title: Catecholamine and renin-angiotensin response during controlled hypotension induced by prostaglandin E1 combined with hemodilution during isoflurane anesthesia.
abstract: OBJECTIVE
  To evaluate the catecholamine and renin-angiotensin response during controlled hypotension combined with hemodilution in the clinical setting.
  
  
  METHODS
  Randomized, prospective study.
  
  
  METHODS
  Inpatient surgery at Nagasaki Rosai Hospital.
  
  
  METHODS
  30 ASA physical status I and II female patients scheduled for total hip arthroplasty.
  
  
  METHODS
  Patients were randomly divided into three groups. Group A (N = 10) received hemodilution alone. Group B (N = 10) received controlled hypotension alone. Group C (N = 10) received hemodilution plus controlled hypotension. Hemodilution was carried out after induction of anesthesia, in which drawn blood was replaced with 6% hydroxyethyl starch, and the final hematocrit value was approximately 22%. Controlled hypotension was induced with prostaglandin E1 (PGE1) to maintain mean arterial blood pressure at 55 mmHg for 80 minutes.
  
  
  RESULTS
  Measurements included plasma renin activity (RA) and plasma concentrations of angiotensin-II (AG-II), aldosterone (AS), norepinephrine (NE), and epinephrine (EP). These indices were measured before hemodilution, after hemodilution, 80 minutes after starting hypotension, and 60 minutes after recovery from hypotension. Hemodilution alone caused no significant change in the values throughout the time course. Controlled hypotension alone caused significant increases in plasma concentrations of NE (+295%) and EP (+203%) at 80 minutes after starting hypotension, whereas it caused no change in plasma RA and plasma concentrations of AG-II and AS. Hemodilution plus controlled hypotension caused significant increases in plasma RA (+271%) and plasma concentrations of AG-II (+188%), AS (+199%), NE (+279%), and EP (+184%) at 80 minutes after starting hypotension.
  
  
  CONCLUSIONS
  The combination of hemodilution and PGE1 induced controlled hypotension causes significant responses, especially in a renin-angiotensin-aldosterone system under isoflurane anesthesia.
authors.affiliation: Department of Anesthesia, Nagasaki Rosai Hospital and Nagasaki University School of Medicine, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Fukusaki
authors.forename: T
authors.initials: T
authors.lastname: Maekawa
authors.forename: I
authors.initials: I
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Hara
authors.forename: K
authors.initials: K
authors.lastname: Sumikawa
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood; D000527:Alprostadil / Q000494:pharmacology*; D018685:Anesthetics, Inhalation; D000804:Angiotensin II / Q000097:blood; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000502:physiology; D002395:Catecholamines / Q000097:blood*; D005260:Female; D006438:Hemodilution; D006801:Humans; D007023:Hypotension, Controlled; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology*
chemical_list: D018685:Anesthetics, Inhalation; D002395:Catecholamines; D000804:Angiotensin II; D000450:Aldosterone; D007530:Isoflurane; D000527:Alprostadil