Postoperative Hypertension

  • Robert N. Sladen


Today the intensivist has many classes and types of antihypertensive agents from which to choose. The available agents include vasodilators, angiotensin-converting enzyme (ACE) inhibitors, beta-adrenoreceptor blockers, calcium channel blockers, alpha2 adrenoreceptor agonists, and dopaminergic agonists. The objective of this chapter is to put these agents into perspective and rationalize the choices of the antihypertensive medications.


Mean Arterial Pressure Systemic Vascular Resistance Sodium Nitroprusside Negative Inotropic Effect Pulmonary Artery Occlusion Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gray RJ, Bateman TM, Czer LS, Conklin C, Matloff JM. Use of esmolol in hypertension after cardiac surgery. Am J Cardiol 1985; 56: 49F - 56F.PubMedCrossRefGoogle Scholar
  2. 2.
    Sladen R. Management of the adult cardiac patient in the intensive care unit. In: Ream AK, Fogdall RP, eds. Acute Cardiovascular Management: Anesthesia and Intensive Care. Philadelphia: Lippincott, 1982: 52848.Google Scholar
  3. 3.
    Fremes SE, Weisel RD, Mickle DA, Teasdale SJ, Aylmer AP, Christakis GT, Madonik MM, Ivanov J, Houle S, McLaughlin PR, Baird RJ. A comparison of nitroglycerin and nitroprusside: I. Treatment of postoperative hypertension. Ann Thorac Surg 1985; 39: 53–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Fremes SE, Weisel RD, Mickle DA, Teasdale SI, Aylmer AP, Christakis GT, Madonik MM, Ivanov J, Houle S, McLaughlin PR, Baird RJ. A comparison of nitroglycerin and nitroprusside: II. The effects of volume loading. Ann Thorac Surg 1985; 39: 61–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Gray RJ, Bateman TM, Czer LS, Conklin CM, Matloff JM. Esmolol: a new ultra short-acting betaadrenergic blocking agent for rapid control of heart rate in postoperative supraventricular tachyarrhythmias. J Am Coll Cardiol 1985; 5: 1451–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Turlapaty P, Laddu A, Murthy VS, Singh B, Lee R. Esmolol: a titratable short-acting intravenous beta-blocker for acute critical care settings. Am Heart J 1987; 114: 866–85.PubMedCrossRefGoogle Scholar
  7. 7.
    Oxorn D, Knox JW, Hill J. Bolus doses of esmolol for the prevention of perioperative hypertension and tachycardia. Can J Anaesth 1990; 37: 206–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Richards DA. Pharmacological effects of labetalol in man. Br J Clin Pharnacol 1976; 3 (4 Suppl 3): 721–3.Google Scholar
  9. 9.
    Sladen RN, Klamerus KJ, Swafford MW, Prough DS, Mann HI, Leslie JB, Goldberg JS, Levitsky S, Molina JE, Mills SA. Labetalol for the control of elevated blood pressure following coronary artery bypass grafting. J Cardiothorac Anesth 1990; 4: 210–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Leslie JB, Kalayjian RW, Sirgo MA, Plachetka JR, Watkins WD. Intravenous labetalol for treatment of postoperative hypertension. Anesthesiology 1987; 67: 413–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Arthur S, Greenberg A. Hyperkalemia associated with intravenous labetalol therapy for acute hypertension in renal transplant recipients. Clin Nephrol 1990; 33: 269–71.PubMedGoogle Scholar
  12. 12.
    Corbalan R, Jalil J, Chamorro G, Casanegra P, Valenzuela P. Effects of captopril versus milrinone therapy in modulating the adrenergic nervous system response to exercise in congestive heart failure. Am J Cardiol 1990; 65: 644–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Ahmad T, Coulthard MG, Eastham EJ. Reversible renal failure due to the use of captopril in a renal allograft recipient treated with cyclosporin. Nephrol Dial Transplant 1989; 4: 311–2.PubMedGoogle Scholar
  14. 14.
    Colson P, Ribstein J, Mimran A, Grolleau D, Chaptal PA, Roquefeuil B. Effect of angiotensin converting enzyme inhibition on blood pressure and renal function during open heart surgery. Anesthesiology 1990; 72: 23–7.PubMedCrossRefGoogle Scholar
  15. 15.
    el-Sadek M, Krause E. Postoperative antiarrhythmic effects of diltiazem in patients undergoing coronary bypass grafting. Cardiology 1994; 85: 290–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Neumayer HH, Kunzendorf U, Schreiber M. Protective effects of calcium antagonists in human renal transplantation. Kidney Int Suppl 1992; 36: S87–93.PubMedGoogle Scholar
  17. 17.
    Kunzendorf U, Walz G, Brockmoeller J, Neumayer HH, Jochimsen F, Roots I, Offermann G, Strom TB. Effects of diltiazem upon metabolism and immunosuppressive action of cyclosporine in kidney graft recipients. Transplantation 1991; 52: 280–4.PubMedCrossRefGoogle Scholar
  18. 18.
    Wagner K, Albrecht S, Neumayer HII. Prevention of posttransplant acute tubular necrosis by the calcium antagonist diltiazem: a prospective randomized study. Am J Nephrol 1987; 7: 287–291.PubMedCrossRefGoogle Scholar
  19. 19.
    Cook E, Clifton GG, Vargas R, Bienvenu G, Williams R, Sambol N, McMahon G, Grandy S, Lar CM, Quon C, Anderson CR, Turlapaty P, Wallin JD. Pharmacokinetics, phannacodynamics, and minimum effective clinical dose of intravenous nicardipine. Clin Pharmacol Ther 1990; 47: 706–18.PubMedCrossRefGoogle Scholar
  20. 20.
    Frampton JE, Faulds D. Nicardipine. A review of its pharmacology and therapeutic efficacy in older patients. Drugs Aging 1993; 3: 165–87.PubMedCrossRefGoogle Scholar
  21. 21.
    Singh BN, Josephson MA. Clinical pharmacology, pharmacokinetics, and hemodynamic effects of nicardipine. Am Heart J 1990; 119: 427–34.PubMedCrossRefGoogle Scholar
  22. 22.
    Cheung DG, Gasster JL, Neutel JM, Weber MA. Acute pharmacokinetic and hemodynamic effects of intravenous bolus dosing of nicardipine. Am Heart J 1990; 119: 438–42.PubMedCrossRefGoogle Scholar
  23. 23.
    Clifton GG, Wallin JD. Intravenous nicardipine: an effective new agent for the treatment of severe hypertension. Angiology 1990; 41: 1005–9.PubMedGoogle Scholar
  24. 24.
    Carbonise B, Jannet D, Touboul C, Khelifati Y, Milliez J. Nicardipine treatment of hypertension during pregnancy. Obstet Gynecol 1993; 81: 908–14.Google Scholar
  25. 25.
    Bernard JM, Pinaud M, Francois T, Rabin M, Macquin-Mavier I, Letenneur J. Deliberate hypotension with nicardipine or nitroprusside during total hip arthroplasty. Anesth Analg 1991; 73: 341–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Lokhandwala MF, Amenta F. Anatomical distribution and function of dopamine receptors in the kidney. FASEB J 1991; 5: 3023–30.PubMedGoogle Scholar
  27. 27.
    Casagrande C, Merlo L, Ferrini R, Miragoli G, Semeraro C. Cardiovascular and renal action of dopaminergic prodrugs. J Cardiovasc Pharmacol 1989; 14 (Suppl 8): S40–59.PubMedGoogle Scholar
  28. 28.
    Nichols AJ, Ruffolo RR Jr, Brooks DP. The pharmacology of fenoldopam. Am J Hypertens 1990; 3: 1165–119S.Google Scholar
  29. 29.
    Post JB 4th, Frishman WH. Fenoldopam: a new dopamine agonist for the treatment of hypertensive urgencies and emergencies. J Clin Phannacol 1998; 38: 2–13.CrossRefGoogle Scholar
  30. 30.
    Murphy MB, McCoy CE, Weber RR, Frederickson ED, Douglas FL, Goldberg LI. Augmentation of renal blood flow and sodium excretion in hypertensive patients during blood pressure reduction by intravenous administration of the dopamine-1 agonist fenoldopam. Circulation 1987; 76: 1312–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Panacek EA, Bednarczyk EM, Dunbar LM, Foulke GE, Holeslaw TL. Randomized, prospective trial of fenoldopam vs sodium nitroprusside in the treatment of acute severe hypertension. Fenoldopam Study Group. Acad Emerg Med 1995; 2: 959–65.PubMedCrossRefGoogle Scholar
  32. 32.
    White WB, Halley SE. Comparative renal effects of intravenous administration of fenoldopam mesylate and sodium nitroprusside in patients with severe hypertension. Arch Intern Med 1989; 149: 870–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Brooks DP, Drutz DJ, Ruffolo RR Jr. Prevention and complete reversal of cyclosporine A-induced renal vasoconstriction and nephrotoxicity in the rat by fenoldopam. J Pharmacol Exp Ther 1990; 254: 375–9.PubMedGoogle Scholar
  34. 34.
    Garwood S, Davis E, Hines RL. Fenoldopam: an effective renal preservation agent in cardiac surgery? (abstract). Anesthesiology 1999; 91: A154.Google Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Robert N. Sladen
    • 1
  1. 1.College of Physicians and SurgeonsColumbia UniversityNew YorkUSA

Personalised recommendations