Ketanserin in the Treatment of Systemic Hypertension During and Following Coronary Artery Bypass Surgery

Abstract

One of the most important prob lems during cardiac surgery is the prevention and treatment of hyper tension, occurring in 40-60% of the patients following coronary artery bypass surgery (CABS). Hyperten sion should be avoided to prevent myocardial damage, neurologic com plications, increased blood loss, and premature graft closure due to inti mal damage. During and following cardiac surgery hypertension is rou tinely treated with vasodilating agents, which generally induce reflex tachycardia and increased intrapul monary shunting. The results obtained with ketan serin, a specific S 2-serotonergic re ceptor blocker with alpha1-adrener gic receptor blocking properties, in the prevention and treatment of hy pertension in patients undergoing cardiac surgery, are presented. Ke tanserin effectively lowers blood pressure by decreasing systemic vas cular resistance but does not com pletely prevent perioperative and postoperative hypertension when ad ministered as a continuous infusion from the start of anesthesia. In con trast to sodium nitroprusside, ketan serin does not induce reflex tachycar dia in the treatment of postoperative systemic hypertension following CABS. The compound improves di uresis and perfusion of the skin pe rioperatively. Ketanserin is devoid of rebound phenomena after its admin istration is stopped. It is postulated that the antihypertensive effect of ke tanserin can be explained by its prop erty of simultaneously blocking al pha 1-adrenergic and S2-serotonergic receptors.