Abstract
Preoperative beta-adrenergic blockade with propranolol, by allowing unopposed alpha-adrenergic stimulation in response to stress, has been suggested as a factor contributing to hypertension following coronary artery bypass surgery (CABG). Thus, one might expect to find an exaggerated haemodynamic response to phenylephrine (PHE), an alpha1 agonist. To study this, the cardiovascular response to PHE infusion at 30, 40, and 50 μg · min−1 prior to and during halothane anaesthesia was measured before surgical stimulation during elective CABG in patients taking chronic propranolol therapy and compared with that of patients not taking any cardiovascular medications. Chronic propranolol therapy did not alter the haemodynamic response to PHE, before or during halothane anaesthesia, and the incidence of postoperative hypertension requiring vasodilator therapy was the same for both groups.
Résumé
On a incriminé l’usage préopératoire de propranolol en tant que facteur associé à l’hypertension postopératoire après chirurgie cardiaque, puisque la stimulation alpha-adrénergique secondaire au stress serait alors sans contrepartie bêta. On pourrait donc dans ce contexte supposer une réponse exagérée à la phényléphrine qui est un stimulant alpha. Nous avons éprouvé cette hypothèse en mesurant l’effet hémodynamique d’une perfusion de phényléphrine à raison de 30, 40 et 50 μg · min−1 avant et pendant une anesthésie à l’halothane (avant l’incision) chez des candidats à une revascularisation coronarienne qui prenaient soit du propranolol de façon chronique soit aucune médication de nature cardiovasculaire. La thérapie chronique au propranolol ne modifiait pas l’effet hémodynamique de la phényléphrine avec ou sans halothane et n’influençait en rien l’incidence d’hypertension postopératoire.
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The study was done at the Cleveland Clinic, Department of Cardiothoracic Anesthesia, 9500 Euclid Avenue, Cleveland, Ohio 44106.
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Grum, D.F., Azmy, S.S. Does propranolol alter the vascular response to phenylephrine before or during halothane anaesthesia in patients with coronary artery disease?. Can J Anaesth 39, 41–46 (1992). https://doi.org/10.1007/BF03008671
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DOI: https://doi.org/10.1007/BF03008671