Endogenous vasopressin and renin-angiotensin systems support blood pressure after epidural block in humans

Studies in experimental animals show that endogenous Arg-vasopressin (AVP) and the renin-angiotensin system support blood pressure when the sympathetic system is impaired pharmacologically or after epidural anesthesia. However, extrapolation to humans is uncertain. Therefore, we administered an AVP...

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Bibliographic Details
Published in:Anesthesiology (Philadelphia) 1994-05, Vol.80 (5), p.1000-1007
Main Authors: Carp, H, Vadhera, R, Jayaram, A, Garvey, D
Format: Article
Language:English
Subjects:
Adult
Anesthesia, Epidural
Arginine Vasopressin - analogs & derivatives
Arginine Vasopressin - antagonists & inhibitors
Arginine Vasopressin - pharmacology
Blood Pressure - drug effects
Enalaprilat - pharmacology
Female
Heart Rate - drug effects
Humans
Male
Reference Values
Renin-Angiotensin System - drug effects
Time Factors
Vasopressins - blood
Vasopressins - physiology
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Summary:Studies in experimental animals show that endogenous Arg-vasopressin (AVP) and the renin-angiotensin system support blood pressure when the sympathetic system is impaired pharmacologically or after epidural anesthesia. However, extrapolation to humans is uncertain. Therefore, we administered an AVP type V1 receptor antagonist and an angiotensin-converting enzyme inhibitor to volunteers and measured the effect on blood pressure after epidural anesthesia. Healthy volunteers in whom epidural catheters were placed were randomly assigned to receive 1.25 mg intravenous enalapril or saline placebo followed by 0.5 mg AVP type V1 antagonist beta-mercapto-beta, beta-cyclopentamethylene-propionyl-o-Met-Tyr-Arg-vasopressin (AVPA) or saline placebo. Finally, 2% lidocaine was injected to obtain a T2 level. Controls received intramuscular lidocaine. Blood pressure did not significantly change after T-2 epidural anesthesia in subjects treated with saline placebo, AVPA or enalapril alone (n = 10, for each treatment). In contrast, combined treatment with enalapril and AVPA resulted in a 36 +/- 11% decrease in blood pressure after epidural dosing (n = 6). Controls given intramuscular lidocaine, in place of the epidural did not develop hypotension after AVPA and enalapril treatment (n = 10). Endogenous AVP and the renin-angiotensin system play important roles in maintaining blood pressure after epidural anesthesia in healthy subjects.
ISSN:0003-3022
DOI:10.1097/00000542-199405000-00008