AUTONOMIC CONTROL OF THE SYSTEMIC VASCULATURE
Although the parasympathetic system can
exert important influences on the circulation, auto-nomic control of the
vasculature is primarily sym-pathetic. Sympathetic outflow to the circulation
passes out of the spinal cord at all thoracic seg-ments and the first two
lumbar segments. These fibers reach blood vessels via specific autonomic nerves
or by traveling along spinal nerves. Sympa-thetic fibers innervate all parts of
the vasculature except for capillaries. Their principal function is to regulate
vascular tone. Variations of arterial vas-cular tone serve to regulate blood
pressure and the distribution of blood flow to the various organs, whereas variations
in venous tone alter vascular capacity, venous pooling, and venous return to
the heart.
The vasculature has sympathetic
vasocon-strictor and vasodilator fibers, but the former are more important
physiologically in most tissue beds. Sympathetic-induced vasoconstriction (via α1-adrenergic receptors) can be potent in
skeletalmuscle, kidneys, gut, and skin; it is least active in the brain and
heart. The most important vasodilatory fibers are those feeding skeletal
muscle, mediating increased blood flow (via β2-adrenergic receptors) in response to exercise.
Vasodepressor (vasovagal) syn-cope, which can occur following intense emotional
strain associated with high sympathetic tone, results from reflex activation of
both vagal and sympathetic vasodilator fibers.
Vascular tone and autonomic influences
on the heart are controlled by vasomotor centers in the reticular formation of
the medulla and lower pons. Distinct vasoconstrictor and vasodilator areas have
been identified. Vasoconstriction is mediated by the anterolateral areas of the
lower pons and upper medulla. They are also responsible for adrenal secre-tion
of catecholamines, as well as the enhancement of cardiac automaticity and
contractility. Vasodilatory areas, which are located in the lower medulla, are
also adrenergic, but function by projecting inhibitory fibers upward to the
vasoconstrictor areas. Vasomo-tor output is modified by inputs from throughout
the central nervous system, including the hypothalamus, cerebral cortex, and
the other areas in the brainstem. Areas in the posterolateral medulla receive
input from both the vagal and the glossopharyngeal nerves and play an important
role in mediating a variety of circulatory reflexes. The sympathetic system
nor-mally maintains some tonic vasoconstriction on the vascular tree. Loss of
this tone following induction of anesthesia or sympathectomy frequently
contributes to perioperative hypotension.
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