stevens MA, McCullough PA, Tobin KJ. A prospective randomized trial of prevention measures in patients at high risk for contrast nephropathy: results of the P. R.I.N.C.E study. J Am Coll Cardiol. 1999;33:403-411.

Chou CC, Hook JB, Hsieh CP. Effects of radiopaque dyes on renal vascular resistance. J Lab Clin Med. 1971;78:705-712.

Katzberg RW, Morris TW, Burgener FA. Renal renin and hemodynamic responses to selective renal artery catheterization and angiography. Invest Radiol. 1977;12:381-388.

Caldicott WJ, Hollenberg NK, Abrams HL. Characteristics of response of renal vascular bed to contrast media: Evidence for vasoconstriction induced by renin-angiotensin system. Invest Radiol. 1970;5:539-547.

Young DB, Rostorfer HH. Renin release responses to acute alterations in renal arterial osmolarity. Am J Physiol. 1973;225:1009-1014.

Spangberg-Viklund B, Nikonoff T, Lundberg M. Acute renal failure caused by low-osmolar radiographic contrast media in patients with diabetic nephropathy. Scand J Urol Nephrol. 1989;23:315-317.

Garibotto G, Saffioti S, Garlaschi G. Comparative effects of nonionic (iopamidol) and ionic (sodium and meglumine diatrizoate) contrast media for urography on urinary excretion of water solutes. Urol Radiol. 1986;8:199-203.

Haller C, Meyer M, Scheele T. Radiocontrast-induced natriuresis associated with increased urinary urodilatin excretion. J Intern Med. 1998;243:155-162.

Malnic G, Marcondes M. Fisiologia Renal. 1986:236.

Vianna PTG. Efeitos da cetamina sobre a função renal e eletrólitos (sódio e potássio): estudo experimental no cão. Rev Bras Anestesiol. 1974;24:503-517.

5dd7d2600e8825483913f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections