Cardiorespiratory response of intravenous angiotensin-converting enzyme inhibitor enalaprilat in hypertensive cardiac surgery patients

摘要: Twenty-four patients undergoing elective coronary artery bypass surgery were studied. Either the angiotensin-converting enzyme (ACE) inhibitor enalaprilat, 0.06 mg/kg, (n = 12), or saline solution (=control group; n was randomly and blindly administered intravenously when mean arterial blood pressure (MAP) increased to 90 mmHg after induction of anesthesia. Cardiorespiratory parameters studied before injection, during subsequent 30 minutes, precardiopulmonary (CPB), post-CPB, at end surgery. MAP significantly reduced 5 minutes administration enalaprilat. The peak reduction observed (from 98 ± 4 68 8 mmHg). Even immediately CPB (112 12 injection enalaprilat), systemic vascular resistance lower than baseline values. Heart rate remained almost unchanged in both groups. Cardiac index slightly enalaprilat (maximum: +0.75 L/min/m2 20 injection). Filling pressures (central venous pressure, pulmonary capillary wedge pressure) also by There no differences from control with regard changes right ventricular hemodynamics (right ejection fraction, end-diastolic volume, end-systolic volume), gas exchange (PaO2), intrapulmonary right-to-left shunting (Qs/Qt). VO2 only 179 28 230 mL/min) (p < 0.05). did not differ between two groups post-CPB. No significant use inotropes vasoconstrictors found entire investigation period. It is concluded that intravenous (IV) ACE effective reducing disease hypertension fentanyl/midazolam. Lack a reflex increase heart left afterload indicated decrease myocardial oxygen consumption, which particular importance patients. Improved tissue perfusion can be assumed because whereas unchanged. Thus, IV enlarges armamentarium for treating recommended cardiac