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Haemodynamic effects of ketanserin following coronary artery bypass grafting
1National University Hospital, Department of Anaesthesia, National University of Singapore.
Insights
Ketanserin effectively manages post-coronary artery bypass grafting hypertension by lowering blood pressure without causing reflex tachycardia. This study shows reduced nitroprusside needs in hypertensive and normotensive patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Post-coronary artery bypass grafting (CABG) hypertension is a common complication.
- Effective management of hypertension is crucial for patient outcomes.
- Existing treatments may have limitations, such as reflex tachycardia.
Purpose of the Study:
- To evaluate the hemodynamic effects of ketanserin in patients with post-CABG hypertension.
- To assess ketanserin's efficacy in reducing the need for other antihypertensive agents like nitroprusside.
- To determine if ketanserin causes undesirable hemodynamic changes or reflex tachycardia.
Main Methods:
- Seventeen patients in the intensive care unit post-CABG were studied.
- Hypertensive patients (SBP ≥ 150 mmHg) received ketanserin 10 mg bolus and 0.1 mg/kg/hr infusion.
- Non-hypertensive patients received a 5 mg bolus and the same infusion.
- Hemodynamic parameters and nitroprusside requirements were monitored.
Main Results:
- Ketanserin significantly decreased arterial blood pressure in hypertensive patients (P < 0.001).
- No significant alterations in cardiac index, vascular resistance, or pulmonary shunt were observed.
- Nitroprusside dose requirements were significantly reduced post-ketanserin therapy (91.6% in Group 1, 78.4% in Group 2).
- Normotensive patients experienced no significant adverse hemodynamic effects.
Conclusions:
- Ketanserin is effective in treating post-CABG hypertension.
- Ketanserin offers an advantage due to the lack of reflex tachycardia.
- It can significantly reduce the requirement for other antihypertensive medications.
Abstract:
The haemodynamic effects of ketanserin were studied consecutively in seventeen patients in the intensive care unit following coronary artery bypass grafting. Hypertensive patients (Group 1, systolic blood pressure (SBP) greater than or equal to 150 mmHg following discontinuation of nitroprusside, n = 10) received intravenous ketanserin 10 mg and infusion of 0.1 mg.kg-1.hr-1 with additional boluses as required to maintain SBP less than or equal to 130 mmHg for one hour. Non-hypertensive patients (Group 2, SBP less than 150 mmHg, n = 7) received a 5 mg bolus and the same infusion. Ketanserin significantly decreased arterial blood pressure (P less than 0.001) in all patients in Group 1. Heart rate was decreased but not significantly. Cardiac index, systemic and pulmonary vascular resistance and pulmonary shunt fraction were not significantly altered from pre-ketanserin values when blood pressure was controlled with nitroprusside. Normotensive patients in Group 2 did not show any undesirable hypotension or significant haemodynamic changes. Mean nitroprusside dose requirements following ketanserin therapy were significantly reduced by 91.6% in Group 1 and 78.4% in Group 2 (P less than 0.05). Ketanserin is effective in treating hypertension following coronary artery bypass grafting with an advantage of lack of reflex tachycardia.