Human Atrial Natriuretic Peptide Prevents the Increase in Pulmonary Artery Pressure Associated With Aortic Unclamping During Abdominal Aortic Aneurysmectomy

• Published in: Journal of cardiothoracic and vascular anesthesia 2008-04, Vol.22 (2), p.204-209
• Main Authors: Sumi, Kazuyuki, MD, Iida, Hiroki, MD, Yamaguchi, Shinobu, MD, Fukuoka, Naokazu, MD, Shimabukuro, Katsuya, MD, Dohi, Shuji, MD
• Format: Article
• Language: English
• Subjects: abdominal aortic aneurysm; Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Aorta, Abdominal - physiology; Aorta, Abdominal - surgery; Aortic Aneurysm, Abdominal - drug therapy; Aortic Aneurysm, Abdominal - physiopathology; Aortic Aneurysm, Abdominal - surgery; Atrial Natriuretic Factor - therapeutic use; Blood Pressure - physiology; Critical Care; Dose-Response Relationship, Drug; Female; human atrial natriuretic peptide; Humans; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - prevention & control; Male; Middle Aged; Peptide Fragments - therapeutic use; Prospective Studies; Pulmonary Artery - physiology; pulmonary artery pressure; Vascular Resistance - physiology; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2007.07.016

Objective: To assess the effect of human atrial natriuretic peptide (HANP) on the pulmonary and systemic circulations during infrarenal abdominal aortic aneurysmectomy. Design: A prospective, randomized study. Setting: A university hospital. Participants: Forty-five patients undergoing infrarenal abdominal aortic aneurysmectomy. Interventions: Abdominal aortic aneurysmectomy patients were randomly assigned to 1 of 3 groups (n = 15 for each group). They were infused with normal saline solution (SA), 0.02 μg/kg/min of HANP (LH), or 0.05 μg/kg/min of HANP (HH), starting 5 minutes after clamping. Hemodynamic variables were measured before/after clamping and unclamping. Measurements and Main Results: Both mean pulmonary arterial pressure (MPAP) and the pulmonary vascular resistance index (PVRI) increased ( v baseline) in the SA group. HANP attenuated the rises in MPAP and PVRI dose dependently (LH and HH groups v SA). Mean arterial pressure and systemic vascular resistance index were not significantly different among the 3 groups. Conclusion: HANP, infused during aortic clamping and abdominal aortic aneurysmectomy, attenuates the rises in pulmonary artery pressure and vascular resistance without severe systemic hypotension. This may result from direct and/or indirect pulmonary vascular effects of HANP because no HANP-induced changes in endothelin-1, angiotensin-II, and thromboxane B2 were detected.