Effects of Propranolol on the Cardiovascular and Renin-Angiotensin Systems during Hypotension Produced by Sodium Nitroprusside in Humans

Marshall, Wayne K.; Bedford, Robert F.; Arnold, William P.; Miller, Ed; Longnecker, David E.; Sussman, Michael D.; Hakala, Michael; Brown, B. R.

doi:10.1097/00132586-198206000-00007

Cited by 5 publications

(5 citation statements)

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“…A number of previous studies have proposed premedication with a β-blocker in combination with SNP during DH for the reduction of reflex tachycardia and rebound hypertension. 8 19 20 However, to the best of our knowledge, no prior studies have investigated the impact of a preoperative oral β-blocker or ACE inhibitor administration on the intraoperative blood loss or achievement of adequate DH when combined with intraoperative NTG as an adjuvant agent under balanced anesthesia.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery

et al. 2015

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PurposeThe aim of this study was to evaluate the effects of premedication with oral atenolol or enalapril, in combination with remifentanil under sevoflurane anesthesia, on intraoperative blood loss by achieving adequate deliberate hypotension (DH) during orthognathic surgery. Furthermore, we investigated the impact thereof on the amount of nitroglycerin (NTG) administered as an adjuvant agent.Materials and MethodsSeventy-three patients undergoing orthognathic surgery were randomly allocated into one of three groups: an angiotensin converting enzyme inhibitor group (Group A, n=24) with enalapril 10 mg, a β blocker group (Group B, n=24) with atenolol 25 mg, or a control group (Group C, n=25) with placebo. All patients were premedicated orally 1 h before the induction of anesthesia. NTG was the only adjuvant agent used to achieve DH when mean arterial blood pressure (MAP) was not controlled, despite the administration of the maximum remifentanil dose (0.3 µg kg-1min-1) with sevoflurane.ResultsSeventy-two patients completed the study. Blood loss was significantly reduced in Group A, compared to Group C (adjusted p=0.045). Over the target range of MAP percentage during DH was significantly higher in Group C than in Groups A and B (adjusted p-values=0.007 and 0.006, respectively). The total amount of NTG administered was significantly less in Group A than Group C (adjusted p=0.015).ConclusionPremedication with enalapril (10 mg) combined with remifentanil under sevoflurane anesthesia attenuated blood loss and achieved satisfactory DH during orthognathic surgery. Furthermore, the amount of NTG was reduced during the surgery.

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Section: Discussionmentioning

confidence: 99%

The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery

et al. 2015

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“…[18] examined the effects of controlled hypotension induced with SNP with or without propranolol on cardiovascular, pulmonary, and renin-angiotensin system, and concluded that propranolol, when given during SNP hypotension, exhibits an early cardiovascular response manifested as a decrease in cardiac output and heart rate and a delayed action on the kidney resulting in an inhibition of renin release and decrease the amount of SNP.…”

Section: Discussionmentioning

confidence: 99%

Effects of preoperative β-blocker on blood loss and blood transfusion during spinal surgeries with sodium nitroprusside-controlled hypotension

Amr

Amin

2012

Saudi J Anaesth

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Background:The present study sought to determine whether premedication with oral β-blocker before hypotensive anesthesia with sodium nitroprusside could improve the quality of surgical field, decrease the blood loss, and decrease the need for homologous blood transfusion and duration of surgery.Methods:Eighty patients scheduled for spinal fixation surgery were included in a prospective, randomized, double-blinded study. Patients were classified into two groups: Group I received oral atenolol 50 mg twice one day before surgery; and Group II received placebo tablets identical in appearance to atenolol tablets for the same period and interval. All patients in both the groups received intraoperative sodium nitroprusside (SNP) as a hypotensive agent. Hemodynamic variables, amount of sodium nitroprusside used, quality of surgical field, and the amount of homologous blood transfusion and blood loss were compared between groups.Results:Heart rate and amount of SNP used were significantly less (P<0.0001) in the atenolol group, but no significant difference was found in intraoperative mean arterial blood pressure (MABP) between the two groups. The time of surgeries was significantly shorter in Group I than in Group II (185±15.21 vs 225±12.61 min), P<0.0001. The quality of surgical field was better in Group I than in Group II in all times of measurements, P<0.0001. The amount of blood loss and the amount of packed red blood cells transfused were significantly less in Group I than in Group II, P<0.0001. No clinically significant complications were observed in either group.Conclusion:Premedication with oral atenolol 50 mg twice/day for one day before hypotensive anesthesia with SNP during spinal surgeries seems to be clinically safe and effective to reduce heart rate, amount of SNP used, amount of blood loss, and amount of blood transfused with better quality of surgical field.

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“…Among these agents are isoflurane, a potent inhalation anesthetic with vasodilating properties, and propranolol, a p-blocker that decreases baseline sympathetic tone and attenuates the stress response (8). Unlike isoflurane, which has been used as a primary agent for induced hypotension (9), p-blockers available before the release of esmolol had elimination half-lives that were too long for this use and thus served as secondary rather than primary hypotensive agents (8,10,11). Esmolol's elimination half-life of 9 min provides both ease in achieving the desired level of hypotension by regulating the dose and ease in terminating the hypotensive effect after the termination of the infusion.…”

Section: Discussionmentioning

confidence: 99%

Deliberate Hypotension in Patients With Intracranial Arteriovenous Malformations

Ornstein

Young

Ostapkovich

et al. 1991

Anesthesia & Analgesia

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Thirty patients undergoing resection of arteriovenous malformations with deliberate hypotension were randomized to receive 1 of 3 hypotensive agents. Anesthesia was maintained with isoflurane and nitrous oxide in all patients. Mean arterial pressure was reduced 20% to 60-65 mm Hg with use of either isoflurane (less than or equal to 4%), sodium nitroprusside (less than or equal to 8 micrograms.kg-1.min-1), or esmolol (less than or equal to 24 mg/min). Esmolol was associated with a decrease in cardiac output from 6.2 +/- 1.3 to 3.8 +/- 0.8 L/min, which, because of a 22% increase in systemic vascular resistance, far exceeded the reduction in mean arterial pressure. Systemic vascular resistance increased despite a 32% decrease in plasma renin activity. In contrast, with sodium nitroprusside or isoflurane, the decrease in mean arterial pressure was associated with decreases in systemic vascular resistance of similar magnitude, with no change in cardiac output. Plasma renin activity levels increased 48% with sodium nitroprusside and 126% with isoflurane. Heart rate increased 13% with sodium nitroprusside, remained unchanged with isoflurane, and decreased 23% with esmolol. Although esmolol may be used as a primary hypotensive agent, the potential for marked myocardial depression must be recognized. The differences in pharmacologic properties for the different hypotensive agents suggest that combinations of these agents may provide a pharmacologic profile superior to either agent alone.

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Effects of Propranolol on the Cardiovascular and Renin-Angiotensin Systems during Hypotension Produced by Sodium Nitroprusside in Humans

Cited by 5 publications

References 0 publications

The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery

The Effects of Oral Atenolol or Enalapril Premedication on Blood Loss and Hypotensive Anesthesia in Orthognathic Surgery

Effects of preoperative β-blocker on blood loss and blood transfusion during spinal surgeries with sodium nitroprusside-controlled hypotension

Deliberate Hypotension in Patients With Intracranial Arteriovenous Malformations

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