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Influence of controlled hypotension using esmolol and sodium nitroprusside on natriuretic peptides in patients undergoing endonasal sinus surgery

Published online by Cambridge University Press:  01 June 2007

A. M. Mengistu ,
M. W. Wolf ,
J. Boldt ,
K. D. Röhm ,
S. W. Suttner  and
S. N. Piper
A. M. Mengistu*
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
M. W. Wolf
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
J. Boldt
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
K. D. Röhm
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
S. W. Suttner
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
S. N. Piper
Affiliation:
Klinikum Ludwigshafen, Department of Anaesthesiology and Intensive Care Medicine, Ludwigshafen, Germany
*
Correspondence to: Andinet M. Mengistu, Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. E-mail: [email protected]; Tel: +49 621 503 3000; Fax: +49 621 503 3024
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Summary

Background and objective

Atrial and brain natriuretic peptide, synthesized by cardiac myocytes, are mediators secreted secondary to cardiac volume expansion and increased filling pressure. The study was designed to assess serum concentration of atrial and brain natriuretic peptide in patients undergoing endonasal sinus surgery receiving controlled hypotension.

Methods

We studied 45 patients without cardiovascular history, scheduled for elective endonasal sinus surgery. Patients were allocated to one of three groups: controlled hypotension was induced either by using esmolol (n = 15) or sodium nitroprusside (n = 15) with a mean arterial pressure of 50–55 mmHg. In the control group (n = 15), mean arterial pressure was adjusted to 70–80 mmHg. Atrial and brain natriuretic peptides were measured preoperatively (T1), at the end of surgery (T2), 2 h (T3), 24 h (T4) and 48 h (T5) postoperatively.

Results

Preoperative atrial and brain natriuretic peptide plasma levels were within normal ranges and similar between all groups. Patients treated with esmolol (atrial natriuretic peptide: 2.46 ± 0.75 μg mL−1; brain natriuretic peptide: 4.34 ± 3.06 μg mL−1) and sodium nitropusside (atrial natriuretic peptide: 2.48 ± 0.92 μg mL−1; brain natriuretic peptide: 4.49 ± 3.21 μg mL−1) showed significantly lower concentrations of atrial and brain natriuretic peptide at T2 and T3 compared with controls (atrial natriuretic peptide: 5.31 ± 2.32 μg mL−1; brain natriuretic peptide: 13.26 ± 8.98 μg mL−1, P < 0.01) as well as a reduction in blood loss and duration of surgery.

Conclusions

Controlled hypotension decreases the release of natriuretic peptides in cardiovascular healthy patients. This effect may be contributed to by changes in cardiac filling pressure due to lower systemic resistance and diminished perfusion pressure.

Keywords

ATRIAL NATRIURETIC FACTORNATRIURETIC PEPTIDEBRAINHYPOTENSION CONTROLLEDESMOLOLNITROPRUSSIDESURGERY, nasal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 6 , June 2007 , pp. 529 - 534
Copyright
Copyright © European Society of Anaesthesiology 2007

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