A multitude of drugs are capable of lowering blood pressure,
including volatile anesthetics (see Chapter 7),
sympathetic antagonists and agonists (see Chapter
12), and calcium channel blockers and angiotensin-converting
enzyme inhibitors (see Chapter 20). This chapter
examines additional agents that may be useful to the anesthesiologist
for intraoperative control of arterial blood pressure: nitrates,
adenosine, and fenoldopam (Figure 13–1 and Table 13–1). Although all these
drugs lower blood pressure by dilating peripheral vessels, they
are not identical in their mechanisms of action, clinical
uses, routes of metabolism, effects on organ systems, or drug interactions.
Trimethaphan, the only ganglionic blocker, is no longer being manufactured
and will not be discussed.
Table 13–1. Comparative
Pharmacology of Hypotensive Agents.1 |Favorite Table|Download (.pdf)
Table 13–1. Comparative
Pharmacology of Hypotensive Agents.1
|Cerebral blood flow, intracranial pressure ||↑↑||↑↑||↑↑||0||↑↑||?|
|Onset||1 min||1 min||5–10 min||3 min||< 1 min||< 15 min|
|Duration||5 min||5 min||2–4 h||10 min||1 min||1 h|
|Metabolism||Blood, kidney||Blood, liver||Liver||Blood?||Blood||Liver|
|Bolus||50–100 Âµg||50–100 Âµg||5–20 mg||NA||6–12 mg||NA|
|Infusion (Âµg/kg/min)||0.5–10||0.5–10||0.25–1.5||10–100||60–120||0.01–1.6 |
|Relative cost2||Low||Low||Low||Moderate||High||Very high|
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