The effect of allopurinol and catalase on cardiovascular hemodynamics during hemorrhagic shock.

The primary objective of this study was to determine the effect that the xanthine oxidase inhibitor allopurinol (ALLO) and the hydrogen peroxide scavenger catalase (CAT) have on the cardiovascular compensatory ability of the dog to respond to severe hemorrhagic hypotension. Twenty-four mongrel dogs were anesthetized with sodium pentabarbitol and surgically prepared to monitor 1) average arterial blood pressure (AAP), 2) central venous pressure (CVP), 3) heart rate (HR), 4) cardiac index (CI = CO/kg), and hindlimb skeletal muscle blood flow (MBF). Total body vascular conductance (TBC) and skeletal muscle vascular conductance (MVC) were calculated by dividing the CI or MBF by the difference between the AAP and CVP. Eight animals were placed into each of the following three groups, bled over a 1-hr period of time to an AAP of 50 mm Hg and monitored for an additional 2 hr. Group I controls received an intravenous volume of lactated Ringer's equivalent to that volume given to groups II and III. Group II was pretreated 24 hr prior to hemorrhage with 100 mg/kg ALLO orally and received a bolus injection of 25 mg/kg 15 min prior to hemorrhage plus an intravenous infusion of 5 mg/kg/hr over the 3-hr study. Group III was given the same ALLO treatment as group II plus an additional 5-mg/kg/hr intravenous infusion of CAT throughout the duration of the 3-hr study. The results show that the intense compensatory increase in total body vascular tone which occurs during severe hypovolemia is significantly reduced at the 60-, 120-, and 180-min periods in the ALLO/CAT group; however, when ALLO alone was used this effect lasted only through the 120-min period. A similar, but statistically less convincing, picture was seen in the skeletal muscle vascular bed. Thus, the ALLO/CAT group seemed to inhibit some free radical mechanisms better than the ALLO group during and immediately following hemorrhage. Allopurinol alone lost its effectiveness before the 3 hr, which suggests that a free radical mechanism may play an early role in the pathophysiologic shock sequence. As shock continues, however, other factors seem to override the free radical mechanism. One possible explanation for this early tissue protective action of allopurinol and catalase is the inhibition of the oxygen free-radical-induced microvascular swelling and plugging.