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The control of hypertension with dibutyryl cyclic AMP
Insights
Rapid infusion of dibutyryl cyclic AMP (DBcAMP) effectively lowered blood pressure in hypertensive surgical patients. This vasodilating agent shows promise for managing hypertension, especially in patients with cardiac or renal issues.
Area of Science:
- Anesthesiology
- Pharmacology
- Cardiovascular Medicine
Background:
- Systolic hypertension is a common complication during general anesthesia.
- Vasodilating agents are crucial for managing intraoperative hypertension.
- Dibutyryl cyclic AMP (DBcAMP) possesses known vasodilating properties.
Purpose of the Study:
- To evaluate the clinical utility of rapid, high-dose dibutyryl cyclic AMP (DBcAMP) infusion for controlling intraoperative hypertension.
- To assess the hemodynamic effects of DBcAMP in patients undergoing surgery.
Main Methods:
- A rapid intravenous infusion of DBcAMP (0.6 mg kg-1 min-1 for 20 min) was administered to 32 middle-aged patients with systolic hypertension (>160 mmHg).
- Hemodynamic parameters including systolic and diastolic arterial pressure, heart rate, and urine volume were monitored.
- Cardiac index was assessed in a subset of patients.
Main Results:
- DBcAMP infusion significantly reduced systolic arterial pressure from 174.0 to 129.0 mmHg and diastolic pressure from 93.1 to 64.8 mmHg.
- Heart rate increased from 81.2 to 91.5 beats min-1, and urine volume increased significantly from 69.4 to 182.7 ml h-1.
- Cardiac index increased in three patients, and tachycardia (>120 beats min-1) occurred in seven patients. The antihypertensive effect was most pronounced with nitrous oxide-oxygen and enflurane anesthesia.
Conclusions:
- Rapid high-dose DBcAMP infusion is effective in controlling intraoperative hypertension.
- DBcAMP may be particularly beneficial for patients with pre-existing cardiac failure, renal disorders, or essential hypertension.
- Further investigation into DBcAMP's role in managing hypertensive emergencies during surgery is warranted.
Abstract:
The effects of the rapid infusion of large doses of dibutyryl cyclic AMP (DBcAMP) were studied to clarify the clinical usefulness of its vasodilating action in 32 middle-aged patients, who underwent various types of surgery and developed systolic hypertension of over 160 mmHg during general anaesthesia. DBcAMP was given i.v. with an infusion pump at a rate of 0.6 mg kg-1 min-1 for 20 min. In all patients just after the infusion, systolic arterial pressure decreased from 174.0 +/- 20.7 to 129.0 +/- 23.9 mmHg, diastolic pressure decreased from 93.1 +/- 13.4 to 64.8 +/- 13.3 mmHg, heart rate increased from 81.2 +/- 15.7 to 91.5 +/- 19.5 beats min-1, and urine volume increased from 69.4 +/- 54.8 to 182.7 +/- 143.5 ml h-1. In three patients, cardiac index increased from 3.44 to 4.24 l min-1 m-2. In seven patients, tachycardia exceeding 120 beats min-1 developed. DBcAMP was also effective in patients with a history of hypertension. The strongest antihypertensive effect was observed in patients anaesthetized with nitrous oxide-oxygen and enflurane. We speculate that DBcAMP is useful to control hypertension and may be particularly indicated in patients with cardiac failure, renal disorders and essential hypertension.