Abstract
The activity of the renin-angiotensin system was measured before, during, and after infrarenal aortic cross-clamping in 13 patients. Five of the patients studied were taking propranolol preoperatively and formed a subgroup. Intraoperative blood loss, volume of crystalloid and colloid infused, haemodynamic parameters and urine output were similar for the two groups.
In eight patients who were not taking propranolol mean plasma renin activity was 2.24 mg.ml-1.hr-1prior to induction, 3.78 mg.-1.hr-1 during surgery prior to cross-clamping and 4.42 mg.ml-1hr-1 15 minutes after the aorta was cross-clamped (increases not statistically significant). Mean plasma renin activity measured ten minutes prior to release of the cross-clamp (5.02 mg.ml-1 hr-1), 15 minutes after clamp release (5.47 mg.ml-1. hr-1), and 30 minutes after reaching the recovery room (5.84 mg.ml-1.hr-1) were significantly greater than preinduction levels. Four patients developed postoperative hypertension (mean blood pressure greater than 120 mmHg); there was not a correlation between the elevated plasma renin activity observed postoperatively and the occurrence of postoperative hypertension.
The five patients taking propranolol had a markedly attenuated renin activity response during and after surgery; the mean plasma renin activity was less than 1.5 mg-1ml-1.hr-1 at all sampling times. Two of these five patients did develop postoperative hypertension. It is concluded that surgery involving infrarenal aortic cross-clamping is associated with increased plasma renin activity with peak levels occurring postoperatively. The observed increases in renin activity do not correlate the development of hypertension postoperatively. Preoperative beta-blockade attenuates the response of the renin angiolensin system, but does not prevent postoperative hypertension.
Résumé
L’activité du système rénine-angiolensine a été mesurée avant, pendant et après la mise du clamp aortique infra-rénal chez 13 patients. Cinq prenaient du propranolol en pré-opératoire. Les pertes sanguines peropératoires, la quantité des colloïdes et des crystalloïdes administrée, les profils hémodynamiques et le débit urinaire étaient similaires pour les deux groupes.
Chez huit patients qui ne prenaient pas de propranotol, l’activité moyenne de ta rénineplasmatique était de 2.24 ng.ml.−1.hre−1 avant l’induction, 3.78 ng.ml-1.hre-1 pendant la chirurgie avant la mise en place du clamp et de 4.42 ng.ml-1. hre-1 quinze minutes après avoir clampé l’aorte (augmentation non statistiquement significative).
L’activité de la rénine plasmatique dix minutes avant le relâchement du clamp (5.02 ng.ml-1.hre-1), 15 minutes après le relâchement du clamp (5.47 ng.ml-1.hre-1) et 30 minutes après l’arrivée en salle de réveil (5.84 ng.ml-1. hre-1) était significativement plus élevée qu’avant l’induction. Quatre patients ont développé une hypertension post-opératoire (pression artérielle moyenne >120 mmHg). Il n’y avait pas de corrélation entre l’activité de la rénine plasmatique en post-opératoire et l’incidence d’hypertension post-opératoire.
Les cinq patients prenant du propranoiol avaient une activité de la rénine plasmatique nettement abaissée durant et après la chirurgie; tous tes échantillons prélevés montraient une activité inférieure à 1.5 ng.ml.-1. hre-1. Deux des cinq patients ont développé une hypertension post-opératoire.
On conclut que l’obstruction aortique sous tes rénales est associée à une augmentation de la rénine plasmatique atteignant son maximum en post-opératoire. II n’y a pas de corrélation entre l’augmentation de l’activité de la rénine et le développement d’hypertension. Les bêtabloqueurs administrés en pré-opératoire atténuent la réponse du système rénine-angiotensine mais ne préviennent pas l’hypertension post-opératoire.
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Grant, R.P., Jenkins, L.C. Modification by preoperative betablockade of the renin response to infrarenal aortic cross-clamping. Can Anaesth Soc J 30, 480–486 (1983). https://doi.org/10.1007/BF03007081
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DOI: https://doi.org/10.1007/BF03007081