Abstract
In patients with congestive heart failure, the release of atrial natriuretic peptide (ANP) is decreased. This study sought to determine the extent of ANP, sympathetic and haemodynamic responses to acutely increased atrial pressure in patients with cardiomyopathies undergoing orthotopic cardiac transplantation. Haemodynamic variables, plasma ANP, norepinephrine, and epinephrine concentrations were measured in 17 patients at five times before and after induction of anaesthesia using either ketamine 1.5 μg·kg−1 or sufentanil 3.6 ± 0.3 μg·kg−1. Preinduction values in the ketamine and sufentanil groups were not significantly different. Compared with preinduction values, increases in mean arterial pressure (26%), pulmonary capillary wedge pressure (90%), right atrial pressure (107%), and heart rate (24%) occurred in the ketamine group while cardiac index decreased by 19% (P < 0.05). Haemodynamic variables in the sufentanil group did not change at any of the times studied. Plasma concentrations of atrial natriuretic peptide were not different within or between treatment groups. Following tracheal intubation plasma norepinephrine levels increased by 116% in the ketamine group (P < 0.05), but did not change in the sufentanil group. Plasma norepinephrine concentrations differed significantly between the ketamine and sufentanil groups. There were no differences in epinephrine concentrations in either group. Despite the anticipated haemodynamic and catecholamine differences found between the ketamine and sufentanil groups, the levels of plasma ANP were similar. Based upon these results, it is concluded that ANP exerts little influence in the control of fluid volume or blood pressure in patients with refractory cardiomyopathy.
Résumé
La liberation du peptide natriuretique par l’oreillette (ANP) diminue chez les patients en insuffisance cardiaque. Cette etude cherche à déterminer l’étendue des réponses svmpathiques et hémodynamiques ainsi que les effets sur l’ANP lors de la dimimution aiguë de la pression auriculaire chez les patients atteints de cardiomyopathies et devant subir une transplantation cardiaque orthotopique. Les données hémodynamiques, l’ANP plasmatique, les concentrations de norépinéphrine et d’épinéphrine furent mesurées chez 17 patients á cinq temps avant et apres l’induction de l’anesthésie avec soit la kétamine 1.5 μg · kg−1 ou le sufentanil 3.6 ± 0.3 μg · kg−1. Les valeurs de pré-induction dans les groupes kétamine et sufentanil n’étaient pas significativement différentes. Comparativement aux valeurs de préinduction, on a observé une augmentation de la pression artérielle moyenne (26%), de la pression de l’artère pulmonaire bloquée (90%), de la pression de l’oreillette droite (107%), et de lafréquence cardiaque (24%) dans le groupe kétamine alors que l’index cardiaque a diminue de 19% (P < 0.05). Les données hémodynamiques dans le groupe sufentanil n’ont pas changé en aucun temps durant l’étude. Les concentrations plasmatiques de l’ANP n’étaient pas différentes à l’intérieur du méme groupe ni entre les deux groupes étudiés. Après l’intubation trachéale, le niveau plasmatique de norépinéphrine a augmenté de 116% dans le groupe kétamine (P < 0.05), mais n’a pas changé dans le groupe sufentanil. Les concentrations plasmatiques de norépinéphrine étaient significativement différentes entre les groupes kétamine et sufentanil. Il n’y avait pas de différence quant aux concentrations d’épinéphrine dans les deux groupes. Malgré une différence hémodynamique et des concentrations anticipées de catécholamines entre le groupe kétamine et sufentanil, les niveaux plasmatiques d’ANP étaient similaires. Se basant sur ces résultats, on conclut que l’ANP exerce peu d’influence sur le contrôle du volume liquidien ou la pression artérielle chez les patients atteints de cardiomyopathie réfractaire.
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Glisson, S.N., Gutzke, G.E., Pifarre, R. et al. Atrial natriuretic peptide responses during anaesthesia in patients with refractory cardiomyopathies. Can J Anaesth 38, 572–577 (1991). https://doi.org/10.1007/BF03008186
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DOI: https://doi.org/10.1007/BF03008186