Summary
A comparison of the levels of serum epinephrine, norepinephrine and blood pressure was made in 25 patients undergoing aorta-coronary bypass or valve replacement who were anaesthetized with a nitrous oxide-narcotic technique. Serum epinephrine and norepinephrine were measured in arterial samples drawn pre-induction, post-induction, before cardiopulmonary bypass, two and eight minutes after initiation of cardiopulmonary bypass, 20 minutes before termination and after termination of cardiopulmonary bypass. In both patient groups significant increases in epinephrine and norepinephrine occurred before cardiopulmonary bypass, with accompanying increase of blood pressure in the valve replacement patients. During cardiopulmonary bypass an initial hypotensive response (p < 0.001) was recorded, followed by a significant increase in blood pressure and epinephrine in both groups. After cardiopulmonary bypass, aorta-coronary bypass patients had epinephrine, norepinephrine and blood pressure equal to levels before cardiopulmonary bypass. In contrast, serum epinephrine continued to rise in the valve replacement patients, with a gradual recovery of blood pressure to pre-bypass levels. These findings demonstrate significant differences in blood pressure and catecholamine response in patients with valvular disease from patients with coronary artery disease.
Résumé
Les taux sériques ďépinéphrine et de norépinéphrine, ainsi que la pression artérielle, ont été comparés chez 25 malades opérés à cœur-ouvert pour pontage aorto-coronarien ou pour remplacement valvulaire, sous protoxydeďazote et narcotique. On a fait les mesures ďépinéphrine et de norépinévphrine dans le sang artériel avant ľinduction de ľanesthésie, après ľinduction, avant te début de la circulation extracorporelle, deux et cinq minutes après le début de laC.E.C., 20 minutes avant sa fin, et enfin après la C.E.C.
Ľ’on a observé avant la C.E.C. une élévation significative de ľépinéphrine et de la norépinéphrine chez les deux groupes de patients, avec élévation de la pression artérielle chez les valvulaires.
Durant la C.E.C., on a observé une élévation significative de la pression artérielle et de ľépinéphrine chez les malades des deux groupes après un épisode initial ďhypotension.
Après la C.E.C., les taux ďépinéphrine et de norépinéphrine et la pression artérielle des malades opérés pour pontage aortocoronarien étaient comparables aux taux précédant la C.E.C. Par contre, les taux ďépinéphrine continuaient ďaugmenter chez les valvulaires avec retour graduel de la pression artérielle aux niveaux observés avant la pompe.
Ces résultats illustrent ľexistence ďune différence significative de pression artérielle et de taux de catécholamines chez les valvulaires, en comparaison avec les malades présentant une pathologie coronarienne.
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Balasaraswathi, K., Glisson, S.N., El-Etr, A.A. et al. Serum epinephrine and norepinephrine during valve replacement and aorta-coronary bypass. Can. Anaesth. Soc. J. 25, 198–203 (1978). https://doi.org/10.1007/BF03004879
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DOI: https://doi.org/10.1007/BF03004879