Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-26T20:10:27.989Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Habler, O. Controlled hypotension. Anaesthesist 2000; 49: 687–689.Google ScholarPubMed
2.Sharrock, NE, Mineo, R, Urquhart, B, Salvati, EA. The effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty performed under lumbar epidural anesthesia. Anesth Analg 1993; 76: 580–584.Google ScholarPubMed
3.Piper, SN, Haisch, G, Kumle, B et al. . Effects of esmolol- and sodium nitroprusside-induced controlled hypotension on hepatocellular integrity in patients undergoing endonasal sinus surgery. Anasthesiol Intensivmed Notfallmed Schmerzther 2003; 38: 781–786.Google Scholar
4.Piper, SN, Suttner, SW, Maleck, WH, Kumle, B, Haisch, G, Boldt, J. Effects of sodium nitroprusside-induced controlled hypotension on pancreatic function assessed by pancreatitis-associated protein in patients undergoing radical prostatectomy. Eur J Anaesthesiol 2002; 19: 609–613.CrossRefGoogle ScholarPubMed
5.de Bold, AJ. Atrial natriuretic factor: a hormone produced by the heart. Science 1985; 230: 767–770.Google Scholar
6.Sudoh, T, Kangawa, K, Minamino, N, Matsuo, H. A new natriuretic peptide in porcine brain. Nature 1988; 332: 78–81.CrossRefGoogle ScholarPubMed
7.Yasue, H, Yoshimura, M, Sumida, H et al. . Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 1994; 90: 195–203.Google Scholar
8.Silver, MA. The natriuretic peptide system: kidney and cardiovascular effects. Curr Opin Nephrol Hypertens 2006; 15: 14–21.CrossRefGoogle ScholarPubMed
9.Levin, ER, Gardner, DG, Samson, WK. Natriuretic peptides. N Engl J Med 1998; 339: 321–328.Google Scholar
10.Richards, AM, Lainchbury, JG, Troughton, RW, Espiner, EA, Nicholls, MG. Clinical applications of B-type natriuretic peptides. Trends Endocrinol Metab 2004; 15: 170–174.CrossRefGoogle ScholarPubMed
11.Doust, JA, Pietrzak, E, Dobson, A, Glasziou, P. How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review. BMJ 2005; 330: 625.Google Scholar
12.Maeda, K, Tsutamoto, T, Wada, A, Hisanaga, T, Kinoshita, M. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J 1998; 135: 825–832.CrossRefGoogle ScholarPubMed
13.Maisel, AS, Krishnaswamy, P, Nowak, RM et al. . Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347: 161–167.CrossRefGoogle ScholarPubMed
14.Kragelund, C, Gronning, B, Kober, L, Hildebrandt, P, Steffensen, R. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 2005; 352: 666–675.CrossRefGoogle ScholarPubMed
15.ten Wolde, M, Tulevski, II, Mulder, JW et al. . Brain natriuretic peptide as a predictor of adverse outcome in patients with pulmonary embolism. Circulation 2003; 107: 2082–2084.CrossRefGoogle ScholarPubMed
16.Yeh, HM, Lau, HP, Lin, JM, Sun, WZ, Wang, MJ, Lai, LP. Preoperative plasma N-terminal pro-brain natriuretic peptide as a marker of cardiac risk in patients undergoing elective non-cardiac surgery. Br J Surg 2005; 92: 1041–1045.Google Scholar
17.Terasako, K. Perioperative plasma concentrations of atrial and brain natriuretic peptides in patients undergoing hip arthroplasty. Anaesth Intens Care 2002; 30: 588–590.Google Scholar
18.Schlossmann, J, Feil, R, Hofmann, F. Signaling through NO and cGMP-dependent protein kinases. Ann Med 2003; 35: 21–27.Google Scholar
19.Melo, LG, Sonnenberg, H. Effect of nitric oxide inhibition on secretion of atrial natriuretic factor in isolated rat heart. Am J Physiol 1996; 270: H306–H311.Google ScholarPubMed
20.Skvorak, JP, Dietz, JR. Endothelin and nitric oxide interact to regulate stretch-induced ANP secretion. Am J Physiol 1997; 273: R301–R306.Google ScholarPubMed
21.Keller, N. Significance of adrenoceptor-mediated atrial natriuretic factor release in normal humans. Scand J Clin Lab Invest 1991; 51: 73–84.CrossRefGoogle ScholarPubMed
22.Legault, L, van Nguyen, P, Holliwell, DL, Leenen, FH. Hemodynamic and plasma atrial natriuretic factor responses to cardiac volume loading in young versus older normotensive humans. Can J Physiol Pharmacol 1992; 70: 1549–1554.CrossRefGoogle ScholarPubMed
23.Berlin, I, Lechat, P, Deray, G et al. . Beta-adrenoceptor blockade potentiates acute exercise-induced release of atrial natriuretic peptide by increasing atrial diameter in normotensive healthy subjects. Eur J Clin Pharmacol 1993; 44: 127–133.CrossRefGoogle ScholarPubMed
24.van den Meiracker, AH, Lameris, TW, van de Ven, LL, Boomsma, F. Increased plasma concentration of natriuretic peptides by selective beta1-blocker bisoprolol. J Cardiovasc Pharmacol 2003; 42: 462–468.Google Scholar
25.Davis, ME, Richards, AM, Nicholls, MG, Yandle, TG, Frampton, CM, Troughton, RW. Introduction of metoprolol increases plasma B-type cardiac natriuretic peptides in mild, stable heart failure. Circulation 2006; 113: 977–985.CrossRefGoogle ScholarPubMed
26.Hryniewicz, K, Androne, AS, Hudaihed, A, Katz, SD. Comparative effects of carvedilol and metoprolol on regional vascular responses to adrenergic stimuli in normal subjects and patients with chronic heart failure. Circulation 2003; 108: 971–976.CrossRefGoogle ScholarPubMed
27.Kohno, M, Yasunari, K, Matsuura, T, Murakawa, K, Takeda, T. Circulating atrial natriuretic polypeptide in essential hypertension. Am Heart J 1987; 113: 1160–1163.CrossRefGoogle ScholarPubMed
28.Ferri, C, Luparini, RL, Giarrizzo, G et al. . Effects of active orthostatism on blood levels of atrial natriuretic peptide in the healthy subject. Medicina (Firenze) 1989; 9: 172–173.Google Scholar
29.Freitas, J, Santos, R, Azevedo, E, Carvalho, M, Rocha-Goncalves, F. Neurohormonal behavior during prolonged orthostatic stress in normotensive subjects. Rev Port Cardiol 2005; 24: 81–86.Google Scholar
30.Tsubo, T, Isozaki, K, Sato, T, Araki, I, Ishihara, H, Matsuki, A. Hemodynamic and endocrine responses to prostaglandin E1 induced hypotension during enflurane anesthesia in surgical patients – evaluation by transesophageal echocardiography. Masui 1993; 42: 66–70.Google ScholarPubMed