Baroreflex sensitivity is impaired in patients with obstructive jaundice.
BACKGROUND
Obstructive jaundice is associated with enhanced susceptibility to hypotensive shock, renal failure, and toxic effects of endotoxin, which results in high perioperative morbidity and mortality. Since the normal arterial baroreflex function is necessary for hemodynamic homeostasis and improving survival in sepsis, this study aimed to determine whether baroreflex sensitivity was impaired in jaundiced patients.


METHODS
Thirty-five patients with obstructive jaundice scheduled for surgery were included, and 30 nonjaundiced patients served as controls. A modified Oxford pharmacologic technique was used for evaluating baroreflex sensitivity immediately before the surgery. Potential factors that may affect baroreflex sensitivity in jaundice, such as liver biochemistry, plasma concentrations of methionine-enkephalin, atrial natriuretic peptide and nitrate, were also measured.


RESULTS
Patients with obstructive jaundice had decreased sensitivity in both the sympathetic and vagal components of the baroreflex, as compared with the controls (P < 0.01). There was a significant inverse correlation between plasma atrial natriuretic peptide concentration and decreased sympathetic baroreflex sensitivity in the jaundiced group (r = -0.44, P = 0.008).


CONCLUSIONS
Baroreflex sensitivity is impaired in patients with obstructive jaundice, which may contribute to their enhanced susceptibility to the well-known perioperative complications. The underlying mechanisms for such a change may be associated with an increased level of plasma atrial natriuretic peptide.
Song
Jian-Gang
JG
Department of Anesthesiology, Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Cao
Yun-Fei
YF
Sun
Yu-Ming
YM
Ge
Yan-Hu
YH
Xu
Xue-Wu
XW
Yang
Li-Qun
LQ
Liu
Zhi-Qiang
ZQ
Song
Shao-Li
SL
Yu
Wei-Feng
WF
D000368:Aged; D000375:Aging / Q000502:physiology; D009320:Atrial Natriuretic Factor / Q000097:blood; D001341:Autonomic Nervous System / Q000503:physiopathology; D017704:Baroreflex / Q000502:physiology*; D001663:Bilirubin / Q000097:blood; D001831:Body Temperature / Q000502:physiology; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D041781:Jaundice, Obstructive / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside; D010656:Phenylephrine; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents
D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D009599:Nitroprusside; D010656:Phenylephrine; D009320:Atrial Natriuretic Factor; D001663:Bilirubin