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Hemodynamic responses to captopril during splenectomy in thalassemic children
V Suwanchinda1, V Tanphaichitr, S Pirayavaraporn
1Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Captopril and furosemide effectively manage perioperative hypertension in beta-thalassemic children undergoing splenectomy. However, postoperative hypertension remains a concern requiring prompt medical attention.
Area of Science:
- Pediatric Surgery
- Cardiovascular Pharmacology
- Hematology
Background:
- Splenectomy in beta-thalassemic children often leads to perioperative hypertension.
- Hypertension post-splenectomy can occasionally result in convulsions.
Purpose of the Study:
- To investigate the efficacy of captopril in reducing hypertensive responses during splenectomy in children with beta-thalassemia.
- To compare the effects of captopril alone, captopril with furosemide, and furosemide alone on blood pressure control.
Main Methods:
- 82 beta-thalassemic children undergoing splenectomy were studied.
- Groups received preoperative intravenous furosemide, oral captopril, or a combination of captopril and furosemide.
- Systolic and diastolic arterial pressures and heart rates were monitored.
Main Results:
- Captopril and the combination therapy significantly lowered arterial pressures before anesthesia compared to furosemide alone.
- The combined captopril-furosemide group showed significantly smaller blood pressure changes during the operation.
- Postoperative hypertension requiring management occurred in 20% of the furosemide group and 14.3% of the other two groups.
Conclusions:
- Captopril combined with furosemide is effective in controlling intraoperative hypertension in this patient population.
- Postoperative hypertension remains a common issue necessitating immediate and appropriate management.
Abstract:
Splenectomy in beta-thalassemic children is frequently accompanied by perioperative hypertension which occasionally is followed by convulsion. The efficacy of captopril in attenuating the hypertensive response to splenectomy was investigated in 82 thalassemic children. The control group, consisting of 40 patients, received intravenous furosemide (1 mg/kg) preoperatively; whereas, 42 children were randomly allocated into 2 groups to receive oral captopril (0.7 mg/kg) or a combination of captopril (0.7 mg/kg) and furosemide (1 mg/kg) before the operation. Before anesthetic induction, both systolic and diastolic arterial pressures in the captopril and the combined groups were significantly lower than the furosemide group (P < 0.001), whereas, the heart rates in all groups were comparable. Changes in arterial pressure in response to the operation were significantly smaller in the combined group when compared with the other two groups (P < 0.001). Immediate postoperative hypertension requiring additional management occurred in 20 per cent of the furosemide group, and 14.3 per cent in the other two groups. One patient in the combined group had a convulsion in association with hypertension. The authors conclude that captopril combined with furosemide effectively controls intraoperative hypertension in thalassemic children undergoing splenectomy; however, postoperative hypertension remains common, and needs appropriate treatment immediately.