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CARDIOVASCULAR EFFECTS OF ADENOSINE IN MAN: 199

The effect of adenosine on central hemodynamics and cerebral blood flow were studied in 30 patients during anesthesia. The studies were approved by the local Ethics committé and performed after informed consent. Hemodynamics were recorded by a Swan-Ganz catheter and an intraarterial cannula. Cardiac output was determined by the thermodilution technique and cerebral blood flow was quantified by positron-emission-tomography. Adenosine concentrations in plasma was determined by high pressure liquid chromatography. Adenosine infusion (0.05-0.3 mg/kg/min) induced a stable hypotension (mean arterial blood pressure, MABP 40-50 mmHg), corresponding to 40-50% reduction of MABP, at an arterial adenosine concentration in the μmolar range (10-20 fold elevation of basals levals). Dipyridamole pretreatment (0,3-0,4 mg/kg,n=11) decreased the dose requirement for adenosine by 50% (p<0,01). Hypotension was caused by a profound decrease in the systemic vascular resistance (61±3%), while cardiac output increased by 40±5%. The myocardial filling pressures were not affected by adenosine. The P-R interval of the ECG was significantly prolonged, indicating inhibition of atrioventricular conductance, more prominent after dipyridamole treatment. Whole body oxygen consumption was significantly decreased by 16%, without elevation of lactate levels. Adenosine induced a general increase in cerebral blood flow, during normoventilation (n=3), and in cortical areas the flow was increased 2-3 fold.Adenosine is a powerful dilator of the resistance vessels in man.