| Effect of Preoperative Renin-Angiotensin System Antagonists on the Difference between Radial and Femoral Arterial Pressure after Cardiopulmonary Bypass in Patients Undergoing Valvular Heart Surgery. |
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Dae Hee Kim, Young Lan Kwak, Jong Hwa Lee, Jae Kwang Shim, Jae Ho Cha, Sou Ouk Bang |
1Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University of Medicine and Science, Incheon
2Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. sokbang@yumc.yonsei.ac.kr
3Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
4Yonsei Cardiorascular Research Institute, Yonsei University College of Medicine, Seoul, Korea. |
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| Abstract |
BACKGROUND
Femoral to radial arterial pressure gradient (deltaP) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on ?P after CPB in patients undergoing valvular heart surgery.
METHODS
Eighty-five patients scheduled for elective valvular heart surgery for regurgitant lesions were divided into two groups: the RAS-A group, in which patients were on RAS-A preoperatively (n = 52) and the control group (n = 33). Hemodynamic variables including RAP, femoral arterial pressure (FAP), body temperature, and hematocrit were recorded at after induction of anesthesia, pre-and post-CPB and sternum closure.
RESULTS
After CPB, systolic deltaP was significantly greater in the RAS-A group than in the control group. Nine (27%) and 36 (69%) patients after CPB, and 6 (18%) and 23 (44%) patients after sternum closure developed systolic deltaP more than 10 mmHg, in the control and RAS-A group, respectively, which were statistically significant. Body temperature, hematocrit and systemic vascular resistance index were not different between groups.
CONCLUSIONS
Preoperative treatment with RAS-A resulted in clinically significant deltaP after cardiopulmonary bypass in about 70% of patients undergoing valvular heart surgery.
Concomitant monitoring of FAP with RAP might be helpful to prevent inadequate vasopressor therapy guided by inaccurate RAP after CPB in this subset of patients. |
| Key Words:
cardiopulmonary bypass; femoral artery pressure; pressure gradient; radial artery pressure; renin-angiotensin system antagonist |
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