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K Amaha

Publications and source records attributed to K Amaha.

At least 55 records · Page 3Linked to original sources

[Effects of thiopental and sevoflurane on hemodynamics during anesthetic management of electroconvulsive therapy].

The effect of thiopental and sevoflurane (1 MAC, 2 MAC) on hemodynamics was assessed in a randomized study involving 38 adult patients undergoing electroconvulsive therapy (ECT). Blood pressure, heart rate and electrocardiogram (ECG) were monitored during the ECT procedure. After oxygenation, hypnosis was induced with a bolus injection of thiopenal (TPS) 4 mg.kg-1. Muscle relaxation was achieved by succinylcholine, 1 mg.kg-1 intravenously before ECT procedure. Ventilation was assisted using a face mask with 100% oxygen (TPS group), 1.7% sevoflurane (1 MAC group) or 3.4% sevoflurane (2 MAC group), plus 50% nitrous oxide and 50% oxygen. Thereafter, an electrical stimulus was administered. A total of 150 treatment sessions were evaluated. The rate pressure product increased in every group right after ECT, but the use of sevoflurane (2 MAC) significantly diminished the response compared with sevoflurane (1 MAC) and thiopental. In the sevoflurane (2 MAC) group, no ventricular arrhythmias were observed. In general, it seems that sevoflurane (2 MAC) is as effective as thiopental and sevoflurane (1 MAC) as an induction agent for ECT.

Adult↗

Inhaled nitric oxide improved the outcome of severe right ventricular failure caused by lipopolysaccharide administration.

OBJECTIVE: To evaluate the efficacy of nitric oxide (NO) inhalation against endotoxin-induced lung injury. DESIGN: Randomized prospective short-term study. SETTING: University school of Medicine Laboratory. INTERVENTIONS: Animal experiment (using 16 Japanese white rabbits). The animals inhaled NO at a concentration of 10 ppm. MEASUREMENTS AND RESULTS: The rabbits were randomly divided into the NO inhaling group (n = 7) and the control group (n = 9). Both groups received continuous infusion of 1200 mcg lipopolysaccharide (LPS) and the NO group inhaled 10 ppm NO during the LPS administration. In the control group, severe right ventricular (RV) failure was observed at 30-90 min of LPS infusion, and 4 of 9 animals died within 90 min of LPS infusion. In the NO group, none of the animals died and the early phase hemodynamic deterioration was milder than in the control group. But pulmonary gas exchange was not significantly different between the two groups throughout the study. At the end of the study there were no significant differences in any parameters of the surviving animals between the two groups. CONCLUSION: Although an improvement of pulmonary gas exchange was not demonstrated, NO inhalation (10 ppm) improved the outcome of severe RV failure caused by LPS infusion.

Analysis of Variance↗

Recovery of post-tetanic and train-of-four responses at the first dorsal interosseous and adductor pollicis muscles in patients receiving vecuronium.

PURPOSE: To compare recovery of accelographical responses to post-tetanic twitch (PTT) and train-of-four (TOF) stimuli obtained at the first dorsal interosseous muscle (DI) with those at the adductor pollicis muscle (AP) after administration of vecuronium 70 micrograms.kg-1. METHODS: Sixty adult patients were randomly assigned to one of four groups: PTT-DI (n = 15), PTT-AP (n = 15), TOF-DI (n = 15), or TOF-AP (n = 15) group. In PTT-DI and PTT-AP groups, responses to PTT were measured accelographically at the DI and at the AP, respectively. In TOF-DI and TOF-AP groups, responses to TOF were measured at the DI and at the AP, respectively. RESULTS: The T1/T0 (T0 = control) was greater in the TOF-DI than in TOF-AP group throughout recovery (P < 0.05), and the T4/T1 was greater in the TOF-DI than in TOF-AP group during the 30-40 min after vecuronium injection (P < 0.05). Time to the return of the first response to PTT (post-tetanic count(1), PTC1) was less in the PTT-DI than in the PTT-AP group (17.7 +/- 4.2 vs 21.7 +/- 5.6 min, mean +/- SD, P = 0.0341). The post-tetanic count PTC (number of single twitch stimuli in response to PTT) was greater in the PTT-DI than in the PTT-AP group during the 10-30 min after vecuronium (P < 0.05). Time to the return of T1 was less in the TOF-DI than in the TOF-AP group (23.1 +/- 6.0 vs 27.6 +/- 4.9 min, P = 0.0334). CONCLUSION: Recovery of responses to PTT and TOF stimuli occurred earlier at the DI than at the AP.

Adult↗

Double burst stimulation2,3: a new stimulating pattern for residual neuromuscular block.

PURPOSE: We present a new stimulating pattern: double burst stimulation2,3 (DBS2,3) for evaluating residual neuromuscular block. METHODS: Forty adult patients were studied. For DBS2,3, two burst stimuli were applied every 750 msec. The first consisted of two tetanic stimuli of 0.2 msec duration and the second of three tetanic stimuli of 0.2 msec duration. At varying degrees of neuromuscular block induced by vecuronium, the presence or absence of fade, or the presence or absence of waxing (i.e., the feeling that the muscular contraction in response to the second burst was stronger than that to the first) was determined by an observer blinded to the depth of neuromuscular block. In addition, the relationship between the train-of-four (TOF) ratio and DBS2,3 ratio was established at varying depths of neuromuscular block (TOF ratio 0.04-1.00). RESULTS: The probabilities of tactile detection of fade in response to DBS2,3 were 100, 76, 15, 9, 3, 0, and 0% at a TOF ratio of 0-0.40, 0.41-0.50, 0.51-0.60, 0.61-0.70, 0.71-0.80, 0.81-0.90, and 0.91-1.00, respectively. Waxing in response to the DBS2,3 was identified in 0, 6, 32, 84, and 98% of cases when the TOF ratios were 0.00-0.60, 0.61-0.70, 0.71-0.80, 0.81-0.90, and 0.91-1.00, respectively. A close linear relationship existed between the TOF ratio and DBS2,3 ratio (r = 0.96, P < 0.000001). CONCLUSION: DBS2,3 is of clinical use because when residual neuromuscular block is clinically important, fade can be identified, but once neuromuscular function returns to a sufficient level, waxing can be detected.

Adult↗

Comparative actions of propofol and thiopentone on cell membranes of isolated guineapig ventricular myocytes.

We have examined the effects of propofol and thiopentone on membrane potentials and currents of isolated guineapig ventricular myocytes using the whole-cell patch-clamp technique. After current clamping, propofol at concentrations greater than 0.5 mumol litre-1 shortened the plateau and action potential duration (APD) (P < 0.05). Thiopentone 10 mumol litre-1 prolonged APD (P < 0.05), whereas concentrations of 50 mumol litre-1 or higher decreased plateau height (P < 0.05) and resting membrane potential (RMP) (P < 0.05) with abbreviation of the prolonged APD. With voltage clamping, propofol 1 mumol litre-1 decreased the L-type Ca2+ current (ICa,L) to 88.4% of control (P < 0.01) without affecting the delayed rectifier K+ current (IK) and propofol 10 mumol litre-1 decreased ICa,L and IK to 75.0% (P < 0.01) and 78.4% (P < 0.01), respectively, with no effect on the inward rectifier K+ current (IK1). Thiopentone 10 mumol litre-1 decreased ICa,L to 88.5% (P < 0.01) and IK to 78.3% (P < 0.05), while thiopentone 100 mumol litre-1 depressed ICa,L to 82.8% (P < 0.01), IK to 27.0% (P < 0.01) and IK1 to 67.3% (P < 0.05). These results indicated that propofol, at concentrations greater than those that are clinically relevant, shortened APD mainly by suppression of ICa,L, and the biphasic effects on APD by thiopentone were caused by depression of IK, and concomitant suppression of ICa,L and IK1 at higher concentrations. The distinct cardiodepressant effects of propofol and thiopentone may be, at least in part, attributed to different actions on membrane Ca2+ and K+ currents.

Action Potentials↗

Increased circulating adrenomedullin, a novel vasodilatory peptide, in sepsis.

Human adrenomedullin (hAM), a potent vasodilatory peptide originally identified in pheochromocytoma, has been shown to be present in various human tissues and circulate in human plasma. We measured plasma concentrations of immunoreactive hAM in patients with sepsis who had been admitted to intensive care unit (ICU). Plasma hAM concentrations in 12 septic patients upon entering the ICU were extremely elevated (107 +/- 139 fmol/ml: mean +/- SD) compared to those of 16 age-matched normal subjects (7.9 +/- 3 fmol/mL). Among 10 patients with normal renal function, plasma hAM levels either decreased or increased during the hospital course; the former group survived and the latter group succumbed. Two patients with acute renal failure had markedly elevated plasma hAM levels during the early course, which declined rapidly during the recovery course. High performance liquid chromatography of plasma extracts from one patient with acute renal failure revealed a single major component of immunoreactive hAM coeluting with authentic hAM (1-52) during acute and recovery phase. Plasma hAM concentration showed positive correlations with heart rate, right atrial pressure, and serum creatinine concentration, but not with other hemodynamic variables. These data suggest that a marked increase in circulating hAM in sepsis may be caused by its decreased clearance and/or its enhanced synthesis by multiple organ dysfunction, and that increased endogenous hAM may be involved in the mechanism of cardiovascular abnormalities associated with sepsis.

Adrenomedullin↗

Amrinone improves contractility of fatigued diaphragm in dogs.

The effects of amrinone, a bipyridine derivative, on diaphragmatic contractility and fatigue were examined in 36 anaesthetized, mechanically ventilated dogs divided into four groups. In Group Ia (n = 8), dogs without diaphragmatic fatigue were given a bolus injection (0.75 mg.kg-1) followed by continuous infusion (10 micrograms.kg-1.min-1) of amrinone iv. In Group Ib (n = 8), animals without fatigue received infusion only of maintenance fluid. In Group IIa (n = 10) and Group IIb (n = 10), diaphragmatic fatigue was induced by intermittent supramaximal bilateral electrophrenic stimulation at a frequency of 20 Hz applied for 30 min. After producing fatigue, amrinone (0.75 mg.kg-1 loading dose plus 10 micrograms.kg-1.min-1 maintenance dose) iv were administered in Group IIa. Only maintenance fluids were administered in Group IIb during this period. Diaphragmatic contractility was assessed in each group by measuring transdiaphragmatic pressure (Pdi). Compared with Group Ib, Pdi at any stimuli in Group Ia did not differ. After producing fatigue, in Group IIa and Group IIb, Pdi decreased at low-frequency (10-30 Hz) stimulation (P < 0.05), whereas no change in Pdi was observed at high-frequency (50-100 Hz) stimulation. In Group IIa, Pdi to each stimulus increased during amrinone infusion compared with Group IIb (p < 0.05). In Group IIb, the speed of recovery from fatigue was relatively slower at low-frequency stimulation. The integrated diaphragmatic electric activity (Edi) did not change throughout the experiment. These results indicate that amrinone improves contractility in the fatigued diaphragm.

Amrinone↗

Optimal stimulating current for train-of-four stimulation in conscious subjects.

The purpose of this study was to determine the optimal stimulating current for train-of-four (TOF) monitoring with regard to the return of TOF response and the discomfort associated with TOF. Two variables were examined at 60, 50, 40, 30, and 20 mA: (1) times from administration of vecuronium 80 micrograms.kg-1 to returns of responses to TOF determined accelographically in 75 anaesthetised patients and (2) discomfort associated with TOF in 15 awake volunteers using visual analogue scale (VAS). Times to return of the first response to stimulation at 60, 50, 40, and 30 mA were not different (29.1 +/- 11.2, 30.1 +/- 12.0, 31.9 +/- 12.6, and 35.4 +/- 14.2 min, respectively, mean +/- SD). However, time to the return of the first response elicited at 20 mA (53.7 +/- 21.6) was longer than at higher currents (P < 0.05). Similarly, with regard to the second, third, and fourth responses, the time to the return at 20 mA was longer than at the other currents (P < 0.05). The VAS associated with TOF at 60, 50, 40, 30, and 20 mA were 7.3 +/- 1.9, 6.7 +/- 1.8, 6.0 +/- 2.0, 4.1 +/- 2.1, and 2.7 +/- 2.3, respectively. The VAS at 30 mA was less than at 60 and 50 mA (P < 0.05), and at 20 mA was less than at 60, 50, and 40 mA (P < 0.05). In conclusion it is suggested that, when testing conscious patients, 30 mA is the optimal stimulating current for TOF monitoring because it represents the best compromise of neuromuscular monitoring and patient discomfort.

Adult↗

Post-tetanic burst count: a stimulating pattern for profound neuromuscular blockade.

The purpose of this study was to compare the pattern of recovery from vecuronium 0.07 mg.kg-1 induced neuromuscular blockade using post-tetanic burst count (PTBC)-(three short tetanic bursts of 0.2 msec duration every 20 msec given every second following a tetanus), and post-tetanic count (PTC)-(0.2 msec single twitch stimuli given every second following a tetanus) using an accelerometer in 60 adult patients during nitrous oxide-oxygen-isoflurane anaesthesia. In addition, the relationship among PTBC, PTC, and T1 (the 1st response in the train-of-four (TOF) stimulation) was examined to investigate whether the PTBC had an advantage over the PTC or TOF for evaluating intense neuromuscular blockade. The PTBC was greater than PTC during the 15-35 min after the administration of vecuronium (unpaired t test with Bonferroni's correction, P < 0.05). Time to the return of PTB response was shorter than that of PTT (17.7 +/- 3.2 vs 22.7 +/- 3.7 min, unpaired t test, P = 0.0005). Time from the return of PTB to that of T1 was longer than the time from the return of PTC to that of T1 (13.3 +/- 2.6 vs 9.2 +/- 2.8 min, unpaired t test, P = 0.0003). At the return of T1, PTBC was greater than PTC (14.3 +/- 6.9 vs 9.4 +/- 2.3, unpaired t test, P = 0.0153). These results suggest that, using PTBC, a more profound level of neuromuscular blockade can be evaluated than that using PTC.

Adult↗

Post-tetanic burst: a new monitoring method for intense neuromuscular block.

A new stimulation pattern for evaluation of intense neuromuscular block (post-tetanic burst (PTB)) was compared with post-tetanic twitch (PTT) during spontaneous recovery from vecuronium-induced neuromuscular block. Thirty adult patients were allocated to two equal groups and we measured times from administration of vecuronium 0.1 mg kg-1 to return of PTB and PTT responses, and evoked responses to PTB and PTT stimuli. For PTB stimulation, a 50-Hz tetanus was applied at 50 mA for 5 s, and after a pause of 3 s, a 50-Hz burst stimulation was applied, consisting of three impulses at 50 mA. PTB stimuli were delivered every 5 min. Similarly, PTT consisted of a tetanus, a 3-s pause and one single twitch stimulation repeated every 5 min. Time to return of the PTB response was significantly shorter than that of PTT (mean 23.7 (SD 7.9) compared with 30.7 (7.0) min) (P = 0.0160), although evoked responses to PTB did not differ significantly from those of PTT throughout recovery from vecuronium-induced neuromuscular block. This study suggested that PTB was more sensitive in evaluating intense neuromuscular block than PTT.

Adult↗

Effects of nitric oxide synthase inhibitor on hemodynamic change and O2 delivery in septic dogs.

To elucidate the role of nitric oxide (NO) in septic shock, we measured hemodynamic and pulmonary gas changes in anesthetized dogs after intravenous administration of bacterial lipopolysaccharide (LPS) with or without NO synthase inhibitor, NG-nitro-L-arginine (L-NNA). Infusion of LPS (250 ng.kg-1.min-1) for 2 h decreased mean arterial pressure over 1-4 h. Although L-NNA (10 mg/kg) blocked LPS-induced hypotension, it decreased cardiac index, oxygen delivery index, arterial pH, and arterial PO2 and increased systemic vascular resistance index in the presence or absence of LPS. Administration of NG-nitro-D-arginine (D-NNA, 10 mg/kg) alone caused fewer hemodynamic effects (increased systemic vascular resistance index and decreased cardiac index) than L-NNA alone. Our study provides evidence that L-NNA prevents endotoxin-induced hypotension but decreases cardiac output and oxygen delivery, effects that may, in part, be due to a nonspecific NO synthase-independent event. Thus clinical use of NO synthase inhibitors for the treatment of septic shock should be cautiously considered.

Amino Acid Oxidoreductases↗

Usefulness of central venous oxygen saturation monitoring during cardiopulmonary resuscitation. A comparative case study with end-tidal carbon dioxide monitoring.

The usefulness of continuous monitoring of central venous oxygen saturation (ScvO2) in comparison with the capnogram during cardiopulmonary resuscitation (CPR) was demonstrated in a cardiac arrest patient. ScvO2 and end-tidal carbon dioxide (ETCO2) decreased following cessation of chest compression or increased during recovery of systemic circulation. During the complete stasis of systemic circulation, when defibrillation was done, ScvO2 did not change, while ETCO2 gradually decreased. However the larger decrease in ScvO2 temporally occurred when chest compression was resumed. And also the ScvO2 monitoring had great advantage to detecting peripheral tissue oxygenation. ScvO2 seems to be no less accurate and reliable monitoring than the capnogram during CPR procedures. Since the capnogram is non-invasively and easily used in cardiac arrest patients, ScvO2 monitoring combined with the capnogram is a more preferable method for assessing the efficacy of ongoing CPR.

Blood Gas Analysis↗

Clinical assessment of a continuous intraarterial blood gas monitoring system.

We evaluated the clinical performance of a continuous intraarterial blood gas monitoring (CIABG) system which includes a fluorometric intravascular sensor. Seventeen patients undergoing elective surgery were monitored perioperatively with the CIABG system (PB3300; Puritan Bennett, Carlsbad, CA). Conventional laboratory blood gas analyses (BGA) were performed simultaneously whenever indicated, and the values were compared with those obtained from the CIABG system. Monitoring time ranged from 24 to 72 hr. The biases (average error between PB3300 and BGA) of pH, PCO2 and PO2 were 0.003 pH unit, -2.8 mmHg, and 0.9 mmHg in the operating room (OR), and 0.005 pH unit, 3.9 mmHg, and 8.5 mmHg in the intensive care unit (ICU), respectively. The precision (standard deviation of the bias) of pH, PCO2 and PO2 were 0.030 pH unit, 2.1 mmHg, and 29.9 mmHg in the OR and 0.035 pH unit, 3.8 mmHg, and 14.7 mmHg in the ICU, respectively. Although the PB3300 system was clinically useful as a trend monitor, the system's precision and reliability were unacceptable for estimation of true blood gas values.

Adult↗

Nicardipine enhances diaphragmatic fatigue.

The effects of nicardipine, a calcium channel blocker, on diaphragmatic fatigue were studied in 20 anaesthetized, mechanically ventilated dogs divided into two groups: control group (Group C, n = 10) and nicardipine group (Group N, n = 10). Diaphragmatic fatigue was induced by intermittent supramaximal electric stimulation to bilateral phrenic nerves at a frequency of 20 Hz for 30 min. In Group N, 5 micrograms.kg-1.min-1 nicardipine iv was infused continuously during this fatigue-producing period. Transdiaphragmatic pressure (Pdi) produced by electrical stimulation (10-100 Hz) of the phrenic nerves was used as an index of diaphragmatic contractility. After a fatigue-producing period, the Pdi in both groups decreased at low frequency (10-30 Hz) stimulation compared with pre-fatigue values (P < 0.05), whereas no change in Pdi was observed at high-frequency (50-100 Hz) stimulation. The decrease of Pdi at low-frequency stimulation was larger in Group N (P < 0.05). The integrated diaphragmatic electric activity (Edi) in both groups did not change at any frequency of stimulation throughout the experiment. We conclude that nicardipine enhances diaphragmatic fatigue.

Animals↗

Cutaneous iontophoretic application of condensed lidocaine.

The purpose of this study was to determine whether iontophoretic application of high concentrations of lidocaine, with the same current, would produce cutaneous local anaesthesia rapidly enough for clinical practice. Twenty healthy volunteers, 17 male and three female, were selected for study. After five-minute or ten-minute iontophoresis using lidocaine 4, 10, 20, 30, 50%, we assessed the response to pin prick with a 27-gauge sterile needle inserted to the depth of 2 mm at five random locations in the iontophoretically-stimulated area. Also, plasma lidocaine concentrations were measured in the venous blood samples which had been taken from three male subjects, at 3, 10, and 30 min after iontophoresis with lidocaine 50%. The pain score after five-minute iontophoresis was higher than that after ten-minute iontophoresis, using each concentration of lidocaine (P < 0.001), whereas the pain scores had no correlation with lidocaine concentration within five-minute and ten-minute iontophoresis groups, respectively (P: NS). On the other hand, plasma lidocaine concentration was < 1.0 micrograms.ml-1 in all samples. No side effects other than erythema were observed after iontophoresis using high concentrations of lidocaine up to 50%. These results showed that by increasing the lidocaine concentration of the applied solution up to 50%, the application time of iontophoresis cannot be reduced from ten to five minutes without losing analgesic effect, although iontophoresis itself can be performed with safety.

Administration, Cutaneous↗

Post-tetanic count and single twitch height at the onset of reflex movement after administration of vecuronium under different types of anaesthesia.

We have studied post-tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecuronium with five different types of anaesthesia. Seventy-five adult patients were allocated randomly to five groups of 15 patients each, to receive one of the following anaesthetics: neuroleptanaesthesia (fentanyl and droperidol) or 1 MAC of either halothane, isoflurane, enflurane or sevoflurane with 66% nitrous oxide in oxygen. During spontaneous recovery from vecuronium-induced neuromuscular block, the carina was stimulated with a suction catheter every 150 s. Single twitch heights at the onset of reflex movement were similar (2.0-2.7% of control values) between the five groups. In contrast, PTC at the onset of reflex movement to carinal stimulation differed (7.4-17.0) between groups.

Adult↗

Effect of tetanic stimulation on subsequent train-of-four responses at various levels of vecuronium-induced neuromuscular block.

Tetanic stimulation influences subsequent neuromuscular responses. In addition, the tetanus-induced changes in neuromuscular responses differ according to the level of neuromuscular block at which tetanic stimulation is delivered. We studied the tetanus-induced effect on subsequent train-of-four (TOF) responses at various levels of vecuronium-induced neuromuscular block in 45 anaesthetized patients. Tetanic stimulation was applied when a twitch height of T1 returned to 25%, 50% and 75% of its control twitch height (T0) (groups 1, 2 and 3, respectively) after administration of vecuronium 0.1 mg kg-1. Maximum post-tetanic percentage increases in TOF responses in groups 1, 2 and 3 were 257 (SD 119)%, 107 (75)% and 68 (54)% for T1/T0 (P < 0.001 for group 1 vs 2; P < 0.001 for group 1 vs 3) and 535 (259)%, 421 (213)% and 292 (171)% for T4/T1 (P < 0.01 for group 1 vs 3), respectively. Durations of post-tetanic increases in TOF responses in groups 1, 2, and 3 were 52 (19) s, 37 (14) s and 32 (13) s for T1/T0 (P < 0.05 for group 1 vs 2; P < 0.01 for group 1 vs 3) and 53 (17) s, 46 (15) s and 35 (12) s for T4/T1 (P < 0.05 for group 1 vs 3), respectively. These data suggest that the tetanus-induced effect on subsequent TOF is more apparent and lasts longer at greater degrees than at lesser degrees of neuromuscular block.

Adult↗

Effects of TNF-alpha on hemodynamic changes and circulating endothelium-derived vasoactive factors in dogs.

To elucidate the relation of tumor necrosis factor-alpha (TNF-alpha)-induced hemodynamic change to endothelium-derived vasoactive factors, we simultaneously measured hemodynamic parameters and circulating endothelin (ET)-1, ET-3, nitrite/nitrate (NOx), and 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) in anesthetized dogs following administration of TNF-alpha with or without NG-nitro-L-arginine (L-NNA), a nitric oxide (NO) synthase inhibitor, and indomethacin, a cyclooxygenase inhibitor. Natural human TNF-alpha (10 micrograms/kg, n = 5) with or without L-NNA (1 mg/kg, n = 5) or indomethacin (2 mg/kg, n = 5) was administered intravenously as a bolus, while administration of vehicle served as control (n = 5). After administration of TNF-alpha, mean arterial pressure and cardiac index significantly decreased, whereas systemic (SVRI) and pulmonary (PVRI) vascular resistance index increased. Plasma levels of ET-1, ET-3, NOx, and 6-keto-PGF1 alpha significantly (P < 0.01) increased at 1 h. L-NNA or indomethacin blocked TNF-alpha-induced hypotension and remarkably increased SVRI but did not affect decreased cardiac index. Our data suggest that endogenous ET-1 may partly contribute to TNF-alpha-induced increases in SVRI and PVRI, against which ET-3, NO, and prostacyclin may function as compensatory vasodilators.

6-Ketoprostaglandin F1 alpha↗