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PERIOPERATIVE HYPERTENSION The Role of DA-1 Agonists (Fenoldopam). R. Sheinbaum M.D. O. Wenker M.D. Perioperative HTN Incidence. Definition Wide range of definitions systolic >110-170 diastolic 95-100-107 % change in BP Leslie JB Acta Anaesthesiol Scand 1993; 37: 5-9.

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perioperative hypertension the role of da 1 agonists fenoldopam

PERIOPERATIVE HYPERTENSIONThe Role of DA-1 Agonists(Fenoldopam)

R. Sheinbaum M.D.

O. Wenker M.D.

perioperative htn incidence
Perioperative HTNIncidence
  • Definition

Wide range of definitions

systolic >110-170

diastolic 95-100-107

% change in BP

    • Leslie JB Acta Anaesthesiol Scand 1993; 37: 5-9
perioperative htn incidence1
Perioperative HTNIncidence
  • Patient Factors
      • underlying risk factors
      • increasing age base of population
      • higher risk procedures
  • Type of Surgery
      • cardiac 40-60 %
      • non cardiac 5 %
    • Estafanos FG Am Heart J 1973 ; 85 : 732-738
    • Viljoen JF J Thorac Cardiovasc Surg 1976 ; 71 : 548
    • Leslie JB Acta Anaesthesiol Scand 1993 ; 37 : 5-9
perioperative htn etiology
Perioperative HTNEtiology
  • Primary HTN
  • Secondary HTN
  • Surgically Associated HTN
  • Anesthesia Related HTN
  • Other
perioperative htn significance
Perioperative HTNSignificance
  • Organ Damage
      • heart
      • brain
      • kidney
  • Surgical Considerations
  • Morbidity
bp q x svr q hr x sv sv preload contractility afterload svr viscosity vessel radius
BP = Q x SVR

Q = HR x SV

SV  preload, contractility, afterload

SVR  viscosity, vessel radius

HypertensionTreatment
slide7

Sympathetic Nervous System Regulation of Blood Pressure

CNS

Adrenal Gland

Catecholamines

Adrenergic Tone

Baroreceptor Reflexes

Veins

Arteries

Resistance

Capacitance

Afterload

Volume/Pressure

Preload

Renin/Angiotensin

Cardiac Output

Kidney

Blood Pressure

Heart

anti htn agents fenoldopam
Anti HTN AgentsFENOLDOPAM
  • Ideal Characteristics
    • effective
    • predictable onset
    • easily titratable
    • few side effects
    • metabolically inert
anti htn agents fenoldopam1
Anti HTN AgentsFENOLDOPAM
  • Comparison to Nitroprusside
      • just as effective in reaching target BP
      • just as quick in reaching target BP
      • Panacek EA Acad Emerg Med 1995 ; 2 : 959-965
fenoldopam versus nitroprusside benefits
Fenoldopam versus NitroprussideBenefits
  • Heart
      • > EF, CI
      • < PCWP, PVR
      • minimal change in HR (dose related)
  • Renal
      • > renal blood flow, Na excretion
      • > Cr Cl
  • Elliot WJ Circulation 1990 ; 81 : 970-977
  • Shusterman NH Am J Med 1993 ; 96 : 161-168
  • Hill AJ J Cardiothorac Vasc Anesth 1993 ; 7 : 279-284
slide11

Comparison of Renal Effects in Severe Hypertension

140

Fenoldopam

120

Nitroprusside

100

80

Change from Baseline (%)

60

40

20

0

-10

Urinary Flow Rate

Sodium Excretion

Creatinine Clearance

Elliott WJ, et al. Circulation 1990;81:970-977

corlopam advantages
CORLOPAMAdvantages
  • Control
  • Effectiveness
  • End Organ Benefits
  • Unique Action
  • Potential Renal Benefits
perioperative htn summary
Perioperative HTNSummary
  • Incidence
  • End Organ Effects
  • Impact on Morbidity/ Mortality
  • Treatment Impact
  • Treatment Options
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