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Terlipressin versus Norepinephrine To Counteract Anesthesia-induced Hypotension in Patients Treated with Renin-Angiotensin System Inhibitors: Effects of Systemic and Regional Hemodynamics

Morelli, Andrea; Tritapepe, Luigi; Rocco, Monica; Conti, Giorgio; Orecchioni, Alessandra; De Gaetano, Andrea; Picchini, Umberto LU ; Pelaia, Paolo; Reale, Carlo and Pietropaoli, Paolo (2005) In Anesthesiology 102(1). p.12-19
Abstract
Background: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia.



Methods: Thirty-two patients scheduled for carotid endarterectomy under general anesthesia and treated with renin-angiotensin system inhibitors had hypotension after induction of general anesthesia. They were randomized to receive 1 mg... (More)
Background: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia.



Methods: Thirty-two patients scheduled for carotid endarterectomy under general anesthesia and treated with renin-angiotensin system inhibitors had hypotension after induction of general anesthesia. They were randomized to receive 1 mg of terlipressin (n = 16) or norepinephrine infusion (n = 16) to counteract anesthesia-induced hypotension. A laser Doppler probe was introduced into the gastric lumen. All measurements were performed just before surgery, during hypotension, at 30 min, and at 4 h.



Results: Terlipressin produced an increase in mean arterial pressure and a decrease in gastric mucosal perfusion detected by laser Doppler flowmetry (P < 0.05) over 30 min that were sustained for 4 h. During the infusion, norepinephrine produced an increase in mean arterial pressure and in gastric mucosal perfusion detected by laser Doppler flowmetry (P < 0.05). If compared to norepinephrine, terlipressin reduced oxygen delivery and oxygen consumption (P < 0.05) and increased arterial lactate concentrations (P < 0.05).



Conclusion: This study showed the efficacy of terlipressin in the treatment of hypotension episodes in anesthetized patients chronically treated with renin-angiotensin system inhibitors, angiotensin converting-enzyme inhibitors, and angiotensin II receptor antagonists. However, the negative effects on gastric mucosal perfusion and the risk of iatrogenic oxygen supply dependency of terlipressin need to be taken into account. (Less)
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author
publishing date
type
Contribution to journal
publication status
published
subject
in
Anesthesiology
volume
102
issue
1
pages
12 - 19
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:19944427899
ISSN
1528-1175
language
English
LU publication?
no
id
93469b67-9cf6-45cd-a937-7ac3012b6742 (old id 4216335)
alternative location
http://journals.lww.com/anesthesiology/Fulltext/2005/01000/Terlipressin_versus_Norepinephrine_to_Counteract.6.aspx
date added to LUP
2014-01-13 15:35:32
date last changed
2017-07-09 03:34:19
@article{93469b67-9cf6-45cd-a937-7ac3012b6742,
  abstract     = {Background: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia.<br/><br>
<br/><br>
Methods: Thirty-two patients scheduled for carotid endarterectomy under general anesthesia and treated with renin-angiotensin system inhibitors had hypotension after induction of general anesthesia. They were randomized to receive 1 mg of terlipressin (n = 16) or norepinephrine infusion (n = 16) to counteract anesthesia-induced hypotension. A laser Doppler probe was introduced into the gastric lumen. All measurements were performed just before surgery, during hypotension, at 30 min, and at 4 h.<br/><br>
<br/><br>
Results: Terlipressin produced an increase in mean arterial pressure and a decrease in gastric mucosal perfusion detected by laser Doppler flowmetry (P &lt; 0.05) over 30 min that were sustained for 4 h. During the infusion, norepinephrine produced an increase in mean arterial pressure and in gastric mucosal perfusion detected by laser Doppler flowmetry (P &lt; 0.05). If compared to norepinephrine, terlipressin reduced oxygen delivery and oxygen consumption (P &lt; 0.05) and increased arterial lactate concentrations (P &lt; 0.05).<br/><br>
<br/><br>
Conclusion: This study showed the efficacy of terlipressin in the treatment of hypotension episodes in anesthetized patients chronically treated with renin-angiotensin system inhibitors, angiotensin converting-enzyme inhibitors, and angiotensin II receptor antagonists. However, the negative effects on gastric mucosal perfusion and the risk of iatrogenic oxygen supply dependency of terlipressin need to be taken into account.},
  author       = {Morelli, Andrea and Tritapepe, Luigi and Rocco, Monica and Conti, Giorgio and Orecchioni, Alessandra and De Gaetano, Andrea and Picchini, Umberto and Pelaia, Paolo and Reale, Carlo and Pietropaoli, Paolo},
  issn         = {1528-1175},
  language     = {eng},
  number       = {1},
  pages        = {12--19},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Anesthesiology},
  title        = {Terlipressin versus Norepinephrine To Counteract Anesthesia-induced Hypotension in Patients Treated with Renin-Angiotensin System Inhibitors: Effects of Systemic and Regional Hemodynamics},
  volume       = {102},
  year         = {2005},
}