Effect of Preoperative Renin-Angiotensin System Antagonists on the Difference between Radial and Femoral Arterial Pressure after Cardiopulmonary Bypass in Patients Undergoing Valvular Heart Surgery / 대한마취과학회지

BACKGROUND: Femoral to radial arterial pressure gradient (deltaP) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on ?P after CPB in patients undergoing valvular heart surgery. METHODS: Eighty-five patients scheduled for elective valvular heart surgery for regurgitant lesions were divided into two groups: the RAS-A group, in which patients were on RAS-A preoperatively (n = 52) and the control group (n = 33). Hemodynamic variables including RAP, femoral arterial pressure (FAP), body temperature, and hematocrit were recorded at after induction of anesthesia, pre-and post-CPB and sternum closure. RESULTS: After CPB, systolic deltaP was significantly greater in the RAS-A group than in the control group. Nine (27%) and 36 (69%) patients after CPB, and 6 (18%) and 23 (44%) patients after sternum closure developed systolic deltaP more than 10 mmHg, in the control and RAS-A group, respectively, which were statistically significant. Body temperature, hematocrit and systemic vascular resistance index were not different between groups. CONCLUSIONS: Preoperative treatment with RAS-A resulted in clinically significant deltaP after cardiopulmonary bypass in about 70% of patients undergoing valvular heart surgery. Concomitant monitoring of FAP with RAP might be helpful to prevent inadequate vasopressor therapy guided by inaccurate RAP after CPB in this subset of patients.

Age-Related Effects of Esmolol on Pressure and Pulse Pressure in the Femoral and Radial Arteries of Patients without Cardiovascular Disease / 대한마취과학회지

BACKGROUND: It has been known that radial artery pressure (RAP) some times underestimate the central pressure. In many studies, femoral artery pressure (FAP) and RAP have been considered as central and peripheral artery pressures, respectively and there might be a possibility that age and the change of blood pressure exert different effect on FAP and RAP. This study evaluated the effect of esmolol (E) on RAP and FAP and the changes in their pulse pressure (PP) in different age groups. METHODS: Fifty-one adult patients without cardiovascular disease were enrolled in this study. Twenty six patients were younger than 25 years (group 1) and 25 patients were older than 50 years (group 2). Radial and femoral arteries were cannulated and recorded before anesthesia. After induction of anesthesia, FAP, RAP and heart rate were recorded (T1) and then E was infused to decrease the FAP to 15% lower than its value of T1(T2). Variables were recorded 30 sec after the cessation of E infusion. RESULTS: Systolic pressure and PP of RAP were greater than of FAP in group 1, but those of FAP were greater than of RAP in group 2 before anesthesia. FAP was higher than RAP in both groups after anesthesia, regardless of the infusion of E. E infusion didn't change the pressure gradients between FAP and RAP in either group, except systolic pressure gradient in group 2. The PP of FAP was identical with of RAP in group 1 at both T1 and T2 but greater than of RAP in group 2 at both periods. E decreased the PP of both RAP and FAP in both groups. CONCLUSIONS: RAP is lower than FAP, and the PP of both pressures are affected by age and esmolol after anesthesia. However, the differences between both pressures are maintained after E infusion.

Study on the Validity of Radial Arterial Pressure during Cardiopulmonary Bypass / 대한마취과학회지

We campared radial and femoral arterial blood pressure in 20 patients, ranging in age from 1-27 years, during and after cardiopulmonary bypass for repair of congenital heart disease. Differences in systolic arterial pressure, mean arterial pressure, diastolic arterial pressure were measured between femoral and radial artery pressure at specfied time (30 min after induction, 10 min after rewarming, 10 min after aortic declamping, 30 min after aortic declamping). This study failed to demonstrate the overt inaccuracy of radial arterial pressure measurement during cardiopulmonary bypass, but we could find the tendency that radial artery pressure may be measured inconsistently during and after cardiopulmonary bypass and altered peripheral resistance may contribute to this inconsistency.