Desflurane-induced Hemodynamic Changes in Patients with Hypertension

Abstract

Background: A rapid increase in the desflurane concentration induces tachycardia and hypertension and increases the plasma catecholamine concentration. This study compared the desflurane-induced hemodynamic responses in hypertensive patients with those of normotensive patients.Methods: Sixty patients, 30 normotensive patient (group 1) and 30 hypertensive patients (group 2), were scheduled to undergo elective surgery under general anesthesia. The hypertensive patients have been taking regular antihypertensive drugs and their blood pressure and heart rate was well controlled. Thirty normotensive patients were not premedicated. The inspired concentration of desflurane through the mask was increased abruptly to 12.0 vol%. The target was to produce an end-tidal concentration of desflurane (E T desf) of 10.0 vol% which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), blood pressure (BP), cardiac index (CI), systemic vascular resistance (SVR), E T desf, end-tidal concentration of carbon dioxide, and peripheral oxygen saturation were measured at the baseline and every 30 seconds for 5 minutes after inhaling of desflurane and for 2 minutes after intubation.Results: The HR, BP, and CI increased significantly in the two groups compared with the baseline. However, the HR, blood pressure, CI, SVR, and E T desf were similar in both groups. In addition, there were no significant differences of hemodynamic changes between the β-blocker and the calcium channel blocker in the hypertensive patients.Conclusions: In patients with well-controlled hypertension, the hemodynamic responses to desflurane are similar to those in normotensive patients.

The effect of intravenous labetalol administration on hemodynamic responses during desflurane inhalation

“…In this study, patients in the saline injection group showed the same pattern as those in previous studies where blood pressure and heart rate temporarily increased after desflurane inhalation and then gradually decreased [ 3 , 6 , 7 ]. Although it is uncommon that hemodynamic responses produced by desflurane are actually harmful to patients, there are studies documenting the occurrence of severe tachycardia (HR > 160 beats/min) or hypertension (systolic BP > 200 mmHg) during induction of anesthesia [ 3 , 6 , 7 ]. We also found a case of severe systolic hypertension (> 180 mmHg).…”

“…Although it is uncommon that hemodynamic responses produced by desflurane are actually harmful to patients, there are studies documenting the occurrence of severe tachycardia (HR > 160 beats/min) or hypertension (systolic BP > 200 mmHg) during induction of anesthesia [3,6,7]. We also found a case of severe systolic hypertension (> 180 mmHg).…”

Optimal dose of remifentanil for the prevention of hemodynamic responses during induction of anesthesia with desflurane

“…Further studies for response of remifentanil use and desflurane inhalation in elderly patients or patients with cardiovascular disease are needed. Interestingly, hemodynamic changes induced by desflurane inhalation in patients with hypertension [18] or diabetic autonomic neuropathy [19] are similar to those in normal subjects.…”