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A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade
BACKGROUND: Pharmacologic angiotensin axis blockade (AAB) has been associated with profound hypotension following anesthetic induction with propofol. To combat this problem, investigators have attempted to withhold angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (AR...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380663/ https://www.ncbi.nlm.nih.gov/pubmed/30702630 http://dx.doi.org/10.1097/MD.0000000000014374 |
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author | Bonavia, Anthony Verbeek, Thomas Adhikary, Sanjib Kunselman, Allen Budde, Arne Lyn-Sue, Jerome Mets, Berend |
author_facet | Bonavia, Anthony Verbeek, Thomas Adhikary, Sanjib Kunselman, Allen Budde, Arne Lyn-Sue, Jerome Mets, Berend |
author_sort | Bonavia, Anthony |
collection | PubMed |
description | BACKGROUND: Pharmacologic angiotensin axis blockade (AAB) has been associated with profound hypotension following anesthetic induction with propofol. To combat this problem, investigators have attempted to withhold angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) preoperatively, or evaluated the effects of different induction agents in conferring greater hemodynamic stability. To date, methohexital has not been compared with the most commonly used induction agent, propofol. Hence, the primary objective was to study the hypothesis that methohexital confers a better hemodynamic profile than propofol for anesthetic induction, in patients receiving AAB. The secondary objective was to investigate the postinduction levels of serum neurohormones in an attempt to explain the mechanisms involved. METHODS: Forty-five adult, hypertensive patients taking ACEi or ARB and scheduled for elective, noncardiac surgery completed the study. Patients were randomized to receive equi-anesthetic doses of either propofol or methohexital for anesthetic induction. Hemodynamic variables were measured and blood samples were drawn before induction and for 15 minutes afterwards. RESULTS: Methohexital resulted in less hypotension compared with propofol (P = .01), although the degree of refractory hypotension was similar (P = .37). The postinduction systolic blood pressure (P = .03), diastolic blood pressure (P < .001) and heart rate (P = .03) were significantly higher in the methohexital group. A nonsignificant elevation of serum norepinephrine and epinephrine levels was observed in the methohexital group, while serum arginine vasopressin and angiotensin II levels did not differ between groups. CONCLUSION: While methohexital was shown to confer greater hemodynamic stability in patients taking ACEi/ARB, the measured hormone levels could not explain the mechanism for this effect. |
format | Online Article Text |
id | pubmed-6380663 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-63806632019-03-04 A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade Bonavia, Anthony Verbeek, Thomas Adhikary, Sanjib Kunselman, Allen Budde, Arne Lyn-Sue, Jerome Mets, Berend Medicine (Baltimore) Research Article BACKGROUND: Pharmacologic angiotensin axis blockade (AAB) has been associated with profound hypotension following anesthetic induction with propofol. To combat this problem, investigators have attempted to withhold angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) preoperatively, or evaluated the effects of different induction agents in conferring greater hemodynamic stability. To date, methohexital has not been compared with the most commonly used induction agent, propofol. Hence, the primary objective was to study the hypothesis that methohexital confers a better hemodynamic profile than propofol for anesthetic induction, in patients receiving AAB. The secondary objective was to investigate the postinduction levels of serum neurohormones in an attempt to explain the mechanisms involved. METHODS: Forty-five adult, hypertensive patients taking ACEi or ARB and scheduled for elective, noncardiac surgery completed the study. Patients were randomized to receive equi-anesthetic doses of either propofol or methohexital for anesthetic induction. Hemodynamic variables were measured and blood samples were drawn before induction and for 15 minutes afterwards. RESULTS: Methohexital resulted in less hypotension compared with propofol (P = .01), although the degree of refractory hypotension was similar (P = .37). The postinduction systolic blood pressure (P = .03), diastolic blood pressure (P < .001) and heart rate (P = .03) were significantly higher in the methohexital group. A nonsignificant elevation of serum norepinephrine and epinephrine levels was observed in the methohexital group, while serum arginine vasopressin and angiotensin II levels did not differ between groups. CONCLUSION: While methohexital was shown to confer greater hemodynamic stability in patients taking ACEi/ARB, the measured hormone levels could not explain the mechanism for this effect. Wolters Kluwer Health 2019-02-01 /pmc/articles/PMC6380663/ /pubmed/30702630 http://dx.doi.org/10.1097/MD.0000000000014374 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 |
spellingShingle | Research Article Bonavia, Anthony Verbeek, Thomas Adhikary, Sanjib Kunselman, Allen Budde, Arne Lyn-Sue, Jerome Mets, Berend A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade |
title | A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade |
title_full | A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade |
title_fullStr | A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade |
title_full_unstemmed | A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade |
title_short | A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade |
title_sort | randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380663/ https://www.ncbi.nlm.nih.gov/pubmed/30702630 http://dx.doi.org/10.1097/MD.0000000000014374 |
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