Skip Navigation



BJA Advance Access published online on October 9, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael268
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
97/6/792    most recent
ael268v1
Right arrow E-Letters: Submit a response to the article
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Oh, Y. J.
Right arrow Articles by Kwak, Y. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Oh, Y. J.
Right arrow Articles by Kwak, Y. L.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted August 24, 2006

Clinical Investigation

Effects of chronic angiotensin II receptor antagonist and angiotensin-converting enzyme inhibitor treatments on neurohormonal levels and haemodynamics during cardiopulmonary bypass{dagger}

Y. J. Oh 1, J. H. Lee 1, S. B. Nam 1, J. K. Shim 1, J. H. Song 2, and Y. L. Kwak 1 *

1 Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
2 Department of Anaesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea

* To whom correspondence should be addressed.
Y. L. Kwak, E-mail: ylkwak{at}yumc.yonsei.ac.kr


  Abstract

Background. Chronic treatment with renin-angiotensin system (RAS) antagonists frequently causes deleterious hypotension during anaesthesia. We compared the effects of angiotensin II receptor antagonists (ARA) and angiotensin-converting enzyme inhibitors (ACEI) on neurohormonal levels and haemodynamics during cardiopulmonary bypass (CPB).

Methods. Forty-four patients undergoing mitral valvular surgery who were treated with either ARA (ARA group, n=14) or ACEI (ACEI group, n=15) over 12 weeks or who were not treated with any RAS antagonist (control group, n=15) were enrolled. The plasma levels of epinephrine, norepinephrine, arginine vasopressin (AVP) and angiotensin II, and haemodynamic variables were measured before (T1) and 15 min after (T2) the start of CPB, before aortic unclamping (T3) and at skin closure (T4). Mean arterial pressure (MAP) was maintained above 60 mm Hg with phenylephrine administration during CPB.

Results. The plasma epinephrine, norepinephrine, AVP and angiotensin II levels increased during CPB in all groups. Compared with the control group, the AVP level was lower at T1 in the ARA group and at T2 in the ARA and ACEI groups. The angiotensin II level was higher at T1, T2 and T3 in ARA group compared with ACEI and control groups. There were no significant differences in the epinephrine and norepinephrine levels among the three groups. The amount of administered phenylephrine during CPB was greater and MAP was lower in the ARA group compared with the ACEI and control groups.

Conclusions. Chronic ARA treatment resulted in more profound hypotension than ACEI treatment during CPB, and this may be associated with the blockade of angiotensin II receptors by ARA.

Keywords: arterial pressure, hypotension; enzymes, angiotensin converting, inhibition; heart, cardiopulmonary bypass; hormones, antidiuretic; hormones, rennin.
{dagger}Presented in part at the Euroanaesthesia 2006 of the annual meeting of the European Society of Anaesthesiology on June 5, 2006 in Madrid, Spain.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Br J AnaesthHome page
B. G. Loef, R. H. Henning, G. Navis, A. J. Rankin, W. van Oeveren, T. Ebels, and A. H. Epema
Changes in glomerular filtration rate after cardiac surgery with cardiopulmonary bypass in patients with mild preoperative renal dysfunction
Br. J. Anaesth., June 1, 2008; 100(6): 759 - 764.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
D. G. Lambert
Urotensin II: from osmoregulation in fish to cardiovascular regulation in man
Br. J. Anaesth., May 1, 2007; 98(5): 557 - 559.
[Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.