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Continuous hydralazine infusion for afterload reduction

M T Swartz, G C Kaiser, V L Willman

    The Annals of Thoracic Surgery
    |August 1, 1981
    PubMed
    Summary
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    Continuous hydralazine infusion effectively reduced impedance in post-cardiopulmonary bypass patients, improving cardiac index and lowering vascular resistance without other vasoactive drugs.

    Area of Science:

    • Cardiovascular Surgery
    • Pharmacology

    Background:

    • Post-cardiopulmonary bypass patients often experience elevated impedance, requiring effective management.
    • Managing hemodynamic instability after cardiac surgery is critical for patient outcomes.

    Purpose of the Study:

    • To evaluate the efficacy of continuous hydralazine infusion in reducing impedance in patients after cardiopulmonary bypass.
    • To assess the impact of hydralazine on cardiac index (CI) and systemic vascular resistance index (SVRI) in this patient population.

    Main Methods:

    • A continuous infusion of hydralazine was administered to 20 patients meeting specific hemodynamic criteria (CI < 2.2 L/m2/min or SVRI > 2,500 dyne sec cm-5).
    • Hemodynamic parameters including mean arterial pressure, CI, and SVRI were measured at various time points up to 4 hours.

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  • No other vasoactive or cardiotonic drugs were used concurrently.

    • Main Results:

    • Significant reductions in SVRI (from 3,235 to 1,520 dyne sec cm-5) and improvements in CI (from 1.96 to 3.20 L/m2/min) were observed within 2 hours.
    • Mean arterial pressure also decreased significantly (from 92 to 75 mm Hg).
    • Pulmonary vascular resistance index decreased, while left atrial, pulmonary artery diastolic, and right atrial pressures showed non-significant increases.

    Conclusions:

    • Continuous hydralazine infusion is an effective method for reducing afterload in patients following cardiopulmonary bypass.
    • This infusion method avoids fluctuations associated with bolus therapy and facilitates a smooth transition to oral hydralazine if necessary.