Terlipressin Versus Norepinephrine to Correct Refractory Arterial Hypotension After General Anesthesia in Patients Chronically Treated with Renin-Angiotensin System Inhibitors

Background Terlipressin, a precursor that is metabolized to lysine-vasopressin, has been proposed as a drug for treatment of intraoperative arterial hypotension refractory to ephedrine in patients who have received long-term treatment with renin-angiotensin system inhibitors. The authors compared the effectiveness of terlipressin and norepinephrine to correct hypotension in these patients. Methods Among 42 patients scheduled for elective carotid endarterectomy, 20 had arterial hypotension following general anesthesia that was refractory to ephedrine. These patients were the basis of the study. After randomization, they received either 1 mg intravenous terlipressin (n = 10) or norepinephrine infusion (n = 10). Beat-by-beat recordings of systolic arterial blood pressure and heart rate were stored on a computer. The intraoperative maximum and minimum values of blood pressure and heart rate, and the time spent with systolic arterial blood pressure below 90 mmHg and above 160 mmHg, were used as indices of hemodynamic stability. Data are expressed as median (95% confidence interval). Results Terlipressin and norepinephrine corrected arterial hypotension in all cases. However, time spent with systolic arterial blood pressure below 90 mmHg was less in the terlipressin group (0 s [0-120 s] vs. 510 s [120-1011 s]; P < 0.001). Nonresponse to treatment (defined as three boluses of terlipressin or three changes in norepinephrine infusion) occurred in zero and eight cases (P < 0.05), respectively. Conclusions In patients who received long-term treatment with renin-angiotensin system inhibitors, intraoperative refractory arterial hypotension was corrected with both terlipressin and norepinephrine. However, terlipressin was more rapidly effective for maintaining normal systolic arterial blood pressure during general anesthesia.

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The Regulatory Function of the Renin–Angiotensin System during General Anesthesia

Anesthesiology ◽

10.1097/00000542-197806000-00004 ◽

1978 ◽

Vol 48 (6) ◽

pp. 399-403 ◽

Cited By ~ 34

Author(s):

Edward D. Miller ◽

David E. Longnecker ◽

Michael J. Peach

Keyword(s):

General Anesthesia ◽

Renin Angiotensin System ◽

Regulatory Function ◽

Angiotensin System ◽

Renin Angiotensin

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INFLUENCE OF GENE POLYMORPHISM OF THE RENIN-ANGIOTENSIN SYSTEM ON THE COURSE OF EARLY BACTERIAL INFECTIONS IN PREMATURE INFANTS

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.19.4.19 ◽

2019 ◽

Vol 19 (4) ◽

pp. 19-24

Author(s):

V.I. Pokhylko ◽

O.M. Kovalova ◽

Yu.I. Cherniavska ◽

S.M. Tsvirenko ◽

V.P. Sarytchev

Keyword(s):

Gene Polymorphism ◽

Premature Infants ◽

Bacterial Infections ◽

Renin Angiotensin System ◽

Arterial Hypotension ◽

Practical Recommendation ◽

Angiotensin System ◽

Renin Angiotensin ◽

Ace Gene ◽

Prematurely Born Infants

In the perinatal-specific infection mortality pattern, bacterial sepsis of newborns and congenital pneumonia account for 23.5% and occupy the I rank. Among the many non-specific clinical signs of infection, hemodynamic disorders are dominant in the development of adverse medical effects. Polymorphism of genes of the renin-angiotensin system, as one of the regulating units, can lead to peculiarities of disorders of hemodynamics in the infectious process. Aim of the study: to study the effect of ACE, AGT2R1 and eNOS gene polymorphism on the development of early bacterial infections and their most severe manifestation – arterial hypotension syndrome. Materials and Methods: two groups of children were formed to achieve the goal. The main group includes 121 prematurely born infants with bacterial infections of the early neonatal period, and the comparison group includes 31 prematurely born infants with no signs of early bacterial infections. Genetic methods included the study of ID polymorphism of ACE gene, AC polymorphism of gene AGT2R1 gene polymorphism and 4a/4b polymorphism of eNOS. Analysis of vital functions in children stratified according to the genotype of the ACE gene, showed that at the first day of life in prematurely born children with genotype II, the mean blood pressure was significantly higher than in children with the genotype ID (35.3 ± 1.55 mm Hg) and 31.7 ± 0.88 mmHg, respectively, p = 0.033). In children with the II genotype of ACE, the hourly diuresis rate at day 1 was significantly lower than in children with the DD genotype (1.6 ± 0.2 ml/kg/h and 2.2 ± 0.21 ml/kg/h, respectively, p = 0.0017), which may indicate better renal circulation in children with the DD genotype. As a result of the study, no influence of the genes of the renin-angiotensin system on the fact of early bacterial infections occurrence was found, but significant influence of the CC-genotype of the AGT2R1 gene on the development of arterial hypotension syndrome in premature infants (OR = 10.17) was detected. A practical recommendation for public health may be to conduct a genetic study to identify ACE and AGT2R1 gene polymorphisms in preterm infants, which will help identify the risk group for systemic and organ haemodynamic disorders and manage it individually.

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