• AANA journal · Feb 2012

    Case Reports

    Catecholamine-resistant hypotension following induction for spinal exploration.

    • Jason Trotter.
    • Sara Bush Lincoln Health Center, Charleston, Illinois, USA. jasonttrotter@hotmail.com
    • AANA J. 2012 Feb 1; 80 (1): 55-60.

    AbstractSystemic blood pressure is regulated by 3 mechanisms: the sympathetic nervous system, the renin-angiotensin system, and the arginine-vasopressin system. The use of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors has become prevalent in the medical treatment of hypertension. These classes of medications inhibit the renin-angiotensin-aldosterone system, specifically the action of angiotensin II, a potent vasoconstrictor. This article describes the case of a 67-year-old man undergoing surgery for a spinal exploration who had hypotension following induction that was refractory to fluid administration and agents with mixed alpha-beta agonistic activity but responded to a vasopressin and phenylephrine infusion. Following the case study is a discussion of the impact that angiotensin II inhibitors may have on a patient undergoing general anesthesia and the role of vasopressin in reversing catecholamine-resistant hypotension.

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