The renin-angiotensin, catecholamine system during controlled hypotension with sodium nitroprusside, trinitroglycerine and trimetaphan under balanced anesthesia
Ogawa, T.; Inoue, S.; Wauquier, A.; Hörig, C.; Cuesta, P.
Masui. Japanese Journal of Anesthesiology 35(10): 1482-1490
1986
ISSN/ISBN: 0021-4892 PMID: 3100833 Document Number: 285649
Thirty two patients (ASA I .apprx. II) scheduled for elective surgery were studied under balanced anesthesia with etomidate (ETOM), cyclazocine (CYCZ) and N2O. During induction, during maintenance of hypotension and after hpotension anesthesia, hemodynamics plus plasma renin activity (PRA), angiotensin (ANG) I, II, epinephrine and norepinephrine were analyzed and compared. Three groups were studied; trimetaphan (TMP), trinitroglycerine (TNG), group, and sodium nitroprusside (SNP) groups. TMP group; PRA, ANG I, epinephrine and nor-epinephrine increased gradually during hypotension. After hypotension, these values increased significantly and returned to control values within 15 minutes. TNG group; PRA, ANGI, II, epinephrine and norepinephrine increased during hypotension but returned to normal values immediately after discontinuation of hypotension. SNP group; PRA, ANG I, II, epinephrine, norepinephrine were stable during hypotension. Rebound hypertension with increase of these values occurred, and continued for 30 minutes. Second infusion of TMP sometimes, induced tachycardia and it was difficult to keep the desired hypotension, due to the elevation of the PRA, ANG, epinephrine and norepinephrine. There was a time lag until the elevation of these values in TMP group. It was difficult to keep deep hypotension in TNG group, due to the elevation of PRA, ANG, epinephrine and norepinephrine during hypotension. SNP was an appropriate drug to maintain the deep hypotension due to the inhibition of PRA, ANG, epinephrine and norepinephrine. Rebound hypertension occurred after discontinuation due to release of large quantity of PRA, ANG, epinephrine and norepinephrine. Under balanced anesthesia with etomidate, cyclazocine and N2O, renin angiotensin, catecholamine autoregulation were kept well. TMP, TNG and SNP showed different effects on renin angiotensin and catecholamines during hypotension anesthesia.