Effects of propranolol on the cardiovascular and renin-angiotensin systems during hypotension produced by sodium nitroprusside in humans

W. K. Marshall, R. F. Bedford, W. P. Arnold, Edward Miller, D. E. Longnecker, M. D. Sussman, M. W. Hakala

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Abstract

The authors examined the effects of controlled hypotension induced with sodium nitroprusside (SNP) with and without propranolol on the cardiovascular, pulmonary, and renin-angiotensin systems in 10 consecutive anesthetized patients with kyphoscoliosis undergoing posterior spinal fusion. SNP infusion (4.1 μg.kg -1.min -1) alone decreased mean systemic arterial pressure (SAP) by 25 torr ± 3 SE (P<0.001), systemic vascular resistance index (SVRI) by 1113 dyne.sec.cm -5.m 2 ± 125 SE (P<0.001), mean pulmonary artery pressure (PAP) by 6 torr ± 2 SE (P<0.02), pulmonary capillary wedge pressure (PCWP) by 4 torr ± 1 SE (P<0.01), pulmonary vascular resistance (PVR) by 50 dyne.sec.cm -5 ± 18 (P<0.05), and Pa(O 2) by 16 torr ± 7 SE (P<0.05), whereas cardiac index increased by 1.08 l.min -1 m 2 ± 0.24 SE (P<0.01) and heart rate increased 16 beats/min ± 5 SE (P<0.02). After 40 min of hypotension, 0.03 mg/kg propranolol was injected intravenously while the SNP infusion rate was held constant. Ten min later there was a significant decrease in the heart rate (10 beats/min ± 4 SE, P<0.02) and cardiac index (0.65 l.min -1.min -1.m -2 ± 0.21, P<0.02). Plasma renin activity (PRA) increased from 2.37 ng .ml -1.h -1 ± 0.7 SE before anesthesia to 6.50 ng.ml -1.h -1 ± 1.45 SE (P<0.05) after 40 min of nitroprusside infusion. Forty min after propranolol there was a significant reduction in PRA to 4.07 ng.ml -1.h -1 ± 0.73 SE (P<0.05). Thus propranolol, when given during SNP hypotension, exhibits an early cardiovascular response manifested as a decrease in cardiac output and heart rate and a delayed action on the kidney resulting in an inhibition of renin release.

Original languageEnglish (US)
Pages (from-to)277-280
Number of pages4
JournalAnesthesiology
Volume55
Issue number3
Publication statusPublished - 1981
Externally publishedYes

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ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Marshall, W. K., Bedford, R. F., Arnold, W. P., Miller, E., Longnecker, D. E., Sussman, M. D., & Hakala, M. W. (1981). Effects of propranolol on the cardiovascular and renin-angiotensin systems during hypotension produced by sodium nitroprusside in humans. Anesthesiology, 55(3), 277-280.