Document Detail

Endogenous vasopressin and renin-angiotensin systems support blood pressure after epidural block in humans.
MedLine Citation:
PMID:  8017639     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Studies in experimental animals show that endogenous Arg-vasopressin (AVP) and the renin-angiotensin system support blood pressure when the sympathetic system is impaired pharmacologically or after epidural anesthesia. However, extrapolation to humans is uncertain. Therefore, we administered an AVP type V1 receptor antagonist and an angiotensin-converting enzyme inhibitor to volunteers and measured the effect on blood pressure after epidural anesthesia. METHODS: Healthy volunteers in whom epidural catheters were placed were randomly assigned to receive 1.25 mg intravenous enalapril or saline placebo followed by 0.5 mg AVP type V1 antagonist beta-mercapto-beta, beta-cyclopentamethylene-propionyl-o-Met-Tyr-Arg-vasopressin (AVPA) or saline placebo. Finally, 2% lidocaine was injected to obtain a T2 level. Controls received intramuscular lidocaine. RESULTS: Blood pressure did not significantly change after T-2 epidural anesthesia in subjects treated with saline placebo, AVPA or enalapril alone (n = 10, for each treatment). In contrast, combined treatment with enalapril and AVPA resulted in a 36 +/- 11% decrease in blood pressure after epidural dosing (n = 6). Controls given intramuscular lidocaine, in place of the epidural did not develop hypotension after AVPA and enalapril treatment (n = 10). CONCLUSIONS: Endogenous AVP and the renin-angiotensin system play important roles in maintaining blood pressure after epidural anesthesia in healthy subjects.
H Carp; R Vadhera; A Jayaram; D Garvey
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  80     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1994 May 
Date Detail:
Created Date:  1994-07-28     Completed Date:  1994-07-28     Revised Date:  2008-08-16    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1000-7; discussion 27A-28A     Citation Subset:  AIM; IM    
Oregon Health Sciences University, Portland 97201.
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MeSH Terms
Anesthesia, Epidural*
Arginine Vasopressin / analogs & derivatives,  antagonists & inhibitors,  pharmacology
Blood Pressure* / drug effects
Enalaprilat / pharmacology
Heart Rate* / drug effects
Reference Values
Renin-Angiotensin System* / drug effects
Time Factors
Vasopressins / blood,  physiology*
Reg. No./Substance:
11000-17-2/Vasopressins; 113-79-1/Arginine Vasopressin; 73168-24-8/vasopressin, 1-(1-mercaptocyclohexaneacetic acid)-2-(O- methyl-L-tyrosine)-8-L-arginine-; 84680-54-6/Enalaprilat

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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