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Departments of 1 Neurology and 2 Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287
The large increase in cerebral blood flow
(CBF) after fluorocarbon (FC)-exchange transfusion is thought to be
caused by low oxygen content, decreased viscosity, or direct
vasodilatory effect of the FC perfusate. The aim of this study was to
determine whether nitric oxide (NO)-mediated vasorelaxation is
increased in FC-perfused hemoglobin (Hb)-free cats because NO is not
scavenged by Hb. We measured regional CBF with radiolabeled
microspheres in three groups of anesthetized mechanically ventilated
cats. The first group [FC + N
-nitro-L-arginine methyl ester
(L-NAME);
n = 7] underwent a complete FC-exchange transfusion with FC-43 and subsequent nitric oxide synthase
(NOS) inhibition with L-NAME (10 mg/kg iv) followed by L-arginine
(100 mg/kg iv). A second group (FC + saline;
n = 6) underwent an identical
protocol, but NOS was not antagonized (saline iv). In a third group
(blood + L-NAME;
n = 7), cats were not FC exchanged but
NOS was inhibited. In a separate cohort of four FC-perfused cats, NOS
activity in brain tissue samples was reduced to 26% of control after
NOS inhibition. FC-exchange transfusion nearly doubled hemispheric
blood flow in both FC-exchanged groups, whereas it was constant in the
blood + L-NAME group. These
increases in regional CBF (hemispheres, brain stem, cerebellum,
thalamus, and white matter) were not reversed by inhibition of NOS,
except in the neurohypophysis, where
L-NAME reduced blood flow to
levels comparable to values in the blood + L-NAME group. In summary, increases in regional CBF after total FC-exchange transfusion are not
caused by a lack of NO scavenging, with the exception of
neurohypophysis. These findings suggest an increased vasorelaxation in
neurohypophysis of FC-perfused and Hb-free cats caused by unscavenged NO, but this mechanism does not play a major role in FC-related CBF
increases in the rest of the cerebral circulation.
nitric oxide synthase inhibition; nitric oxide synthase activity; fluorocarbons; regional cerebral blood flow; neurohypophysial blood flow
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