title: Catecholamine-resistant hypotension following induction for spinal exploration.
abstract: Systemic blood pressure is regulated by 3 mechanisms: the sympathetic nervous system, the renin-angiotensin system, and the arginine-vasopressin system. The use of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors has become prevalent in the medical treatment of hypertension. These classes of medications inhibit the renin-angiotensin-aldosterone system, specifically the action of angiotensin II, a potent vasoconstrictor. This article describes the case of a 67-year-old man undergoing surgery for a spinal exploration who had hypotension following induction that was refractory to fluid administration and agents with mixed alpha-beta agonistic activity but responded to a vasopressin and phenylephrine infusion. Following the case study is a discussion of the impact that angiotensin II inhibitors may have on a patient undergoing general anesthesia and the role of vasopressin in reversing catecholamine-resistant hypotension.
authors.affiliation: Sara Bush Lincoln Health Center, Charleston, Illinois, USA. jasonttrotter@hotmail.com
authors.forename: Jason
authors.initials: J
authors.lastname: Trotter
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D000777:Anesthetics / Q000009:adverse effects*; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects*; D002395:Catecholamines / Q000627:therapeutic use*; D004347:Drug Interactions; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D012084:Renin-Angiotensin System / Q000187:drug effects; D013122:Spinal Diseases / Q000601:surgery*
chemical_list: D000777:Anesthetics; D057911:Angiotensin Receptor Antagonists; D002395:Catecholamines