Effect of Preoperative Renin-Angiotensin System Antagonists on the Difference between Radial and Femoral Arterial Pressure after Cardiopulmonary Bypass in Patients Undergoing Valvular Heart Surgery.
10.4097/kjae.2007.53.2.199
- Author:
Dae Hee KIM
1
;
Young Lan KWAK
;
Jong Hwa LEE
;
Jae Kwang SHIM
;
Jae Ho CHA
;
Sou Ouk BANG
Author Information
1. Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon
- Publication Type:Original Article
- Keywords:
cardiopulmonary bypass;
femoral artery pressure;
pressure gradient;
radial artery pressure;
renin-angiotensin system antagonist
- MeSH:
Anesthesia;
Arterial Pressure*;
Body Temperature;
Cardiopulmonary Bypass*;
Heart*;
Hematocrit;
Hemodynamics;
Humans;
Perfusion;
Radial Artery;
Renin-Angiotensin System*;
Sternum;
Thoracic Surgery*;
Vascular Resistance;
Vasodilation
- From:Korean Journal of Anesthesiology
2007;53(2):199-205
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Femoral to radial arterial pressure gradient (deltaP) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on ?P after CPB in patients undergoing valvular heart surgery. METHODS: Eighty-five patients scheduled for elective valvular heart surgery for regurgitant lesions were divided into two groups: the RAS-A group, in which patients were on RAS-A preoperatively (n = 52) and the control group (n = 33). Hemodynamic variables including RAP, femoral arterial pressure (FAP), body temperature, and hematocrit were recorded at after induction of anesthesia, pre-and post-CPB and sternum closure. RESULTS: After CPB, systolic deltaP was significantly greater in the RAS-A group than in the control group. Nine (27%) and 36 (69%) patients after CPB, and 6 (18%) and 23 (44%) patients after sternum closure developed systolic deltaP more than 10 mmHg, in the control and RAS-A group, respectively, which were statistically significant. Body temperature, hematocrit and systemic vascular resistance index were not different between groups. CONCLUSIONS: Preoperative treatment with RAS-A resulted in clinically significant deltaP after cardiopulmonary bypass in about 70% of patients undergoing valvular heart surgery. Concomitant monitoring of FAP with RAP might be helpful to prevent inadequate vasopressor therapy guided by inaccurate RAP after CPB in this subset of patients.
