Abstract

In patients with secondary hyperparathyroidism arterial hypertension is a frequent comorbid disease. Sympathetic hyperactivity, disturbed endothelial endo- and paracrine activity (diminished NO synthesis and excesive endothelin excretion) and hyperactivity of renine-angiotensine-aldosterone system along with dyslipidemia – induced atheromatic plaque build-up result in arterial hypertension.

Overt or silent comorbid coronary ischemic disease, which is the most frequent cause of death in chronic end-stage renal insufficiency sufferers is the indication for perioperative use of beta-adrenergic blockers in these patients.

The aim of our study was evaluation of cardiovascular stabilising effect of beta-adrenergic blockers used in the preoperative preparation for general anesthesia for surgical parathyroidectomy in patients with secondary hyperparathyroidism and arterial hypertension. Interdependence of beta-adrenergic blockers use and cardiovascular stability, intensity of cardiovascular instability and the rate of dysrrhythmia were investigated.

A group of 61 dialysed patients with chronic renal insufficiency and arterial hypertension, who underwent surgical parathyroidectomy in the years 2001 – 2005 in the Clinic of General, Endocrine and Transplantation Surgery of the Medical University of Gdansk, was analysed. The patients were allocated into two groups: A – a group of 32 beta-adrenergic blockers users in preoperative preparation and B – a group of 29 who did not use beta-adrenergic blockers in preoperative preparation.

Both groups were homogenous as regards their age, sex and duration of general anesthesia. Summarised duration of particular hemodynamic deviations and their variability were analysed. Dysrrhythmia episodes during general anesthesia were also analysed.

Two separate anlyses were performed: for induction and conduction of general anesthesia, respectively.

Group A demonstrated neither systolic arterial pressure increase > 200 mm Hg nor diastolic arterial pressure increase > 140 mm Hg in any of its patients, and group B demonstrated systolic arterial pressure increase > 200 mm Hg or diastolic arterial pressure increase > 140 mm Hg in 5 of its patients. Both arterial pressure values and their variability were different in both groups.

Beta-adrenergic blockers provided significantly better arterial pressure stability and allowed to maintain arterial pressure within constant values in our study. The results of our study revealed also that beta-blockers use in the preoperative preparation for general anesthesia significantly statistically increases cardiovascular stability and decreases the frequency and severity of hemodynamic disturbances during the surgical procedure. Circulatory stability was greater and the intensity of cardiovascular disturbances was minor in patients taking beta – blockers compared to patients not taking beta-adrenergic agents in the preoperative preparation.

Upon the obtained results the authors consider preoperative use of beta-adrenergic agents as increasing surgical parathyroidectomy safety in dialysed patients with chronic renal failure and arterial hyperetension.

Adres: dr Paweł Dutka
Katedra i Klinika Anestezjologii i Intensywnej Terapii AMG
Gdańsk, ul. Dębinki 7
e-mail: pididi@gumed.edu.pl