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Antihypertensive Mechanism of Ketanserin in Postoperative Hypertension After Cardiopulmonary Bypass

the Sir Humphry Davy Department of Anaesthesia, University of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom.

Abstract

The effect of ketanserin (0.15 mg/kg followed by an infusion at 6 mg/hr) was studied in 13 patients who developed hypertension (blood pressure > 150/90 mm Hg) after cardiopulmonary bypass (CPB) for coronary artery bypass grafting. Eleven patients responded to ketanserin with a decrease of arterial pressure from 159 ± 15/83 ± 10 mm Hg to 131 ± 9/70 ± 12 mm Hg (P < 0.01), which was sustained during the subsequent infusion of ketanserin. Mean plasma ketanserin concentrations were maintained at 187 /µg/L (range 118–525). No significant changes in plasma levels of 5-hydroxyindoles or in platelet 5-hydroxytryptamine content were observed during or after CPB, or after administration of ketanserin. Plasma epinephrine (398 ± 124 pg/ml) and norepinephrine (1161 ± 673 pg/ml) concentrations were markedly increased during the hypertensive period after CPB. Plasma epincphrine concentrations decreased (P < 0.01) during ketanserin infusion to 213 ± 101 pg/ml, whereas plasma norepinephrine concentrations did not change. The pressor response to three graded doses of phenylephrine was decreased during CPB (P < 0.01), and a further decrease (P < 0.05) occurred during infusion of ketanserin. The hypotensive effect of ketanserin after CPB may be attributable to alpha₁,-adrenoceptor blockade rather than to its antiserotoninergic effect. Serotonin does not appear to be involved in the short-term disturbances of arterial pressure during or after CPB.

Key Words: SEROTONIN–-ketanserin. • PHARMACOLOGY–-ketanserin. • ANESTHESIA • CARDIOVASCULAR–-ketanserin.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999