Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Baroreflex function in a patient with Bartter’s syndrome


There is little information regarding circulatory responses in Bartter’s syndrome, with the exception of marked resistance to vasopressors. We investigated baroreflex function in a 40-year-old woman with this syndrome. The patient showed oscillation of heart rate even with a small increase in blood pressure after administration ofvasopressor agents. Variations in heart rate and blood pressure were exaggerated during halothane, nitrous oxide and oxygen anaesthesia. Although the mechanism of the unstable baroreflex in this syndrome remains to be proved, the instability may be attributable to many factors such as prostaglandins, hypovolemia, hypokalemia, halothane, nitrous oxide and positive pressure ventilation.


Il y a très peu d’information concernant les réponses vasculaires chez les patients atteints de syndrome de Bartter à l’exception de celle concernant une résistance marquée aux vasopresseurs. On a investigué la fonction des barorécepteurs chez une femme âgée de 40 ans atteinte de ce syndrome. La patiente a démontré une oscillation de la fréquence cardiaque même avec une augmentation minime de la tension artérielle suite à l’administration d’agents vasopresseurs. Les variations de la fréquence cardiaque et de la pression artérielle étaient exagérées lors de l’anesthésie à l’halothane, protoxide d’azote et oxygène. Même si le mécanisme de cette instabilité des barorécepteurs dans ce syndrome reste à prouver, cette instabilité peul-être attribuer à plusieurs facteurs dont les prostaglandines, l’hypovo-lémie, l’hypokalémie, l’halothane, le protoxide d’azote et la ventilation à pression positive.


  1. 1

    Abston PA, Priano LL. Bartter’s syndrome: Anesthetic implications based on pathophysiology and treatment. Anesth Analg 1981; 60:764–6.

  2. 2

    Radfar N, Gill JR Jr,Banter FC, Bravo E, Taylor AA, Bowden RE. Hypokalemia, in Bartter’s syndrome and other disorders, produces resistance to vasopressors via prostaglandin overproduction. Proc Soc Exp Biol Med 1978; 158:502–7.

  3. 3

    Bartte FC. Bartter’s syndrome. Urol Clin North Am 1977; 4:253–61.

  4. 4

    Donker AJM, deJong PE, Statius van Eps LW, Brentjens JRH, Bakker K, Doorenbos H. Indo- methacin in Bartter’s syndrome. Nephron 1977; 19:200–13.

  5. 5

    Banter FC, Pronove P, Gill JR Jr,MacCardle RC. Hyperplasia of the juxtaglomerular complex with hyperaldosteronism and hypokalemic alkalosis. A new syndrome. Am J Med 1962; 33:811–28.

  6. 6

    HortonR, Zipser R, Fichman M. Prostaglandins, renal function and vascular regulation. Med Clin North Am 1981; 65:891–914.

  7. 7

    Sasaki H, Okumura M, Asano T, Arakawa K. Responses to angiotensin II antagonist before and after treatment with indomethacin in Bartter’s syndrome. Br Med J 1977; 2:995–6.

  8. 8

    Staszewska-Barczak J. Prostanoids and cardiac reflexes of sympathetic and vagal origin. Am J Cardiol 1983; 52:36A-45A.

  9. 9

    Duke PC, Fownes D, Wade JG. Halothane depresses baroreflex control of heart rate in man. Anes- thesiology 1977; 46:184–7.

  10. 10

    Duke PC, Trosky S. The effect of halothane with nitrous oxide on baroreflex control of heart rate in man. Can Anaesth Soc J 1980; 27:531–4.

  11. 11

    Scher AM. Carotid and aortic regulation of arterial blood pressure. Circulation 1977; 56:521–8.

  12. 12

    Smyth HS, Sleight P, Pickering GW. Reflex regulation of arterial pressure during sleep in man: a quantitative method of assessing baroreflex sensitivity. Circ Res 1969; 24:109–21.

  13. 13

    Ismailov ShI,Valdman AV. Hemodynamic responses of normotensive and hypertensive rats to administration of prostaglandins and indomethacin. Biullenten’ Eksperimental’ noi Biologii i Meditsiny 1982; 94:45–8.

  14. 14

    Robinson BF, Epstein SE, Beiser GD, Braunwald E. Control of heart rate by the autonomic nervous system. Circ Res 1966; 19:400–11.

  15. 15

    Modlinger RS, Nicolis GL, Krakoff LR, Gabrilove JL. Some observations on the pathogenesis of Banter’s syndrome. N Engl J Med 1973; 289:1022–4.

  16. 16

    Guyton AC. Textbook of medical physiology, 5th ed. Philadelphia: Saunders, 1976; 11.

  17. 17

    Andresen MC, Kuraoka S, Brown AM. Individual and combined actions of calcium, sodium, and potassium ions on baroreceptors in the rat. Circ Res 1979; 45:757–63.

  18. 18

    Saum WR, Ayachi S, Brown AM. Actions of sodium and potassium ions on baroreceptors of normotensive and spontaneously hypertensive rats. Circ Res 1977; 41:768–74.

  19. 19

    Seagard JL, Hopp FA, Bosnjak ZJ, Elegbe EO, Kampine JP. Extent and mechanism of halothane sensitization of the carotid sinus baroreceptors. Anesthesiology 1983; 58:432–7.

  20. 20

    Seagard JL, Hopp FA, Donegan JH, Kalbfleisch JH, Kampine JP. Halothane and the carotid sinus reflex: Evidence for multiple sites of action. Anesthesiology 1982; 57:191–202.

  21. 21

    Bagshaw RJ, Cox RH. Nitrous oxide and the baroreceptor reflexes in the dog. Acta Anaesthesiol Scand 1982; 26:31–8.

  22. 22

    Peveler RC, Bergel DH, Robinson JL, Sleight P. The effect of phenylephrine upon arterial pressure, carotid sinus radius and baroreflex sensitivity in the conscious greyhound. Clin Sci 1983; 64:455–61.

  23. 23

    Davis AL, McCloskey DI, Potter EK. Respiratory modulation of baroreceptor and chemoreceptor reflexes affecting heart rate through the sympathetic nervous system. J Physiol 1977; 272:691–703.

Download references

Author information

Correspondence to Toshiaki Nishikawa or Shuji Dohi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Nishikawa, T., Dohi, S. Baroreflex function in a patient with Bartter’s syndrome. Can Anaesth Soc J 32, 646–650 (1985).

Download citation

Key words

  • complications: Bartter’s syndrome
  • hormone: prostaglandins
  • reflex: baroreflex
  • sympathetic nervous system: sympathomimetic agents