Who uses urapidil during cardiopulmonary bypass as a vasodilator? I increased the volatile anesthetics, gave nitroglicerin during the last 25 years, but our perfusionist indicated that she administered this quiet frequently with other anesthsiologists. Your opinion?
Hello!
I have never used urapidil (an alfa 1 adreno-receptor blocking agent) during cardiopulmonary bypass (CPB). Our first option to lower a high MAP during CPB is to increase the dose of sevoflurane administrated in the CPB circuit by the perfusionist. The next option is often to add a sufficient dose of alfentanyl to look for the response of an added dose of opiod. Approx dose of 1.0-2.0 mg. If a nice response probably more of fentanyl later. In some cases we have added droperiol 5.0 mg (up to a total of 10.mg) or sodium nitroprusside. I think nitroglycerin might dilate veins to much an will often render into more volume added by the perfusionist. Many years ago when we started our cardiac surgery program i Örebro, Sweden (1987) we used high doses of fentanyl during induction and droperiodol. Isoflurane before CPB but in those days we did not use inhalation agents during CPB. Then very frequently sodium nitroprusside was used, but nowadays almost never. In the cardiac intensive care unit often labetalol are used to lower the blood pressure if sufficient doses of opioids and clonidin (or dexmethedomedin) have been given. If a tendency to bradycardia instead dihydralazin, 6,25-12,5 mg i.v .
Very useful and interesting ,thanks. Particularly , your tretment opitions in the ICU period. Best wishes
Andrea
Dear Andrea. My first choice to lower a high MAP during CPB is to increase the dose of nitroglycerin to maximum 1- 1.5 mg/hr. if it can not treat high MAP, the second option if the patient is diabetic is phentolamin and infusion of propofol is last selection. propofol is my second choice in non diabetic patient. Effect of phentolamin in diabetics is excellent. Most patients respond to it, even non diabetics. Theses choices are based on their mechanism of action.
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