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Canadian Journal of Anaesthesia

, Volume 35, Issue 3, pp 242–248 | Cite as

Additive effects of dihydralazine during enflurane or isoflurane hypotensive anaesthesia for spinal fusion

  • Bernard Bourreli
  • Michel Pinaud
  • Norbert Passuti
  • Jean-Pierre Gunst
  • Jean-Christophe Drouet
  • Jean-Pierre Remi
Article

Abstract

Sixteen patients (13–38 yr) undergoing spinal fusion for scoliosis under controlled hypotension were studied to determine the haemodynamic and neuroendocrine responses to TV dihydralazine (1.0 mg · kg-1) followed by 0.5 and 1 MAC of enflurane or isoflurane. Twenty minutes after dihydralazine administration mean arterial pressure (-20 per cent) and systemic vascular resistance (-50 per cent) decreased, and cardiac index (+57 per cent), heart rate (+37 per cent) and intrapulmonary shunt increased. Plasma renin activity and aldosterone and norepinephrine levels increased. Further decreases in mean arterial pressure and in systemic vascular resistance were observed when 0 .5 MAC enflurane or isoflurane were added. With 1 MAC anaesthetic levels a further decrease in mean arterial pressure was observed in both goups, but pressure fell to a lower level with isoflurane than with enflurane (p < 0.01). The reduction of arterial blood pressure to a level of 50–60 mmHg for three to four hours was easy to control and was free of complications. The preliminary PV administration of dihydralazine allowed a reduced volatile agent concentration which attenuated undesirable haemodynamic effects, in spite of renin and norepinephrine release, and permitted a rapid intraoperative awakening.

Key words

anaesthetics volatile enflurane isoflurane anaesthetic techniques hypotensive dihydralazine polypeptides renin-angiotensin surgery orthopaedic spinal fusion sympathetic nervous system catecholamine. 

Résumé

La réponse hémodynamique et neuroendocrinienne à ľinjection intraveineuse de dihydralazine (1.0 mg · kg-1) suivie de ľadministration ďenflurane ou ďisoflurane (0.5 puis 1.0 MAC) a été étudiée chez 16 patients âgés de 13 à 38 ans subissant une correction chirurgicale de scoliose sous hypotension contrôlée. Vingt minutes après ľinjection de dihydralazine, la pression artérielle moyenne et les résistances vasculaires systémiques se sont abaissées (-20 et -50 pour cent respectivement) et ľindex cardiaque et la fréquence cardiaque se sont élevés (+57 et +37 pour cent respectivement) de même que le shunt intrapulmonaire. Une diminution supplémentaire de la pression artérielle moyenne et des résistances vasculaires systémiques a été observée après introduction ďenflurane ou ďisoflurane à MAC 0.5. ľaugmentation de la concentration alvéolaire à MAC 1.0 a majoré la baisse de pression artérielle dans les deux groupes, mais le niveau de pression atteint a été plus bas avec ľisoflurane qu’avec ľenflurane (p < 0.01). La réduction de pression artérielle moyenne à un niveau de 50 à 60 mmHg a été facile à contrôler pendant trois à quatre heures et n’a pas entraîné de complication. ľadministration intraveineuse préalable de dihydralazine permet la réduction des concentrations alvéolaires des agents anesthésiques volatils ce qui atténue leurs effets hémodynamiques indésirables en dépit ďune libération de rénine et de noradrénaline, et donc facilite un réveil peropératoire rapide.

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Copyright information

© Canadian Anesthesiologists 1988

Authors and Affiliations

  • Bernard Bourreli
    • 1
  • Michel Pinaud
    • 1
  • Norbert Passuti
    • 1
  • Jean-Pierre Gunst
    • 1
  • Jean-Christophe Drouet
    • 1
  • Jean-Pierre Remi
    • 1
  1. 1.Département ďAnesthésiologie, Clinique Orthopédique et Service de Médecine Nucléaire (JPR)Centre Hospitalier UniversitaireNantesFrance

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