A comparison of fenoldopam and nitroprusside in the control of hypertension following coronary artery surgery

Aj, Hill; Feneck, R. O.; Walesby, R.K.

doi:10.1016/1053-0770(93)90005-6

Cited by 37 publications

(11 citation statements)

References 25 publications

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“…The ideal perioperative antihypertensive agent would have rapid onset and short duration of activity with easy titration to effect and a low risk of overshoot hypotension [42]. The benefits and limitations of currently used agents are summarized in tables 3 and 4[29,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. Where available, comparison studies have been included; however, it should be noted that rigorous studies involving commonly used antihypertensives are few and far between and, with the exception of the ECLIPSE program, were completed more than a decade ago.…”

Section: Traditional Therapies For Perioperative Hypertension: Meritsmentioning

confidence: 99%

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

et al. 2011

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Background/Aims: Patients who develop acute kidney injury (AKI) after cardiac surgery continue to have a high mortality rate. Although factors that predispose to postoperative renal dysfunction have been identified, this knowledge has not been associated with a substantial reduction in the incidence of this serious adverse event. Methods: This review uses the existing literature to explore the relationship between AKI and perioperative blood pressure (BP) control in cardiac surgery patients. The results of recent novel analyses are introduced, and the implications of these studies for the management of cardiac surgery patients in the perioperative period are discussed. Results: Preexisting isolated systolic hypertension and wide pulse pressure increase the risk of postoperative renal dysfunction in the cardiac surgery population. New data suggest that BP lability (i.e., BP excursions outside an acceptable physiologic range) during cardiac surgery may also be an important predictor of subsequent renal dysfunction. Conclusion: Recently published data suggest that perioperative BP lability influences both the risk of postoperative renal dysfunction and 30-day mortality. Future studies will determine whether the use of agents that allow improved BP control within a desirable range will reduce the incidence of postoperative AKI in cardiac surgery patients.

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Section: Traditional Therapies For Perioperative Hypertension: Meritsmentioning

confidence: 99%

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

et al. 2011

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“…. Clinical studies suggest that the effi cacy of fenoldopam in decreasing blood pressure in patients with hypertensive urgency, including those with hypertension after coronary artery bypass grafting, is similar to that of sodium nitroprusside [28][29][30]. In contrast to nitroprusside, however, fenoldopam also increases renal perfusion, leading to enhanced diuresis and natriuresis.…”

Section: Clevidipinementioning

confidence: 90%

Strategies for managing perioperative hypertension

Desai

Muntazar

Goldberg

2009

Current Science Inc

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Acute perioperative hypertension is associated with a higher risk of perioperative myocardial ischemia, bleeding, stroke, and renal failure. The immediate concern of short-term antihypertensive therapy is to prevent excessive surgical bleeding from arterial anastomoses, myocardial ischemia, and neurologic complications while causing minimal adverse effects until oral therapy can be resumed. This article reviews perioperative hypertension emergencies/urgencies and various approaches for management.

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“…Along with providing vasodilation to the renal vasculature, fenoldopam also has direct natriuretic and diuretic properties. 49,50 It has a rapid onset (4 minutes) and short duration. Time to maximal effect and elimination half-life are 15 and 5 minutes, respectively.…”

Section: Fenoldopammentioning

confidence: 99%

Pharmacological Review of Postoperative Hypertension

Lewis

2002

Journal of Pharmacy Practice

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Postoperative hypertension is an acute, transient increase in blood pressure that develops within 30 to 90 minutes following a surgical procedure and typically lasts for 4 to 8 hours after surgery. It is defined as a systolic blood pressure greater than 160 mm Hg or a diastolic blood pressure greater than 90 mm Hg. The increase in blood pressure is primarily due to increased systemic vascular resistance brought about by reflex changes in humoral factors, including increased levels of catecholamines, renin, and serotonin as well as alterations in baroreceptor function and carotid reflexes. Potential complications of untreated postoperative hypertension include depressed left ventricular performance, increased myocardial oxygen demand resulting in ischemic episodes, cerebrovascular accidents, arrhythmias, and suture line disruption and bleeding. Despite longstanding recognition that high blood pressure is a frequent complication after surgery, formal guidelines for the treatment of postoperative hyper-tension have not been developed. Postoperative hypertension is a pathophysiological state that requires rapid assessment and appropriate treatment. Several pharmacologic agents are available to achieve and maintain normotension after surgery, including nitrovasodilators (nitroglycerin and sodium nitroprusside), adrenergic blocking agents, and dihydroperidine calcium channel antagonists. Angiotensinconverting enzyme inhibitors and fenoldopam also have been used. Each has its own distinct mechanism of action and adverse effect profile. In cardiac surgery, nicardipine is as effective as nitrovasodilators and offers coronary selectivity. In patients who are hypertensive after neurosurgical procedures, avoid direct-acting vasodilators, which may exacerbate increased intracranial pressure; -adrenergic receptor antagonists and ACEIs are the preferred agents in these patients. More data are needed to define roles and benefits of fenoldopam in managing postoperative hypertension.KEY WORDS: postoperative complications, surgery, hypertension. P ERIOPERATIVE HYPERTENSION during cardiacor noncardiac surgery is a unique clinical problem characterized by systemic vasoconstriction often with intravascular hypovolemia that usually requires shortterm intravenous therapy. It is an acute, transient increase in blood pressure that develops within 30 to 90 minutes following a surgical procedure and typically lasts for 4 to 8 hours after surgery. 1,2 The incidence ranges from 3% to 75% and depends on both the criteria used to define hypertension as well as the surgical population studied. 3 Perioperative hypertension occurs in less than 4% of patients undergoing major noncardiac surgery and increases to just over 5% in valve replacement surgery. 4 The incidence increases dramatically with coronary artery bypass grafting, ranging from 30% to 80%, 4-6 with higher frequencies reported in patients who have severe burns, intracranial pathology, pre-eclampsia or eclampsia, hyperthyroidism, renal disease, or myocardial ischemia due to atherosclero...

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A comparison of fenoldopam and nitroprusside in the control of hypertension following coronary artery surgery

Cited by 37 publications

References 25 publications

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

Acute Kidney Injury following Cardiac Surgery: Role of Perioperative Blood Pressure Control

Strategies for managing perioperative hypertension

Pharmacological Review of Postoperative Hypertension

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