Perioperative hypertension the role of da 1 agonists fenoldopam
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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


    Perioperative hypertension the role of da 1 agonists fenoldopam

    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


  • Perioperative hypertension the role of da 1 agonists fenoldopam

    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