Perioperative hypertension associated neurohumoral stress response in craniotomy patients: Effects of β-blocker and angiotensin converting enzyme inhibitor

Development of perioperative hypertension in craniotomy procedures is commonly associated with activation of sympathetic events through renin-angiotensin-aldosterone system (RAAS). Preemptive therapy with β-blockers or angiotensin converting enzyme (ACE) inhibitors may attenuate this hypertensive response. We conducted a randomized, double blind; placebo controlled study to compare the effect of β-blocker (atenolol) and an ACE inhibitor (Lisinopril) on perioperative hypertension in patients undergoing for the craniotomy and also studied biochemical markers of these two systems. Eighty five patients undergoing craniotomy for supratentorial tumor removal were screened and randomized into three groups to receive either (atenolol; lisinopril or placebo). Blood analysis of renin, aldosterone, norepinephrine and sodium levels was drawn 12 h prior to surgery, at the time of dural opening, and at the time of extubation. Differences in mean arterial pressure (MAP), hear rate (HR) and biochemical markers between three groups were analyzed using one-way ANOVA. Perioperative hemodynamic changes were highly associated with biochemical markers in all the three groups. Specifically, HR was significantly attenuated by atenolol in the immediate extubation period (p