Background and Objective

Anaphylactic shock is a serious adverse drug reaction that can occur in response to contrast media used during coronary computed tomography angiography. The imaging quality of coronary computed tomography angiography is improved by β-blockers, which decrease heart rate. In this study, we sought to analyze anaphylactic shock treatment in patients receiving short-acting β1-blockers.

Methods

We examined the influence of epinephrine and glucagon on hemodynamics during β-blocker treatment, using a dog histamine shock model; the β1-blocker landiolol hydrochloride was used. The effects of these drugs were assessed by recording changes relative to established baselines.

Results

Histamine and landiolol decreased mean blood pressure. Histamine exerted no apparent effect on heart rate, whereas landiolol decreased heart rate. Further, landiolol reduced histamine-mediated increases in the force of cardiac contraction. Increasing the doses of epinephrine and glucagon ameliorated anaphylactic shock-induced deterioration in hemodynamic parameters in subjects receiving landiolol.

Conclusions

In patients receiving landiolol for coronary computed tomography angiography, deterioration in hemodynamic parameters due to anaphylactic shock can be mitigated by increasing the doses of epinephrine and glucagon. Clinicians should thus prepare appropriate amounts of epinephrine and glucagon prior to coronary computed tomography angiography.

中文翻译：

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盐酸兰地洛尔对组胺诱发休克模型血流动力学的影响

背景与目的

过敏性休克是一种严重的药物不良反应，可在冠状动脉计算机断层扫描血管造影术中使用造影剂时发生。β受体阻滞剂可降低心率，从而提高冠状动脉计算机断层扫描血管造影的成像质量。在本研究中，我们试图分析接受短效 β1 受体阻滞剂的患者的过敏性休克治疗。

方法

我们使用狗组胺休克模型检查了肾上腺素和胰高血糖素对 β 受体阻滞剂治疗期间血流动力学的影响；使用β1-受体阻滞剂兰地洛尔盐酸盐。通过记录相对于既定基线的变化来评估这些药物的效果。

结果

组胺和兰地洛尔降低了平均血压。组胺对心率没有明显影响，而兰地洛尔可降低心率。此外，兰地洛尔降低了组胺介导的心脏收缩力的增加。在接受兰地洛尔的受试者中，增加肾上腺素和胰高血糖素的剂量可改善过敏性休克引起的血液动力学参数恶化。

结论

在接受兰地洛尔冠状动脉计算机断层扫描血管造影的患者中，可以通过增加肾上腺素和胰高血糖素的剂量来减轻过敏性休克引起的血流动力学参数的恶化。因此，临床医生应在冠状动脉计算机断层扫描血管造影术前准备适量的肾上腺素和胰高血糖素。