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PERIOPERATIVE HYPERTENSION The Role of DA-1 Agonists (Fenoldopam)

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)

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  1. PERIOPERATIVE HYPERTENSIONThe Role of DA-1 Agonists(Fenoldopam) R. Sheinbaum M.D. O. Wenker M.D.

  2. 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

  3. 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

  4. Perioperative HTNEtiology • Primary HTN • Secondary HTN • Surgically Associated HTN • Anesthesia Related HTN • Other

  5. Perioperative HTNSignificance • Organ Damage • heart • brain • kidney • Surgical Considerations • Morbidity

  6. BP = Q x SVR Q = HR x SV SV  preload, contractility, afterload SVR  viscosity, vessel radius HypertensionTreatment

  7. 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

  8. Anti HTN AgentsFENOLDOPAM • Ideal Characteristics • effective • predictable onset • easily titratable • few side effects • metabolically inert

  9. 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

  10. 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

  11. 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

  12. CONTROL

  13. CORLOPAMAdvantages • Control • Effectiveness • End Organ Benefits • Unique Action • Potential Renal Benefits

  14. Perioperative HTNSummary • Incidence • End Organ Effects • Impact on Morbidity/ Mortality • Treatment Impact • Treatment Options

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