Fenoldopam infusion for the treatment of postoperative hypertension
Study Objective: To examine the safety and efficacy of intravenous fenoldopam as compared to placebo for the treatment of postoperative hypertension. Design: Randomized, placebo-controlled, double-blind study. Setting: Community hospital. Patients: 16 ASA I–III hypertensive patients scheduled for no...
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| Veröffentlicht in: | Journal of clinical anesthesia 1993-09, Vol.5 (5), p.386-391 |
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| creator | Goldberg, Michael E. Cantillo, Joaquin Nemiroff, Mark S. Subramoni, Jaya Muñoz, Raul Torjman, Marc Schieren, Hugh |
| description | Study Objective: To examine the safety and efficacy of intravenous fenoldopam as compared to placebo for the treatment of postoperative hypertension.
Design: Randomized, placebo-controlled, double-blind study.
Setting: Community hospital.
Patients: 16 ASA I–III hypertensive patients scheduled for noncardiac surgical procedures.
Interventions: Treatment with fenoldopam or placebo was initiated immediately after other causes of hypertension had been ruled out. Hypertension was defined as a supine systolic blood pressure (SBP) or diastolic blood pressure (DBP) greater than 20% over the patient's preoperative baseline, which was obtained 6 hours prior to the procedure with the patient lying quietly. The baseline consisted of 3 consecutive blood pressure (BP) measurements obtained at 5-minute intervals and not varying by more than 10%. Fenoldopam or placebo infusion was initiated at 0.1 μg/kg/min and increased and decreased as necessary until the therapeutic goal BP was reached or treatment failure had occurred. The therapeutic goal BP was a decrease to at least 10% above the preoperative baseline, and failure of treatment was defined as inability to reach this BP level after 15 minutes at 1.5 μg/kg/min.
Measurements and Main Results: BP and heart rate (HR) data were collected consistently throughout the study and 1 hour after termination of infusion. Laboratory studies and 12-lead electrocardiographic results were obtained at the start of the study and repeated 24 hours after termination of infusion. Blood samples were obtained for the measurement of epinephrine, norepinephrine, and dopamine levels and were analyzed using high-performance liquid chromatography with electrochemical detection. Pretreatment BP measurements were significantly elevated from baseline in both groups. Fenoldopam treatment significantly reduced BP to the therapeutic goal in 8 of 8 patients; placebo reduced BP to this goal in only 4 of 8 patients (
p < 0.05). At the end of the titration period, the therapeutic goal BP was not significantly different from baseline in the fenoldopam group. HR was significantly elevated (
p < 0.05) at goal in the fenoldopam group as compared with the placebo group. Fenoldopam administration lowered SBP and DBP to goal in a mean time of 28 minutes versus 42.5 minutes in the placebo group. There were no significant differences in catecholamine levels at any of the measurement periods.
Conclusion: Fenoldopam is an effective drug for reducing BP f ollowing hyp |
| doi_str_mv | 10.1016/0952-8180(93)90102-K |
| format | Article |
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Design: Randomized, placebo-controlled, double-blind study.
Setting: Community hospital.
Patients: 16 ASA I–III hypertensive patients scheduled for noncardiac surgical procedures.
Interventions: Treatment with fenoldopam or placebo was initiated immediately after other causes of hypertension had been ruled out. Hypertension was defined as a supine systolic blood pressure (SBP) or diastolic blood pressure (DBP) greater than 20% over the patient's preoperative baseline, which was obtained 6 hours prior to the procedure with the patient lying quietly. The baseline consisted of 3 consecutive blood pressure (BP) measurements obtained at 5-minute intervals and not varying by more than 10%. Fenoldopam or placebo infusion was initiated at 0.1 μg/kg/min and increased and decreased as necessary until the therapeutic goal BP was reached or treatment failure had occurred. The therapeutic goal BP was a decrease to at least 10% above the preoperative baseline, and failure of treatment was defined as inability to reach this BP level after 15 minutes at 1.5 μg/kg/min.
Measurements and Main Results: BP and heart rate (HR) data were collected consistently throughout the study and 1 hour after termination of infusion. Laboratory studies and 12-lead electrocardiographic results were obtained at the start of the study and repeated 24 hours after termination of infusion. Blood samples were obtained for the measurement of epinephrine, norepinephrine, and dopamine levels and were analyzed using high-performance liquid chromatography with electrochemical detection. Pretreatment BP measurements were significantly elevated from baseline in both groups. Fenoldopam treatment significantly reduced BP to the therapeutic goal in 8 of 8 patients; placebo reduced BP to this goal in only 4 of 8 patients (
p < 0.05). At the end of the titration period, the therapeutic goal BP was not significantly different from baseline in the fenoldopam group. HR was significantly elevated (
p < 0.05) at goal in the fenoldopam group as compared with the placebo group. Fenoldopam administration lowered SBP and DBP to goal in a mean time of 28 minutes versus 42.5 minutes in the placebo group. There were no significant differences in catecholamine levels at any of the measurement periods.
Conclusion: Fenoldopam is an effective drug for reducing BP f ollowing hypertensive episodes in the postoperative setting. Fenoldopam use is associated with an increase in HR
versus placebo.</description><identifier>ISSN: 0952-8180</identifier><identifier>EISSN: 1873-4529</identifier><identifier>DOI: 10.1016/0952-8180(93)90102-K</identifier><identifier>PMID: 8105829</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine - administration & dosage ; 2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine - analogs & derivatives ; Adult ; Aged ; Blood Pressure - physiology ; Dopamine ; Dopamine Agents - administration & dosage ; Double-Blind Method ; Epinephrine - blood ; Female ; Fenoldopam ; Heart Rate - physiology ; Humans ; Hypertension - drug therapy ; Hypertension - physiopathology ; hypertension, postoperative ; Infusions, Intravenous ; Male ; Middle Aged ; Norepinephrine - blood ; Postoperative Complications - drug therapy ; Postoperative Complications - physiopathology ; Surgical Procedures, Operative</subject><ispartof>Journal of clinical anesthesia, 1993-09, Vol.5 (5), p.386-391</ispartof><rights>1993</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c357t-a008c54863fc9738303d2bbeb96c57adf63512ab3705116bf43d90d1f2e00e893</citedby><cites>FETCH-LOGICAL-c357t-a008c54863fc9738303d2bbeb96c57adf63512ab3705116bf43d90d1f2e00e893</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/0952-8180(93)90102-K$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8105829$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goldberg, Michael E.</creatorcontrib><creatorcontrib>Cantillo, Joaquin</creatorcontrib><creatorcontrib>Nemiroff, Mark S.</creatorcontrib><creatorcontrib>Subramoni, Jaya</creatorcontrib><creatorcontrib>Muñoz, Raul</creatorcontrib><creatorcontrib>Torjman, Marc</creatorcontrib><creatorcontrib>Schieren, Hugh</creatorcontrib><title>Fenoldopam infusion for the treatment of postoperative hypertension</title><title>Journal of clinical anesthesia</title><addtitle>J Clin Anesth</addtitle><description>Study Objective: To examine the safety and efficacy of intravenous fenoldopam as compared to placebo for the treatment of postoperative hypertension.
Design: Randomized, placebo-controlled, double-blind study.
Setting: Community hospital.
Patients: 16 ASA I–III hypertensive patients scheduled for noncardiac surgical procedures.
Interventions: Treatment with fenoldopam or placebo was initiated immediately after other causes of hypertension had been ruled out. Hypertension was defined as a supine systolic blood pressure (SBP) or diastolic blood pressure (DBP) greater than 20% over the patient's preoperative baseline, which was obtained 6 hours prior to the procedure with the patient lying quietly. The baseline consisted of 3 consecutive blood pressure (BP) measurements obtained at 5-minute intervals and not varying by more than 10%. Fenoldopam or placebo infusion was initiated at 0.1 μg/kg/min and increased and decreased as necessary until the therapeutic goal BP was reached or treatment failure had occurred. The therapeutic goal BP was a decrease to at least 10% above the preoperative baseline, and failure of treatment was defined as inability to reach this BP level after 15 minutes at 1.5 μg/kg/min.
Measurements and Main Results: BP and heart rate (HR) data were collected consistently throughout the study and 1 hour after termination of infusion. Laboratory studies and 12-lead electrocardiographic results were obtained at the start of the study and repeated 24 hours after termination of infusion. Blood samples were obtained for the measurement of epinephrine, norepinephrine, and dopamine levels and were analyzed using high-performance liquid chromatography with electrochemical detection. Pretreatment BP measurements were significantly elevated from baseline in both groups. Fenoldopam treatment significantly reduced BP to the therapeutic goal in 8 of 8 patients; placebo reduced BP to this goal in only 4 of 8 patients (
p < 0.05). At the end of the titration period, the therapeutic goal BP was not significantly different from baseline in the fenoldopam group. HR was significantly elevated (
p < 0.05) at goal in the fenoldopam group as compared with the placebo group. Fenoldopam administration lowered SBP and DBP to goal in a mean time of 28 minutes versus 42.5 minutes in the placebo group. There were no significant differences in catecholamine levels at any of the measurement periods.
Conclusion: Fenoldopam is an effective drug for reducing BP f ollowing hypertensive episodes in the postoperative setting. Fenoldopam use is associated with an increase in HR
versus placebo.</description><subject>2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine - administration & dosage</subject><subject>2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine - analogs & derivatives</subject><subject>Adult</subject><subject>Aged</subject><subject>Blood Pressure - physiology</subject><subject>Dopamine</subject><subject>Dopamine Agents - administration & dosage</subject><subject>Double-Blind Method</subject><subject>Epinephrine - blood</subject><subject>Female</subject><subject>Fenoldopam</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - physiopathology</subject><subject>hypertension, postoperative</subject><subject>Infusions, Intravenous</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Norepinephrine - blood</subject><subject>Postoperative Complications - drug therapy</subject><subject>Postoperative Complications - physiopathology</subject><subject>Surgical Procedures, Operative</subject><issn>0952-8180</issn><issn>1873-4529</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1993</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LAzEQhoMotVb_gcKeRA-rk81-JBdBilVpwYueQzY7oZHuZk3SQv-9W1t69DQD78cwDyHXFB4o0PIRRJGlnHK4E-xeAIUsnZ-QMeUVS_MiE6dkfLSck4sQvgFgEOiIjDiFgmdiTKYz7Nyqcb1qE9uZdbCuS4zzSVxiEj2q2GIXE2eS3oXoevQq2g0my-2wRux2_ktyZtQq4NVhTsjX7OVz-pYuPl7fp8-LVLOiiqkC4LrIecmMFhXjDFiT1TXWotRFpRpTsoJmqmYVFJSWtclZI6ChJkMA5IJNyO2-t_fuZ40hytYGjauV6tCtg6xKyHLGYTDme6P2LgSPRvbetspvJQW5Yyd3YOQOjBRM_rGT8yF2c-hf1y02x9AB1qA_7XUcntxY9DJoi53GxnrUUTbO_n_gF4jrfho</recordid><startdate>19930901</startdate><enddate>19930901</enddate><creator>Goldberg, Michael E.</creator><creator>Cantillo, Joaquin</creator><creator>Nemiroff, Mark S.</creator><creator>Subramoni, Jaya</creator><creator>Muñoz, Raul</creator><creator>Torjman, Marc</creator><creator>Schieren, Hugh</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19930901</creationdate><title>Fenoldopam infusion for the treatment of postoperative hypertension</title><author>Goldberg, Michael E. ; Cantillo, Joaquin ; Nemiroff, Mark S. ; Subramoni, Jaya ; Muñoz, Raul ; Torjman, Marc ; Schieren, Hugh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c357t-a008c54863fc9738303d2bbeb96c57adf63512ab3705116bf43d90d1f2e00e893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1993</creationdate><topic>2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine - administration & dosage</topic><topic>2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine - analogs & derivatives</topic><topic>Adult</topic><topic>Aged</topic><topic>Blood Pressure - physiology</topic><topic>Dopamine</topic><topic>Dopamine Agents - administration & dosage</topic><topic>Double-Blind Method</topic><topic>Epinephrine - blood</topic><topic>Female</topic><topic>Fenoldopam</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - physiopathology</topic><topic>hypertension, postoperative</topic><topic>Infusions, Intravenous</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Norepinephrine - blood</topic><topic>Postoperative Complications - drug therapy</topic><topic>Postoperative Complications - physiopathology</topic><topic>Surgical Procedures, Operative</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goldberg, Michael E.</creatorcontrib><creatorcontrib>Cantillo, Joaquin</creatorcontrib><creatorcontrib>Nemiroff, Mark S.</creatorcontrib><creatorcontrib>Subramoni, Jaya</creatorcontrib><creatorcontrib>Muñoz, Raul</creatorcontrib><creatorcontrib>Torjman, Marc</creatorcontrib><creatorcontrib>Schieren, Hugh</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goldberg, Michael E.</au><au>Cantillo, Joaquin</au><au>Nemiroff, Mark S.</au><au>Subramoni, Jaya</au><au>Muñoz, Raul</au><au>Torjman, Marc</au><au>Schieren, Hugh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fenoldopam infusion for the treatment of postoperative hypertension</atitle><jtitle>Journal of clinical anesthesia</jtitle><addtitle>J Clin Anesth</addtitle><date>1993-09-01</date><risdate>1993</risdate><volume>5</volume><issue>5</issue><spage>386</spage><epage>391</epage><pages>386-391</pages><issn>0952-8180</issn><eissn>1873-4529</eissn><abstract>Study Objective: To examine the safety and efficacy of intravenous fenoldopam as compared to placebo for the treatment of postoperative hypertension.
Design: Randomized, placebo-controlled, double-blind study.
Setting: Community hospital.
Patients: 16 ASA I–III hypertensive patients scheduled for noncardiac surgical procedures.
Interventions: Treatment with fenoldopam or placebo was initiated immediately after other causes of hypertension had been ruled out. Hypertension was defined as a supine systolic blood pressure (SBP) or diastolic blood pressure (DBP) greater than 20% over the patient's preoperative baseline, which was obtained 6 hours prior to the procedure with the patient lying quietly. The baseline consisted of 3 consecutive blood pressure (BP) measurements obtained at 5-minute intervals and not varying by more than 10%. Fenoldopam or placebo infusion was initiated at 0.1 μg/kg/min and increased and decreased as necessary until the therapeutic goal BP was reached or treatment failure had occurred. The therapeutic goal BP was a decrease to at least 10% above the preoperative baseline, and failure of treatment was defined as inability to reach this BP level after 15 minutes at 1.5 μg/kg/min.
Measurements and Main Results: BP and heart rate (HR) data were collected consistently throughout the study and 1 hour after termination of infusion. Laboratory studies and 12-lead electrocardiographic results were obtained at the start of the study and repeated 24 hours after termination of infusion. Blood samples were obtained for the measurement of epinephrine, norepinephrine, and dopamine levels and were analyzed using high-performance liquid chromatography with electrochemical detection. Pretreatment BP measurements were significantly elevated from baseline in both groups. Fenoldopam treatment significantly reduced BP to the therapeutic goal in 8 of 8 patients; placebo reduced BP to this goal in only 4 of 8 patients (
p < 0.05). At the end of the titration period, the therapeutic goal BP was not significantly different from baseline in the fenoldopam group. HR was significantly elevated (
p < 0.05) at goal in the fenoldopam group as compared with the placebo group. Fenoldopam administration lowered SBP and DBP to goal in a mean time of 28 minutes versus 42.5 minutes in the placebo group. There were no significant differences in catecholamine levels at any of the measurement periods.
Conclusion: Fenoldopam is an effective drug for reducing BP f ollowing hypertensive episodes in the postoperative setting. Fenoldopam use is associated with an increase in HR
versus placebo.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>8105829</pmid><doi>10.1016/0952-8180(93)90102-K</doi><tpages>6</tpages></addata></record> |
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| identifier | ISSN: 0952-8180 |
| ispartof | Journal of clinical anesthesia, 1993-09, Vol.5 (5), p.386-391 |
| issn | 0952-8180 1873-4529 |
| language | eng |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | 2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine - administration & dosage 2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine - analogs & derivatives Adult Aged Blood Pressure - physiology Dopamine Dopamine Agents - administration & dosage Double-Blind Method Epinephrine - blood Female Fenoldopam Heart Rate - physiology Humans Hypertension - drug therapy Hypertension - physiopathology hypertension, postoperative Infusions, Intravenous Male Middle Aged Norepinephrine - blood Postoperative Complications - drug therapy Postoperative Complications - physiopathology Surgical Procedures, Operative |
| title | Fenoldopam infusion for the treatment of postoperative hypertension |
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