effect of a single infusion dose of propranolol on the portal hypertension

ABSTRACT

This pilot study involved 1 patients, with portal hypertension, admitted for elective splenectomy and devascularization. At laparotomy 4mg propranolol in 200ml glucose 5% were infused, while monitoring the splenic vein pressure, the pulse rate, the brachial arterial pressure and the ECG. 9 of the 10 patients responded by an initial, significant increase of the portal pressure. The mean of the maximum rise was 4.2 + 2.8 ch H2O above the mean baseline, which was 40.9 + 3.67 cm H2O. On continuing the propranolol infusion there was decline of the portal pressure. In 6 patients there was reduction below the preinfusion retained levels higher than the baseline values. The ultimate mean change in the portal pressure was insignificant reduction by 2.1 + 3.14 ml H2O. This was associated, however, with a highly significant drop in the pulse rate by a mean of 24.77 + 2.76%. The blood pressure did not show appreciable changes. The results are not in favor of the use of propranolol for the treatment of portal hypertension. They are also not promising as regard the potential use of the drug for emergency control of acute variceal hemorrhage. Its significant initial portal hypertensive effect may augment bleeding, whereas its delayed insignificant hypotensive effect is unlikely to be influential